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This
section GaramChai features Medical articles by Dr.Kumaresh
Krishnamoorthy
Nose
Bleed
What
is a nosebleed?
A nosebleed
occurs when the membranes lining the inner nose are disturbed
or irritated enough to cause abnormal bleeding. The medical
term for nosebleed is epistaxis. There are two types of nosebleeds:
anterior and posterior. If the bleeding is near the front
of the nose, it is an anterior nosebleed. Nosebleeds in children
are almost always of the anterior type. Anterior nosebleeds
are common in dry climates or during the winter months when
the dry air parches the nasal membranes so that they crust,
crack, and bleed. A posterior nosebleed occurs in the back
of the nose and is not always characterized by rapid bleeding
but may be slow, steady ooze. Posterior nosebleeds are more
likely to occur in older people. It may be more difficult
to locate the site of the damage in a posterior nosebleed
than in an anterior nosebleed. An anterior nosebleed is usually
not as severe or serious as a posterior nosebleed.
What
causes nosebleeds?
If
you have a nosebleed after a heavy blow to your skull, it
could mean you have a fractured skull. You should go to the
hospital immediately.
The most
common causes of nosebleed are:
- A
breakdown in the membranes lining the nose. This can be
triggered by poorly humidified air or probing, bumping,
picking, or rubbing your nose.
- Blowing
the nose forcefully can also cause a nosebleed, especially
if the nasal lining is already inflamed because of a virus,
bacteria, or allergy.
- Injury
to the face or nose.
- Scars
and damage from previous nosebleeds that reopen and bleed.
- High
blood pressure.
- Medicines
that slow the time normally required for the blood to clot.
Why
is the nose prone to bleeding?
The
nose has many blood vessels in it to help warm and humidify
the air you breathe. These vessels lie close to the surface,
making them easy to injure.
What
are the symptoms of nosebleeds?
Symptoms
of anterior nosebleed include intermittent or constant bleeding
out of the front of the nose. Blood can flow from one or both
nostrils and can flow into the throat. Symptoms of posterior
nosebleed include bleeding that stops and starts, rapid bleeding
from the back of the nose, or a slow, steady ooze. Sometimes
the blood flows back into the throat. Especially with posterior
nose bleeding, one can lose blood quickly.
How
are nosebleeds treated?
Nosebleeds
may be treated by first aid, packing, cauterization, surgical
procedures including reconstruction of the nasal septum and
arterial ligation, and embolization.
First
Aid for Nosebleeds
Most
common nosebleeds will stop after the application of first
aid by the patient.
- When
your nose starts bleeding, sit up and lean forward to prevent
blood from passing into your throat, which may cause choking.
- Pinch
the nose firmly together between the thumb and index finger,
just below the nasal bones, and hold it for 10 minutes.
- Moisten
a cotton ball or pad with a saline nasal spray and press
it against the bleeding part of the nose if possible.
- If
a nosebleed does not respond to first aid or lasts more
than 20 minutes, it is necessary to see an ENT specialist.
Cautery
Cauterization
is a procedure used to force the blood to clot (coagulate)
at the site of the bleeding. Cautery may be done with silver
nitrate or with an electrocautery instrument. Electrocautery
is usually reserved for more severe bleeding and posterior
nosebleeds, and usually requires the use of local anesthesia.
Nasal
Packing
Nasal
packing may be used to treat nosebleeds not responsive to
cautery. Packing for anterior nosebleeds (near the front of
the nose) is relatively simple. Packing for posterior nosebleeds
(in the back of the nose) can be more difficult and uncomfortable.
For posterior nosebleeds, rolled gauze or recently developed
inflatable balloon devices may be used. If a posterior pack
is placed, an anterior pack will also be used as well. Patients
will receive antibiotics to prevent infection. Patients should
never remove their packing; severe bleeding and improperly
handled packing can be fatal.
Surgical
Treatment of Nosebleeds
While
most nosebleeds stop with cautery and/or packing, severe or
recurrent bleeding may require surgical treatment. Procedures
may include:
Endoscopic
examination under general anesthesia and Septoplasty (surgical
reconstruction of the nasal septum)
Packing
may fail because of lack of cooperation (especially among
children) or from problems such as a deviated septum. An endoscopic
exam under general anesthesia may be performed, bleeding sites
may be cauterized, deviated septum may be straightened, packing
may be replaced, and arterial ligation may be performed during
the same procedure, if necessary.
Arterial
Ligation
Arterial
ligation involves constricting specific blood vessels in order
to stop bleeding. Procedures may require local or general
anesthesia.
Embolization
for Nosebleeds
Embolization
entails the introduction of a substance into a blood vessel
in order to close it and prevent bleeding
How
can I help prevent a nosebleed?
Some causes
of nosebleeds can be prevented or managed as follows:
- When
you have a nasal infection, keep your nose well coated with
a petrolatum- based ointment or an antibiotic ointment until
your nose heals (usually 3 to 5 days).
- Avoid
injuring the nasal mucosa with nose-picking, rubbing, or
forceful blowing.
- Use
a saline nasal spray to keep the nose moist.
- Do
not pick or blow nose (sniffing is all right).
- Keep
children's fingernails short to discourage nose picking.
- Quit
smoking. Smoking dries out your nose and also irritates
it.
- Open
your mouth when you sneeze.
Author:
Dr.Kumaresh Krishnamoorthy, M.S (ENT)
Head
and Neck Surgery Fellowship (Buffalo, USA)
Neurotology
& Skull Base Surgery Fellowship (Cincinnati, USA)
Senior
Consultant in ENT - Head and Neck Surgeon and Skull Base Surgeon
Apollo
Hospitals, 154/11, Bannerghatta Road, BANGALORE 560 076, INDIA
Phone:
91-(0) - 99002 36819
Email:
drkumaresh@drkumaresh.com
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