The nose is the main gateway to the respiratory
(breathing) system. The inside of the nose is covered with mucosa
(moist, soft tissues) that has a rich blood supply. This warms and
moistens the air we breathe. Air passes to and from the lungs through
the nostrils. A thin flexible wall called a nasal septum separates the
two nostrils.
Little's Area- it is situated in the anterior inferior part of nasal
septum. Four arteries anastomose here to form a vascular plexus called
'Kiesselbach's plexus'. This area is exposed to dying effect of
inspiratory current and to finger trauma, and is the usual site for
epistaxis in children and young adults.
It is defined as a bleeding from inside nose. It is present in all age
groups. It is a sign not a disease and an attempt has to made to find
out cause behind it. Epistaxis is often a frightening sight to the
patient and the attendants, especially if the patient is a kid.
Etiology:
A. Local Causes:
a. Nose- 1. Trauma- finger nail trauma , injuries to nose, fractures of
middle third of the face, violent sneezing.
2. Infections- Acute- viral rhinitis, nasal diphtheria, and acute
sinusitis.
Chronic- Atrophic rhinitis, rhinitis sica, tuberculosis,
granulomatous lesions like rhinosporodiasis, syphilitic
nasal septum perforation.
3. Foreign bodies- Living and non- living.
4. Neoplams of nose and paranasal sinuses.
5. Atmospheric changes- High altitude and sudden compression.
6. Deviated nasal septum.
b. Nasopharynx- 1. Adenoiditis.
2. Juvenile angiofibroma.
3. Malignant tumors.
B. General Causes:
a.Cardiavascular- hypertension, mitral stenosis are commonly seen in
old age.
b.Allergies.
c.Drugs - Aspirin, Fexofenadine/Allegra/Telfast, warfarin, ibuprofen,
clopidogrel, isotretinoin, desmopressin, ginseng and others
d.Alcohol (due to vasodilation)
e.Anemia
f.Connective tissue disease
g.Blood dyscrasias
h.Envenomation by mambas, taipans, kraits, and death adders
i.Heart failure (due to an increase in venous pressure)
j.Hematological malignancy
k.Idiopathic thrombocytopenic purpura
l.Pregnancy
m.Vascular disorders
n.Vitamin C or Vitamin K deficiency
o.von Willebrand's disease
C. Idiopathic- Many times the cause of Epistaxis is not clear.
Classification of Epistaxis:
1.Anterior Epistaxis- when the blood is coming out from the front of
nose with the patient in sitting position. Mostly occur in children or
young adults. Bleeding is usually mild, and can be controlled by local
pressure.
2.Posterior Epistaxis- Many the blood flows back into the throat.
Patient may swallow it and later have a "coffee coloured" vomitus. This
may erroneously be diagnosed as haematemesis. It commonly present after
40 years of age.
Diagnosis:
1.Clinical history- to detect any injury.
2.Physical examination with the help of nasal speculum.
3.Nasal endoscopy.
4.Blood Test
5.Angiography
Management:
a.Make the patient sit up with a backrest and record any blood
loss-taking place through spitting and vomiting.
b.Reassure the patient.
c.Don't panic because most of the time bleeding can be controlled by
pinching the nose tightly for about five minutes.
d.Ice compress can be applied in the nose. They cause bleeding blood
vessels to constrict & bleeding stops.
e.Keep check on pulse, BP and respiration.
f.Maintain haemodynamics.
g.Investigate and treat the patient for any underlying local and
general causes.
h.Nasal Packing
i.Surgeries in emergencies condition.
j.Homoeopathy- the medicine is selected on the basis on the symptoms
similarity and underlying cause. The epistaxis can also be treated
safely and effectively with homeopathic medicines. Homoeopathic
remedies selected after properly studying the patient's case are very
effective in stopping epistaxis without any relapse.
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