Epistaxis


Bleeding from the nose is a frequently occurring disease. Nasal mucosa is richly vascularized, which allows to the nose and paranasal sinuses perform their basic functions: cleansing, warming, humidifying the breathed air.

 

The most common cause of bleeding from the nose (70-75%) are systemic diseases such as:

 

  • vascular disease (hypertension, atherosclerosis, Rendu–Osler–Weber disease)
  • congenital and acquired bleeding disorders
  • problems with blood clotting
  • liver or kidney failure
  • hematological diseases

 

The other causes of bleeding (25-30%) are the local conditions such as:

 

  • acute infections of the upper respiratory tract with rhinitis
  • nose and facial injuries
  • operations of the nose and paranasal sinuses
  • foreign body
  • chronic atrophic rhinitis of nasal cavity
  • tumors of the nasal cavity, paranasal sinuses and nasopharynx
  • diseases with production of granulation tissue (pregnancy granuloma, tuberculosis, Wegener's disease)
  • perforation of nasal septum

 

The diagnostics of epistaxis should contain:

 

  • physical examination (a history of bleeding from the nose and general comorbidity)
  • ENT examination (Endoscopic assessment of the nasal cavity and paranasal sinuses)
  • examination of the patient (blood pressure, heart rate)

 

In certain situations, it may be advisable to perform additional tests:

 

  • laboratory tests (hematology, clinical chemistry, coagulogram)
  • radiology (X-ray of nose and facial bones, paranasal sinus computed tomography, magnetic resonance, angiography)
  • pathological examination

 

Treatment depends on the amount of blood lost, and diagnosed the cause of bleeding.

 

In general treatment of the following applies:

 

  • causal behavior (reduction of blood pressure, vitamin K, deficiency supplement of plasma clotting factors and platelets)
  • calcium and vitamin C
  • cyclonamine
  • ε – aminocaproic acid (Exacyl)
  • transfusion of red blood cells

 

In the topical treatment of the following applies:

 

  • electrocoagulation
  • cryotherapy
  • laser photocoagulation
  • tamponade anterior and/or posterior
  • maxillary artery ligation and / or external carotid artery
  • ligation of ethmoidal artery anterior and/or posterior
  • embolization of branches of the maxillary artery
  • surgical removal of tumors of the nasal cavity and / or paranasal sinuses

 

After leaving the hospital, there is a possibility of recurrent of a bleeding from the nose. Then it is necessary to go to the otolaryngological ER. Follow up is carried out in outpatient clinics. In identified general causes of bleeding it is recommended, general follow up and treatment with an appropriate specialist.

 

Anna Rzepakowska MD