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

What is epistaxis?
Epistaxis, commonly known as a nosebleed, is the medical term for bleeding from the nose.

What causes nosebleeds?
Nosebleeds can occur due to various factors, including dry air, trauma, sinus infections, allergies, and underlying medical conditions.

Is epistaxis a common problem?
Yes, nosebleeds are a common occurrence, and most people experience them at some point in their lives.

What are the different types of nosebleeds?
Nosebleeds are categorized into anterior (front of the nose) and posterior (back of the nose) based on their origin.

How are anterior nosebleeds treated?
Anterior nosebleeds are usually managed by pinching the nostrils together and leaning forward to prevent blood from flowing down the throat.

What causes posterior nosebleeds, and how are they treated?
Posterior nosebleeds often result from more serious underlying conditions and may require medical evaluation and treatment, such as nasal packing or cauterization.

Can you use cold compresses to treat nosebleeds?
Applying a cold compress to the nose or back of the neck can help constrict blood vessels and stop bleeding.

Are there over-the-counter (OTC) treatments for nosebleeds?
Nasal saline sprays and nasal gels can help keep the nasal passages moist, reducing the risk of nosebleeds, especially in dry climates.

Should you tilt your head back during a nosebleed?
No, tilting the head back can cause blood to flow down the throat, potentially leading to swallowing blood or choking. It's best to lean forward.

When should you seek medical attention for a nosebleed?
Medical attention is needed if the bleeding is heavy, lasts for more than 20-30 minutes, or is recurrent.

What role do blood-thinning medications play in nosebleeds?
Blood-thinning medications like anticoagulants can increase the risk of nosebleeds, and adjusting the medication may be necessary.

Can frequent nosebleeds be a sign of an underlying medical condition?
Yes, recurrent nosebleeds may indicate an underlying issue, such as blood disorders, hypertension, or nasal polyps.

Can cauterization be used to treat chronic nosebleeds?
Cauterization, a procedure where blood vessels are sealed, can be an effective treatment for chronic nosebleeds.

How does humidity affect the risk of nosebleeds?
Low humidity can dry the nasal passages, making them more prone to bleeding. Using a humidifier can help prevent nosebleeds in dry environments.

Is nasal packing a common treatment for severe nosebleeds?
Yes, nasal packing, which involves inserting gauze or an inflatable balloon into the nose, can help stop severe nosebleeds.

What is the role of topical antibiotics in nosebleed treatment?
Topical antibiotics may be prescribed if nosebleeds are caused by an underlying infection or inflammation.

Can nosebleeds be prevented?
Preventive measures include keeping the nasal passages moist, avoiding nasal trauma, and managing underlying medical conditions.

Can nosebleeds be a symptom of nasal tumours or cancer?
While rare, nosebleeds can be a symptom of nasal tumours or cancer, especially if they are recurrent and accompanied by other concerning symptoms.

Is it normal to experience nosebleeds during pregnancy?
Some pregnant individuals may experience nosebleeds due to hormonal changes and increased blood flow. They are usually not a cause for concern.

Can nosebleeds be hereditary?
There is no direct hereditary link to nosebleeds, but a family history of certain medical conditions may increase the risk.

Are there alternative therapies like cauterization for children with recurrent nosebleeds?
In children with frequent nosebleeds, cauterization is generally considered a last resort due to their developing nasal structures.

Can nosebleeds be related to high blood pressure?
High blood pressure can increase the risk of nosebleeds, but it is not usually the sole cause. Proper blood pressure management is essential.

Is there a connection between nosebleeds and sinusitis?
Sinusitis, inflammation of the sinuses, can lead to nasal congestion and increased risk of nosebleeds.

Can nosebleeds be associated with bleeding disorders like haemophilia?
Yes, bleeding disorders like haemophilia can lead to spontaneous nosebleeds, and they should be managed by a healthcare professional.

Review
FAQs reviewed by Dr. Sumit Mrig, Associate Director and Head ENT(Ear Nose Throat).