Epistaxsis or ‘nasal bleeding’ can be dramatic and frightening especially when you see your child suffering from it. Medical experts call this a common ENT complaint or symptom which can be innocuous or might indicate a serious underlying disorder in some cases.
“Nasal bleeding is considered serious if it doesn’t stop by pinching the nose and bending the head forward and breathing through the mouth for more than two minutes. If there is a recurring nasal bleed, an ENT consultant should be consulted for the control and evaluation of the bleed,” says Dr Prashanth Reddy, consultant, ENT Surgeon, BGS Global Hospitals.
The nasal mucosa is rich in blood supply and is supplied by multiple blood vessels. Hence even a minor trauma like nose picking or common cold can cause an episode of nose bleeding. People who have uncontrolled hypertension or bleeding disorders occasionally suffer from a nasal bleed.
However nasal bleeding is also symptomatic of tumor in the nose, experts say.
“Nasal bleeding can occur in any age . And a correct diagnosis can be arrived at after a thorough examination and evaluation. Generally in dry and hot conditions, there is drying of the nasal mucosa which in turn can lead to nasal bleeding in all age groups,” says Dr M Pavankumar, associate professor, MS Ramaiah Medical College.
He said bleeding happens when children pick their nose too often or insert foreign objects into the nasal cavity.It happens in the case of adults due to undiagnosed or uncontrolled hypertension, tumors and trauma.
Experts say that bleeding causes can be divided into local triggers ( trauma, mucosal irritation, septal abnormality, inflammatory diseases, tumors etc), systemic causes (blood dyscrasias, arteriosclerosis, hereditary hemorrhagic telangiectasia), and idiopathic causes. Local trauma is the most common cause, followed by facial trauma, foreign bodies, nasal or sinus infections and prolonged inhalation of dry air.
Direct pressure is usually effective in stopping epistaxis by applying pressure to the front of the nasal cavity.Decongestants such as oxymetazoline or neosynephrine may also be used.
Gently applying Vaseline or other ointments to the front of the nose on a daily basis helps to moisturise the nose and prevent nose bleeds due to dryness.
It is also very important to avoid any trauma to the nose or blowing the nose too aggressively.
Chemical cauterisation with silver nitrate is also used for the control of epistaxis.
Another method of treatment is angiographic embolisation of the internal maxillary artery, (selective blocking of blood vessels by placing tiny particles in the vessel. Once the particles are in place, the blood flow along that vessel is dimished or stopped entirely).
Direct surgical ligation or clipping is an increasing popular alternative to embolisation.
When adequate supportive care is provided and underlying medical problems are controlled, most patients are unlikely to experience any rebleeding. Others may have minor recurrences that resolve spontaneously or with minimal self-treatment. A small percentage of patients may require more aggressive treatments.
STUDIES
According to Dr Pavankumar, in a retrospective cohort study of 2,405 patients with epistaxis (3,666 total episodes), Purkey et al used multivariate analysis to identify a series of risk factors for nosebleeds.
The likelihood of epistaxis was found to increase in patients with allergic rhinitis, chronic sinusitis, hypertension, hematologic malignancy, coagulopathy, or as mentioned, hereditary hemorrhagic telangiectasia.
The investigators also found increased nosebleeds in old age and colder weather.
Hydration plays a key role
Drink at least eight glasses of water daily as winter air and heat can sometimes mess with your nose. Always keep yourself hydrated.
INCIDENCE
Approximately 60 per cent of the population will be affected by epistaxis at some point in their life. About six per cent will require professional medical attention.
PRECAUTIONS
The following information should be imparted to patients
Steam
Hot water steam and deep and gentle breathing can help patients to stop bleeding.
Vinegar-Blue Brine
A patient has to take a cotton ball, dip it in white vinegar and keep it in the nostril. It will seal up the blood vessel wall and stop the flow of the blood.
Zinc
Consumption of zinc rich
foods like whole-wheat bread and brown rice will help. Popcorn based dishes that contain zinc can be consumed as well.
Use an Ice Pack.
Ice is a good solution to stop bleeding as it constricts the blood vessels, and reduces inflammation. Place crushed iced into a plastic zipper-type bag and cover with a towel and place it on bleeding nose.
Vitamin K
Eat vitamin K rich foods
such as dark green leafy vegetables, because vitamin k is essential for clotting blood.
Drink Orange Juice
Vitamin C is necessary to the formation of collagen, which helps create a moist lining in your nose. So drink and eat vitamin C-rich foods to help stave off nose bleeds.
In dry and hot conditions, there is drying of the nasal mucosa which in turn can lead to frequent nasal bleeding.
Dr M Pavankumar