Epistaxis

What is epistaxis?

Epistaxis or nosebleed is any bleeding originating from the nasal passages. This bleeding can be caused by trauma, irritation or dryness of the lining of the nose, allergic rhinitis, colds or sinusitis.

Other causes may be nasal obstruction, in cases of deviated septum or foreign objects in the nose. In most cases it has its origin in the septum, which is the vertical cartilage that separates the nasal chambers and is lined with very fragile blood vessels, which can break. Such epistaxis is easy to stop.

In any case, any epistaxis requires medical help if it persists after fifteen or twenty minutes of treatment, if it is repeated frequently, if the blood drains towards the throat or if a neck or head injury is suspected. The best way to stop the bleeding is to sit leaning forward and plug your nostrils with your fingers, breathing through your mouth.

Prognosis of epistaxis

Normally, most nosebleeds usually stop without medical help within fifteen to twenty minutes. However, when the bleeding or hemorrhage originates in the posterior segments, it is necessary to see a specialist to stop it.

These hemorrhages can be dangerous, and are common after an injury, or sometimes caused by high blood pressure, nasal disorders, arteriosclerosis, etc.

Nosebleeds can sometimes indicate the presence of another serious problem, such as a blood clotting disorder or the presence of a nasal tumor.

Symptoms of epistaxis

The main sign or symptom of epistaxis is a nosebleed. Epistaxis is usually initially scanty and of limited duration. In more severe cases, blood may flow out of one nostril and/or become bilateral as blood flows through the nostrils.

Other symptoms of epistaxis include:

• Sweating.
• Dizziness.
• Nausea and vomiting, due to swallowing blood.
• Tachycardia.
• Hypotension.

Medical tests for epistaxis

In the event that the bleeding does not stop, the patient may need an urgent assessment by a specialist to control this bleeding.

The objective of the medical tests will be to identify and localize the bleeding, and for this purpose an anterior rhinoscopy is usually performed. On other occasions a nasal endoscopy may be performed and the oropharynx explored.

Epistaxis usually stops within fifteen minutes.

What are the causes of epistaxis?

There are several causes that can originate or produce epistaxis:

• Nasal trauma.
• Nasal septum deviation.
• Malformation of the septum.
• The patient has been exposed to chemical components or fumes that irritate the nasal mucosa.
• Use of anticoagulant medications.
• Sudden changes in altitude.
• Severe rhinitis.
• Severe hypertension.

On the other hand, there are other causes originated by external factors:

• Hemopholia.
• Tumors in the nasal cavity.
• Anemia.
• Alcohol intoxication.
• Hormone problems.
• Leukemia.

Can epistaxis be prevented?

The best way to prevent nosebleeds is to avoid risk factors. These are the following:

• Very dry weather.
• Dry air in heated environments.
• Angiomas in the blood vessels.
• The nose has an irregularity or deformity.
• The patient has a cold.
• Sinusitis.
• Sarcoidosis.
• The patient has high blood pressure.
• The patient takes anticoagulant medication.
• The patient uses cocaine.

In turn, you can do the following:

• Lubricate the nasal passages.
• Use saline spray to moisten the inside of the nose.
• Do not touch your nose or the inside of your nose. Short fingernails may help.
• Moist air (especially in bedrooms).

Treatment of epistaxis

Most nosebleeds eventually stop on their own without outside help in about a quarter of an hour. However, nosebleeds originating from the back of the nose may be more serious and require medical attention.

Independently, the patient should do the following:

• Remain calm, sit up and lean forward.
• Pinch your nose.
• Do not scratch or rub your nose.
• Avoid straining, standing up, etc.

If the bleeding is very severe, it can be treated with cauterization, although it is first necessary to locate and identify the origin and the point where the bleeding is occurring. Anterior nasal packing is also an option, although it requires hospitalization of the patient.

Finally, surgical treatment is sometimes necessary to definitively control the bleeding. There are three methods: electrocoagulation, arterial ligation and laser photocoagulation. In all cases, general anesthesia or sedation will be used, and vision through endoscopy will be used.

Which specialist treats epistaxis?

The specialist in charge of diagnosing and treating epistaxis and nosebleeds is the ENT specialist.