In the medical field, the term epistaxis refers to nosebleeds. An otolaryngologist and cervicofacial surgeon provides insights into managing nosebleeds and when medical intervention is necessary.
Causes of Epistaxis
The causes of nasal bleeding can vary based on the patient’s age:
- Capillary fragility, often called childhood hemorrhagic diathesis, can lead to recurrent nosebleeds in preschool and school-age children. Changes in humidity or exposure to heat may trigger these occurrences.
- In the latter half of life, frequent use of anti-aggregant drugs (e.g., acetylsalicylic derivatives) or anticoagulants can result in profuse bleeding from the nasal passages if the nasal mucosa is compromised or small varicose veins are present.
When to Consult a Doctor
Recurring nosebleeds should always be considered and should prompt a specialist consultation. An examination by an otolaryngologist should include an endoscopic evaluation of the upper air-digestive tract. This examination can help rule out bleeding lesions, often associated with septal varices and occasionally benign or malignant growths.
What to Do in Case of Epistaxis
Several measures can help control bleeding:
- Begin by clearing the nasal passages to expel any clots.
- Pinch the nostrils between the thumb and forefinger to halt blood flow and encourage hemostasis if a varix is present in the anterior part of the nasal cavity (Lucus Valsalvae).
- Maintain a forward-leaning posture to prevent blood from flowing into the lower digestive tract, which can induce nausea and vomiting or alarm the patient if partially digested blood is expelled.
If the bleeding persists or if it is the first episode of a nosebleed, consider contacting an emergency room.
In most cases, epistaxis does not pose an immediate health risk. Although bleeding may appear substantial, it seldom affects hemoglobin levels. Nevertheless, it is crucial to remember that recurring, significant, unilateral bleeding, possibly coupled with nasal obstruction, may be associated with benign or malignant nasal passage growths. Specialist consultation is essential.
Epistaxis: Treatment and Prevention
Do not attempt DIY nasal tamponade using cotton and gauze. If it is deemed necessary, a specialist should perform it. While the swab stops bleeding immediately, it may traumatize and irritate the nasal mucosa. It is common, especially in individuals taking antiplatelet or anticoagulant medication, for bleeding to recur upon swab removal. Atraumatic nasal care is recommended. In cases of septal varices, under proper contact anesthesia, diathermocaustication can be considered.
Preventive measures include caring for the nasal environment. Using creams dedicated to humidifying and lubricating the nasal mucosa is advisable, particularly for patients on antiplatelet or anticoagulant therapy and allergy sufferers during sensitization periods. Hyaluronic acid, known for aiding tissue regeneration and healing, can accelerate mucosal recovery.