What is epistaxis?
Hemorrhage occurs from the nostril, nasal cavity or nasopharynx is called epistaxis. It occurs as a result of the rupture of small vessels that lie in the anterior part of the cartilaginous nasal septum. It is usually not a life-threatening condition but can cause significant concern.
Basics: When mucosa is eroded and breaks in blood vessels then bleeding occurs. More than 90% of bleeding occurs anteriorly. Bleeding from the anterior part causes constant oozing. Posterior bleeds occur from far back in the nasal cavity. It is usually more profuse and has an arterial origin. It has a greater risk of airway compromise, aspiration of blood, and greater difficulty controlling bleeding.
What causes epistaxis?
Local causes of epistaxis:
• Acute and chronic infections
• Rhinitis
• Nasal trauma (nose picking, facial trauma, forceful nose blowing)
• Drying of nasal mucosa
• Septal perforation
• Vascular malformation
• Chemical irritants
• Deviated nasal septum
• Bleeding polyp
• Neoplasm of nose or sinuses
• Tumors of nasopharynx
Systemic causes of epistaxis:
• Blood disorders
• Hereditary haemorrhage
• Hypertension
• Anticoagulant medicines
Can nosebleeds be a sign of something serious?
Mostly, there is no known cause for a nosebleed. Nosebleeds, especially repeated nosebleeds, may be a symptom of a more serious problem. High blood pressure does not cause nosebleeds, according to some study but hypertension can prolong bleeding.
Can nosebleeds be a sign of cancer?
While frequent nose bleeds can be a sign of a more serious problem, including cancer of the nasal cavity, getting nosebleeds once a month probably is not frequent enough to cause cancer or serious problem. In general, nosebleeds are more common during winter season.
How do you stop an epistaxis?
• Press the nose for 5-10 minutes.
• Anterior nasal packing for 28 to 48 hours.
• Sit upright and lean forward to avoid swallowing of blood or to enter throat or sinus.
• Apply ice wrapped in a towel.
What are the complications of epistaxis?
• Sinusitis
• External nasal deformity
• Septal hematoma/perforation
• Balloon migration
• Aspiration
• Mucosal pressure necrosis
• Vasovagal episode
How to investigate epistaxis?
Physical examination: • Examination of pulse, B.P. and respiration
• ENT examination
• Hepatic and renal examination
• Cardiovascular examination
• Imaging for postnasal mass, mediastinal tumors etc.
Examination in acute epistaxis:
• The patient blows the nose gently to clear blood clots. Examination is done with headlight and nasal speculum.
• Mucosal vasoconstriction is helpful in active bleeding.
• The vasoconstrictor may also be applied to strips of cotton or neurosurgical pledges and placed in the nose after application by spraying. 3 cotton strips or pledges are placed both sides.
• For patient’s comfort during subsequent examination and treatment, topical anesthetic is helpful. Nasal packing is performed if bleeding source is not visible.
• Examination of the posterior nasal cavities and nasopharynx with endoscope or fiberoptic rhino laryngoscope is done if posterior epistaxis is suspected.
What are the homeopathic remedies indications for epistaxis?
Aconitum napellus
Ammonium carbonicum
Arnica Montana
Carbo vegetabilis
Ipecacuanha
Millefolium
Phosphorus
