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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.
CONTACT:
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.
For the columns authored by Dr.Kumaresh Krishnamoorthy in "Dr.Kumaresh Krishnamoorthy Column", please click here.
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