Epistaxis / Nosebleeding

Hemorrhage from the nostril, nasal cavity or nasopharynx is called epistaxis. It occurs as a result of rupture of small vessels that lie in the anterior part of cartilaginous nasal septum. It is usually not a life-threatening condition but can cause significant concern.

epistaxis

 

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Basics: When mucosa is eroded and breaks in blood vessels then bleeding occurs. More than 90% of bleeding occurs anteriorly. Bleeding from anterior part causes constant oozing. Posterior bleeds occurs from far back in the nasal cavity. It is usually more profuse and has arterial origin. It has a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.

Epistaxis is commonly seen in

Epistaxis is more common in occurrence at the age of 2-10 years and in older age groups that is 50-80 years of age.

Races affected

Individuals of any race can be affected by epistaxis.

Causes

Local causes of epistaxis:

• Acute and chronic infections

• Rhinitis

• Nasal trauma ( nose picking, foreign bodies, forceful nose blowing)

• Drying of nasal mucosa

• Septal perforation

• Vascular malformation

• Chemical irritants

• Deviated nasal septum

• Bleeding polyp

• Neoplasm of nose or sinuses

• Tumors of nasopharynx

Systemic causes of epistaxis:

• Blood disorders

• Hereditary hemorrhage

• Hypertension

• Anticoagulant medicines

Investigations for Epistaxis

Physical examination: • Examination of pulse, B.P. and respiration

• ENT examination

• Hepatic and renal examination

• Cardiovascular examination

• Imaging for postnasal mass, mediastinal tumors etc.

Examination in acute epistaxis:

• The patient blows the nose gently to clear blood clots. Examination is done with headlight and nasal speculum.

• Mucosal vasoconstriction is helpful in active bleeding.

• The vasoconstrictor may also be applied to strips of cotton or neurosurgical pledgets and placed in nose after application by spraying. 3 cotton strips or pledgets are placed both sides.

• For patient’s comfort during subsequent examination and treatment, topical anaesthetic is helpful. Nasal packing is performed if bleeding source is not visible.

• Examination of the posterior nasal cavities and nasopharynx with endoscope or fibreoptic rhinolaryngoscope is done if posterior epistaxis is suspected.

Treatment

• Vasoconstrictive spray

• Topical coagulants.

• Topical anesthetics

• Nasal packing for 48 to 72 hours.

• Application of ointment with a fingertip inside the nose.

• Remedies for nosebleeds: A + D ointment, methylsalicylate/menthol, Polysporin, neomycin/bacitracin/polymyxin, or Vaseline.

• Saline mist nasal spray is often helpful

Prognosis of Epistaxis

• Uncomplicated epistaxis responds to simple first-aid measures.

• Patient with some medical problem or taking anticoagulants or if bleeding is severe then the patient should be hospitalized.

Complications

• Sinusitis

• External nasal deformity

• Septal hematoma/perforation

• Balloon migration

• Aspiration

• Mucosal pressure necrosis

• Vasovagal episode

Diet / management of Epistaxis

• Press the nose for 5-10 minutes.

• Anterior nasal packing for 28 to 48 hours.

• Sit upright and lean forward to avoid swallowing of blood or to enter throat or sinus.

• Apply ice wrapped in a towel.

Homeopathic treatment for Epistaxis

Aconitum napellus

• Nosebleed with anxiety and restlessness.

• Fullness of head, in young and plethoric persons.

Ammonium carbonicum

• Epistaxis every morning on washing face.

• Epistaxis with dry coryza, especially at night.

• Hands look blue after washing in cold water and veins distended.

Arnica Montana

• Epistaxis preceded by tingling.

• Copious after every exertion, from mechanical causes, after washing face, during whooping-cough, typhus, etc.

• Nosebleed in growing children.

• Discharge of several drops of thin blood from nose on first blowing it in the morning.

• Blood bright-red, mixed with clots and leaving a bruised sensation behind.

Carbo vegetabilis

• Frequent and continued nosebleed, especially in the morning and forenoon, or when pressing at a stool.

• Great paleness of face during and after bleeding.

• Blood thin and black.

• Aggravation at night, in old and debilitated persons, excited by motions or jarring and after debauch.

• Nosebleed often followed by a pain in chest.

Ipecacuanha

• Profuse epistaxis of bright-red blood.

• Bleeding occurs in continuous or intermittent fevers, during whooping-cough.

• Face pale, bloated, with blue margins around eyes.

Millefolium

• Excessive nosebleed in congestions to chest and head.

• Piercing pains from eyes to root of nose.

• Blood bright-red, arterial, flowing without apparent cause.

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