Epistaxis (Nosebleed) Treatment in Delhi, India

Nosebleed is the loss of blood from the inner lining tissue of the nose. There are mainly two types of nose bleeding:

1. Posterior nosebleeds

   These originate from the back of the nose, near the throat. They are heavier and harder to control. It may require medical attention.

2. Anterior nosebleeds

   These originate from the front of the nose. They are more fluent and usually not serious.

   Most of the nasal bleeding is anterior. It originated from a plexus of blood vessels in the anterior underlying septum, also known as Kiesselbach's area.

   Posterior Nosebleeds are less common but more serious. They originate in the posterior septum lying over the vomer bone or on the inferior/middle turbinate. Posterior nosebleeds usually occur in patients who have undergone nasal or sinus surgery or face pre-existing bleeding disorders. 

Several symptoms can be noticed during epistaxis. Some of the common ones are listed below:

1. Blood coming out of either one or both nostrils
2. People feel weak or even faint if the bleeding is thorough
3. The patient may vomit or feel nausea if the blood is swallowed
4. Prolonged bleeding of the nose may cause anaemia
5. A huge nosebleed may lead to dark or tarry bowel movements

A nosebleed can be triggered by common situations.

1. Local trauma is one of the most commonly reported reasons for a nose bleed.
2. Facial trauma, nasal infections, and the entrance of foreign bodies may lead to the causes of epistaxis.
3. The use of aspirin may lead to bleeding of the nose.
4. Some people face bleeding disorders such as haemophilia.
5. Chemical irritants such as ammonia
6. Platelet functional disorders - thrombocytopenia and additional causes of abnormal platelets. They generally include splenomegaly and leukaemia
7. Cocaine use- if the septum looks sloughed or atrophic. The drug is usually taken by inhaling and has a very strong vasoconstrictive impact, leading to the complete demolition of the nasal septum.
8. People who intake blood thinners/anticoagulants such as warfarin and heparin are likely to face nose bleeds.

Hypertension is prevalent when patients present with acute bleeding. The undiagnosed hypertension incidences found are no higher than they would be predicted in the estimated population. Systematic research and review found that a total of six out of nine studies agree that the pressure of arterial epistaxis is higher than the posterior nosebleeds.

A routine laboratory check-up is not mandated to diagnose the illness. Nosebleeds are harmless, self-limiting, and impulsive. Patients with signs of reluctant or severe epistaxis must have Complete Blood Count (CBC), Partial Thromboplastin Time (PTT) as well as Prothrombin Time(PT).

There are two categories of Epistaxis: Anterior and Posterior. They can be differentiated during clinical management. Tropical spray with epinephrine and anaesthetic can be helpful for vasoconstriction to enable visualization of the source of bleeding.

Epistaxis can be self-treated in the case of minor blood flow.

1. The patient is suggested to sit upright, lean slightly forward, and pinch both nostrils shut for five to ten minutes. This may help stop a nosebleed on repeating the procedure.
2. Survey the patient's pulse rate and blood pressure.
3. In case the bleeding has stopped, continue inspecting the nose, using a nasal speculum; assess cautery.
4. The history of severe and prolonged bleeding will need expert help. One must watch carefully for signs of hypovolaemia.
5. Nasal cautery is one of the common treatments for epistaxis. A caustic agent such as silver nitrate or an electrically charged wire, such as platinum, is utilized to stop bleeding in the nasal membrane.
6. The Chemical cautery of the noticeable blood vessels on the anterior fraction of the nasal septum is the most popular medication method for idiopathic recurrent epistaxis.
7. Examine the nasal cavity carefully. Look for any bleeding points, which can usually be noticed on the anterior septum; oozing point, or a visible clot. Take notice of any pus suggesting a particular bacterial infection.

In the case of excessive bleeding, one must seek medical care. Visit a doctor shortly in case of:

1. Bleeding profusely and severely
2. Bleeding for more than thirty minutes in a row
3. When a child under the age of two years is having a nosebleed
4. Started bleeding followed by an injury or trauma
5. Intake of blood-thinning drugs

Complications of epistaxis include medical conditions such as Haemorrhagic shock, Aspiration, Septic shock, Sinusitis, Cerebral abscess, Pneumocephalus, Septal pressure necrosis, Epiphora (from blockage of the lacrimal duct), Neurogenic syncope during packing, and Hypoxia (from impaired nasal air movement)

There are certain traditional risk factors for epistaxis:

1. Conditions such as Nasal perforation, rhinitis, nasal, sinusitis, deviation, upper respiratory tract infection, and septum do not increase the risk of repetition.
2. Significant factors for recurrent nosebleeds included congestive heart failure, hypertension, diabetes mellitus, and anaemia.
3. The use of warfarin has heightened the risk of repetition.
4. Aspirin was not found to increase the risk. Few major unfavourable cardiovascular incidents were observed within thirty days of the first nosebleed.
5. Congestive heart failure bears an unusual risk for recurrent epistaxis.

1. Nose Bleeding First Aid - Kit, Home Care, What to Expect