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Epistaxis

Nosebleed, or epistaxis, may either be a primary disorder or occur secondary to another condition. Such bleeding in children generally originates in the anterior nasal septum and tends to be mild. In adults, such bleeding is most likely to originate in the posterior septum and can be severe. Epistaxis is twice as common in children as in adults.

Only rarely is a nosebleed life threatening or fatal. In these cases, the hemorrhage (severe bleeding) is usually from a posterior location, higher and deeper in the nose. Posterior bleeds usually drain down the back of the throat, but can also bleed out of both nostrils. Also, in most cases of severe nosebleeds, the person has another health problem, such as high blood pressure, a bleeding disorder or use of blood-thinning medication that is working against the blood-clotting process.

Causes

Epistaxis usually follows trauma from external or internal causes: a blow to the nose, nose picking, or insertion of a foreign body. Less commonly, it follows polyps; acute or chronic infections, such as sinusitis or rhinitis, that cause congestion and eventual bleeding from capillary blood vessels; or inhalation of chemicals that irritate the nasal mucosa. It may also follow sudden mechanical decompression ( caisson disease) and violent exercise.

Predisposing factors

Such factors include anticoagulant therapy, hypertension, chronic aspirin use, high altitudes and dry climates, sclerotic vessel disease, Hodgkin's disease, neoplastic disorders, scurvy, vitamin K deficiency, rheumatic fever, blood dyscrasias (hemophilia, purpura, leukemia, and anemias), and hemorrhagic telangiectasia.

Signs and symptoms

Nosebleeds usually involve one nostril, but occasionally both nostrils are involved. If one nostril becomes partially blocked with a blood clot, the blood might flow out the other nostril or down the back of the throat. In a posterior nosebleed (higher up in the nose), large amounts of blood typically flow down the back of the throat. The amount of bleeding from a nosebleed can vary with posterior bleeds usually bleeding significantly more.

Diagnosis

In otherwise healthy people, most mild anterior nosebleeds can be self-diagnosed and treated at home. If your nosebleed is severe and does not respond to first-aid measures, you will need to see a doctor immediately.

The doctor will review your health history and current medications.

Treatment

Different treatment measures are used for anterior and posterior bleeding. Drug therapy, transfusions, and surgery may also be necessary.

Local measures

For anterior bleeding, treatment consists of application of a cotton ball saturated with epinephrine to the bleeding site and external pressure, followed by cauterization with electrocautery or a silver nitrate stick. If these measures don't control the bleeding, petroleum gauze nasal packing may be needed.

For posterior bleeding, treatment includes use of a nasal balloon catheter to control bleeding effectively, gauze packing inserted through the nose, or postnasal packing inserted through the mouth, depending on the bleeding site. (Gauze packing generally remains in place for 24 to 48 hours; postnasal packing remains in place for 3 to 5 days.)

Alternative treatment

Estrogen cream, the same preparation used to revitalize vaginal tissue, can toughen fragile blood vessels in the anterior septum and forestall the need for cauterization. Botanical medicines known as stiptics, which slow down and can stop bleeding, may be taken internally or applied topically. Some of the plants used are achillea (yarrow), trillium, geranium, and shepard's purse ( capsella-bursa ). Homeopathic remedies can be one of the quickest and most effective treatments for epistaxis. One well known remedy for nosebleeds is phosphorus.

Other measures

Antibiotics may be appropriate if the packing must remain in place for longer than 24 hours. If local measures fail to control bleeding, additional treatment may include supplemental vitamin K and, for severe bleeding, blood transfusions and surgical ligation or embolization of a bleeding artery.

Prevention

A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray can help prevent nosebleeds, especially during the winter months.