Epistaxis (Nose Bleeding): Causes, Treatment
Introductions of epistaxis (nose bleeding):
Epistaxis (nose bleeding) means bleeding from the nose. It is a common problem and 70% of adult males have had experience epistaxis (nose bleeding) over the age of 60 years, it is also common in children.
Causes of epistaxis (nose bleeding):
- Trauma (fracture, foreign body, nose picking)
- Inflammation (rhinitis, sinusitis)
- Neoplastic (cancer, juvenile nasopharyngeal angiofibroma, haemangioma)
- Environmental (high altitude, air conditioning)
- Anticoagulant therapy
- Blood disorders (haemophilia, leukaemia, thrombocytopenia, dengue)
- Raised venous pressure
- Nose surgery
- Use of Steroid nasal spray
- In 85% cases, cause is unknown
Assessment of epistaxis (nose bleeding):
Asses either the patients are in shock or not. If not in the shock take a full history to find out any cause and try to locate the bleeding point. If severe bleeding occurs, give I/V saline infusion, sent blood for full blood count, Hb, coagulation screen and blood grouping & cross matching if necessary.
Management of epistaxis (nose bleeding):
- Pressure by the finger on the nostrils with or without ice cold packs or sucking ice cubes.
- Local cautery: chemical or electrocautery if the bleeding point is seen. Antibiotic ointment or cream is applied to the cautery site.
- Anterior nasal packing, if the bleeding point is not seen or above measure fails. It is given by paraffin gauze, BIPP, ribbon gauze with antibiotic ointment, Merocel, Caltostat etc. The pack is kept for 24-48 hours, antibiotic is given.
- Posterior nasal pack if above measure fails. It is given by gauze with 3 threads, Foley’s catheter of Brighton balloon.
- If bleeding is not controlled by packing or cautery one of the following surgery may be needed:
- Septoplasty or submucous resection
- Endoscopic cautery
- Ligation or clipping of maxillary artery in the pterygomaxillary fossa by artery ligation by Caldwell-Luc operation
- Ethmoid artery ligation by Howarth incision
- External carotid artery ligation
- Embolization of vessels under radiographic control with gel sponge or beads.
Dr. Abdul Matin, FRCS (Edin, Eng, Glasgow), DLO(eng)
Associate Professor, ENT