Epistaxis: Causes & Treatment

Remember the run up to the annual school day when one of your classmates collapses in the field and you discover he/she has nose-bleeding? At least once in our lifetime, we would have bled from the nose. Bleeding from the nose due to a bursting of a blood vessel – the nostril, nasal cavity or nasopharynx – is called epistaxis.

There are 2 kinds of nose-bleeding – anterior (in the front of the nose) and posterior (in the back of the nose). Most nose-bleeding cases are harmless and stop on their own and they can happen on their own or because of a trauma, medication, tumors or nasal/sinus surgery.

About 90 percent and more cases of nose-bleeding happen in the anteroinferior (front bottom) nasal septum (the wall that divides the nose between left and right sides) in a portion called Kiesselbach’s plexus which is situated over the anterior nasal septum and formed by anastomoses which is the coming together of 5 arteries. About 5-10 percent of nose-bleeding happens at the posterior nasal cavity called Woodruff’s plexus which is situated over the posterior middle turbinate and formed by connections of internal maxillary artery like the posterior nasal, sphenopalatine and acending pharyngeal arteries. Posterior bleeding usually starts from the lateral wall and less from the nasal septum.

Most epistaxis cases happen due to the following-

• Local factors – Local trauma and injury due to medical treatment, or to the turbinate mucosa and septum, mucosal inflammation and upper respiratory tract infections, sinusitis and allergies, septal abnormality like deviations, nasal fractures and perforations, tumors of the nasal cavity, sinuses and nasopharynx, nose picking, facial trauma, foreign bodies, etc.
• Systematic factors – Hypertension, blood disorders, arteriosclerosis, hereditary hemorrhagic telangiectasia, use of anticoagulants like aspirin, clopidogrel, warfarin, immunodeficiency and liver failure, low platelet levels. Clotting abnormalities can bring about recurrent nosebleeding. Consumption of alternative medicines also increases risk of bleeding.
• Idiopathic factors – Unknown causes.

There is no single definitive treatment for the management of epistaxis, a lot of factors decide the kind of treatment. In any case of nose-bleeding, the first line of treatment is applying local pressure as first aid which is pinching the fleshy portion of the nose, a little before the bony portion. Application of Vaseline Petroleum Jelly to the front of the nose regularly can help moisturise and prevent nose-bleeding due to dryness. There are decongestant nasal sprays to cure it besides chemical or electric cautery which is burning the vessel shut, topical therapies to stop bleeding, nasal packing in case topical methods fail, embolization which is a procedure to block off the bleeding by placing a material inside the vessel or surgical arterial ligation which is tying off the vessel. The next level is to go for an endoscopy to check for tumors.

Avoiding nasal trauma is very important after a case of epistaxis – in the form of picking healing scabs or blowing nose/sneezing violently.