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. Diagnosis:
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 the drying 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 the nose. It can present in any age
group. It is a sign not a disease and an attempt has to be made to find
out the cause behind it. Epistaxis is often a frightening sight to the
patient and the attendants, especially if the patient is a child.
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 rhino-sporodiasis, 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.Cardiovascular
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:
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
Many
times, 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
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.
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.
Please E-mail dr_ramanand@rediffmail.com for any questions/treatment