July 31, 2018 Posted By: DR KRANTHI P 254 viewsRSS
Winter season is soon approaching, it’s time for runny noses, common cold, and fever.
This is commonly a season when you might notice blood from your nose as well.
Whenever your nose starts bleeding you are not going to think that it is due to change in weather or place.
Anybody would start raising doubts inside their mind, serious doubts.
Bleeding nose can make you anxious about your health. Although nose bleeding can rarely indicate any serious health issues you would still have questions like:
What could be the cause?
Is it stress, allergy, or climate?
Does it indicate a serious underlying health problem?
If you have such questions in your mind lets clear all your doubts about nose bleeding.
What Is Nose Bleeding?
Nosebleed is also known as epistaxis. The nose contains blood vessels which are very fragile which can make bleeding easily.
There are two types of epistaxis,
Anterior epistaxis: The blood vessels in the front of the nose will break and bleed. The blood flows out from the front of the nose with the patient in sitting position.
Posterior epistaxis: The bleeding happens at the back part of the nose. It is dangerous as the blood flows down the throat in this case. The patient may swallow it and later have a “coffee-colored” vomitus. This may erroneously be diagnosed as haematemesis.
Causes Of Epistaxis
The causes can generally be divided into three types, they include:
Traumas like injuries of the nose, intranasal surgery, fingernail trauma, fracture in the midface or base of the skull, a hard blow on the nose, and violent sneeze;
Infections like acute viral rhinitis, nasal diphtheria, sinusitis and diseases that cause crusts;
Foreign bodies like rhinolith;
Atmospheric changes like high altitude and sudden decompression;
Neoplasms of the nose and paranasal sinuses: Benign – Haemangioma, papilloma and Malignant – Carcinoma or sarcoma;
Deviated nasal septum.
Adenoiditis, juvenile angiofibroma, and malignant tumors.
It includes conditions like disorders of blood and blood vessels, liver disease, kidney disease, cardiovascular diseases, mediastinal compression, acute general infection, vicarious menstruation, and use of drugs.
Most of the cases the cause for nose bleeding is not exactly known.
Which Parts Of The Nose Is Bleeding?
The major areas within where epistaxis happens in a nose are
Little Area: It is situated in the anterior inferior part of the nasal septum, just above the vestibule. Almost in 90% of the cases bleeding occurs from this site.
Above the level of middle turbinate: Bleeding from above the middle turbinate and corresponding area on the septum is often due to the damage of anterior and posterior ethmoidal vessels
Below the level of middle turbinate: Bleeding starts from the branches of sphenopalatine artery. It may not be visible as it is lying lateral to middle or inferior turbinate. It may require an infrastructure of these turbinates for localization of the bleeding site and placement of packing to control it.
Posterior part of the nasal cavity: The blood flows directly into the pharynx.
Diffuse: Bleeding happens from both the septum and lateral nasal wall. This is often seen in general systemic disorders and blood dyscrasias.
Diagnosis Of Epistaxis
The doctor will check for these conditions when you go for a treatment initially.
Mode of onset
Duration and frequency of bleeding
Amount of blood loss
Whether bleeding is an anterior or posterior type.
Family history of bleeding tendency.
History of known medical ailment
History of drug intake (analgesics, anticoagulant, etc.)
Most of the time, bleeding occurs from the little’s area and can be easily controlled by pinching the nose with thumb and index finger for about 5 minutes as it would compress the blood vessels in that area.
Treatment For Epistaxis
Cauterization: It is used in anterior epistaxis when the bleeding point has been located. The area is initially given anaesthesia and then the bleeding point cauterized with a bead of silver nitrate or coagulated with electrocautery. This process is used in minor bleeds.
Anterior Nasal Packing: In case of active anterior epistaxis, the blood clots inside the nose are removed by suction and attempt is made to localize the bleeding site.
Posterior Nasal Packing: It is required to treat patients bleeding into their throat. A post nasal pack is first prepared by tying three silk ties to a piece of gauze rolled into the shape of a cone.
Endoscopic Cautery: a Posterior bleeding point can be better located with an endoscope. It can be coagulated with suction cautery. Local anesthesia with sedation may be required.
Ligation of vessels:
Externalcarotid artery ligation
Maxillary artery ligation
Ethmoidal artery ligation
What Are The General Measures To Take In Epistaxis?
Make the patient sit up by resting the back and record any blood loss taking place through spitting or vomiting. The mild sedation is given to keep a check on a pulse, BP, and respiration
Keep checking on hemodynamics sometimes blood transfusion may be required.
Antibiotics may be given to prevent sinusitis if the pack is to be kept beyond 24 hours.
Intermittent oxygen may be required in patients with bilateral packs because increased pulmonary resistance from Naso-pulmonary reflex.
Investigate and treat the patient for any underlying local or general cause.
In some cases nose, bleeding would require medical assistance, that is where you can rely on Sankhya hospital.
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