Epistaxis

Epistaxis

The term Epistaxis is the name given to any type of blood loss through the nose, often through the nostrils, or through the nose through the mouth.

There are two types of epistaxis:

  1. Anterior – (approximately 90% cases), that is, closer to the outside of the nose.
  2. Posterior – (approximately 10%), that is, more in the interior: less common, but with more severe effects.

How does bleeding happen?

Epistaxis occurs when small vessels (veins or arteries) that pass through the mucous membranes of the nose rupture.

Why do these little vessels break?

In general, vessels become fragile and more susceptible to rupture by local factors, which can be identified by otorhinolaryngological examination, or by systemic factors as listed below.

Local Factors:

  • Anatomic deformities Inhalation of chemicals Inflammation (secondary to acute respiratory tract infections such as chronic sinusitis, allergic rhinitis and environmental irritants);
  • Foreign bodies;
  • Intranasal tumors;
  • Use of nasal medications;
  • Previous Surgeries;
  • Trauma;

Systemic Factors:

  • Use of certain medications (aspirin, warfarin, clopidogrel, desmopressin);
  • Alcohol intoxication;
  • Allergies;
  • Blood clotting disorders;
  • Heart problems;
  • Tumors of the blood (leukemia);
  • Arterial hypertension;
  • Infectious diseases;
  • Malnutrition (especially anemia);
  • Use of narcotics;
  • Vascular diseases;

What to do when you have Epistaxis?

If you have frequent episodes of epistaxis, it is worthwhile to seek the otolaryngologist before even a new event to discover the cause, clarify any doubts and start treatment.

If you are bleeding at this time, initially stay calm, most epistaxis improve spontaneously within a few minutes and do not require urgent medical attention.

Pinch the side of the nose against the septum on the affected side for a few minutes, sit erect, do not lift, and do not lower your head. A cotton swab soaked in vasoconstrictor solution (Afrin, Sorine…) may be placed into the nostril and then continued for at least 5 to 10 minutes. After bleeding stops, do not force the nose to blow because it may cause new bleeding. Do not insert anything into the nostrils. Do not try to clean them with a cotton swab, finger, tweezers, tissues, toilet paper. Use humidifiers or wet towels to humidify the environment.

How is the treatment done?

The otolaryngologist can perform the cauterization (chemical or thermal) of the affected blood vessels and control their healing. Sometimes it is necessary to perform a nasal packing in the most varied forms (cotton, gauze, sponges or expandable materials) for a period of 24 to 48 hours. When removed, wounds are usually already healing. Patients with blood clotting disorders or chronic use of medicinal products that affect coagulation (aspirin, oral anticoagulants or injectables) should be dosed appropriately or suspended momentarily.

Patients on chemotherapy, with leukemia, or post-radiotherapy frequently suffer from epistaxis and should seek the specialist. Bleeds of greater proportions, longer or with maintenance of bleeding even with tampon, can be treated with surgery for ligature or electro cauterization of these arteries under general anesthesia.

 

 

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