Epistaxis or nosebleed is a fairly common and usually non-worrisome issue characterized by the discharge of blood from the nose. In fact, about 60% of people experience a nosebleed at least once in their life, although only a small proportion will need medical intervention. In patients, especially children, the incidence of nosebleeds is increased, while it usually stops occurring so often after puberty. The cause of epistaxis is usually not serious, however if the nosebleed occurs frequently enough, it needs medical investigation.
What causes epistaxis?
The causes of epistaxis are varied and vary in severity. These include:
- Injury to the nose from external blows.
- The regular use of nasal sprays, which causes dryness of the nasal mucosa.
- Chronic inflammatory conditions such as rhinitis or sinusitis can lead to inflammation of the nasal mucosa and subsequent bleeding.
- Benign or malignant tumors within the nasal cavity or paranasal sinuses.
- Scoliosis of the nasal septum.
- Arterial hypertension.
- Hereditary blood diseases such as hereditary hemorrhagic telangiectasia.
- Vascular diseases such as vasculitis.
- Disorders of blood coagulation.
- Diseases such as hemophilia or leukemia.
- Taking anticoagulant drugs.
- Environmental factors such as changes in humidity, temperature or high altitudes.
However, in many cases, despite a thorough evaluation, no clear cause is identified and the epistaxis is classified as idiopathic.
Types of nosebleed
Epistaxis is classified based on the anatomical origin of the bleeding into anterior and posterior. Anterior is the most common type, which originates from the anterior part of the nasal septum, where fragile blood vessels are located. It is generally less severe and easier to manage. Posterior epistaxis on the other hand starts from larger blood vessels in the posterior nasal cavity. This type is less common but more serious and difficult to manage as it can cause extensive blood loss. In fact, it often requires a more aggressive approach with hospitalization or even surgery.
Treatment options
Treatment of nosebleed initially requires calm and not panic. The first movement that most people make is to lift the head upwards, a practice which is not recommended. Instead, the patient should sit or stand with the head slightly tilted forward as soon as the nosebleed begins. Afterwards, it is recommended to gently blow your nose to clear the nasal cavity. The next management measure is to lightly press the soft part of the nose with the fingers for about ten minutes, without changing the forward tilt of the head. Ingestion of blood should be avoided. A simple, isolated episode of nosebleed can be successfully treated with the above measures.
However, in cases where nosebleeds recur, a more thorough evaluation by a specialist is recommended. Especially if the bleeding is extensive, it is recommended that the patient go to the hospital in order to receive first aid. Then, a visit to an ENT Surgeon is deemed necessary, as the next step is to perform a nasal endoscopy. This test indicates the focus of the bleeding. Once the focus is found and the extent of the problem recognized, there are two options available:
- the plugging of the nasal cavity with eespeciallyhemostatic materials,
- the cauterization of the vessel, which is responsible for the epistaxis, chemical or electrical with the use of diathermy.
In advanced cases, endoscopic surgery may be performed to ligate larger blood vessels. Finally, it should be noted that the management of hypertension, the treatment of any blood diseases and the restoration of any nasal diseases of inflammatory etiology are vital to avoid future recurrences of epistaxis. In any case, ENT Surgeon in Athens Dr. Olga Papadopoulou treats every case of epistaxis with due care in order to avoid future recurrences.