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MANAGEMENT OF NOSE BLEEDS (EPISTAXIS) by Prof Dr. Sanjeev Mohanty

Updated: Nov 22, 2021




Nosebleeds are a fairly common occurrence in day to day living. They tend to be frightening to a non-medical professional because they can be profuse and dramatic, however, are they rarely life-threatening. They can occur at any age but are most common under age 10 and over age 50.


Nosebleeds can be divided into two types:

1.Anterior (front of the nose) and

2.Posterior (back of the nose)

Anterior epistaxis represents about 90% of nosebleeds and tend to be easier to manage. With an anterior nosebleed, the blood will tend to come out the front of the nose. Bleeding that is more profuse and going down the back of the throat is a more likely indicator of posterior epistaxis. The nasal mucous membranes warm and humidify air as it passes through the nose. To accomplish this, the nose has a very rich vascular supply. There is a collection of blood vessels on the anterior septum, where the vast majority of nosebleeds occur. Often, there is no obvious cause for the bleeding and it may seem very random. Some factors that may cause bleeding include dry air, trauma either from an injury or from picking the nose, chemical irritants, nasal septal deformities, allergies, upper respiratory infections, medications such as aspirin and other anti-coagulants, and medical illnesses such as hypertension and vascular disease. At times, nosebleed could be the first clinical manifestation of an underlying systemic disease like malignancy of the lymphoid system blood vessels and coagulation disorders. Sometimes, unprovoked spontaneous bleeding from the nose occurs in teenaged boys harboring rare vascular tumors like juvenile nasopharyngeal angiofibroma.


Most nosebleeds can be managed conservatively. Humidifying the air and applying nasal saline sprays may help as the first line of treatment.

1.Avoid hard nose blowing and nose picking, especially in children.

2. Avoid hot and spicy foods and hot showers and avoid aspirin and other anti-coagulants unless prescribed medically. If bleeding occurs, sit down and lean forward and relax.

3. Pinch the nose firmly on the soft part of the nose so that pressure is applied against the septum. Apply an ice pack to the external nose.

4. Pinch the nose for a few minutes. If it is still bleeding then pinch the nose for another 10-15 minutes. If bleeding continues then medical attention may be necessary. Topical over-the-counter nasal sprays containing oxymetazoline or phenylephrine may help to decrease bleeding as a temporary measure.

If bleeding persists or recurs or is severe then a consultation with an ENT surgeon is recommended. A diagnostic nasal endoscopy would help in clinching the site and the probable cause of bleeding. A surgical procedure may or may not be needed. Anterior bleeding can sometimes be managed with chemical cauterization using silver nitrate. Occasionally, persistent bleeding will require nasal packing and, if there is a recurrence or intractable bleeding, surgical management or embolization may be required. The surgical approach is very straightforward with an endoscopic approach to visualize the bleeding site and ligate or clip the offending vessel and prevent further episodes.



Glossary :

Epistaxis: Bleeding from the nose Highly Vascular: Having a large concentration of blood vessels. Septum: The partition between the left and right nasal passages. Trauma: Physical Injury (internal or external) Endoscopy: Examination of internal organs using a specialized instrument.

(EPISTAXIS)


For further queries about the infections, diseases, and treatments of the ear, nose or throat, Dr Mohanty’s Speciality ENT Clinics in Chennai, India can help in a number of ways,

FOR MORE INFORMATION, CONTACT US :

Dr Mohanty’s Speciality ENT Clinics

Manapakkam, Chennai, India.

For Consultation: +91 97910 74677

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