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Nose Bleeds

Nose bleeds (nosebleeds), known as epistaxis, are typically caused by irritation or damage to the septum. More often than not, they are simply an annoyance and require no medical treatment. However, they can occasionally be very dangerous, even life threatening. Serious nose bleeds must be attended to by a physician immediately. There are two types of epistaxis, anterior and posterior.

Anterior nose bleeds are most frequently experienced and occur most commonly when the septum, the dividing section of the nose separating each nostril, is damaged either by a scratch from a sharp fingernail or by a blow. The septum carries blood vessels which can easily be ruptured. Blood then flows from the septum, out of the patient’s nose when he or she is in an upright position.

Posterior nose bleeds are a much rarer form of epistaxis and are caused by a bleed that begins deep within the nose, high up in the nasal cavity. Blood flows down the back of the mouth and throat no matter how the patient angles himself or herself. These are much more dangerous and require medical attention.

Determining which type of nose bleed the patient has is critical. Posterior epistaxis occurs most frequently in those with high blood pressure, facial injury or in the elderly.

Anterior epistaxis can be brought on by a multitude of causes. Most often, it is the result of very hot, or cold and dry climates, such as those found in New York or New Jersey during the winter. Under these conditions, the membrane of the nose becomes dry and may crack and bleed. This is easily prevented by taking a small dab of lubricating ointments or creams and applying it to the inside of the nose, particularly the septum.

Re-bleeding is what occurs when a nose bleed begins to bleed after the initial flow has been stopped. To prevent re-bleeding, the nose must not be picked or blown. Increasing the humidity of the air also helps to mitigate drying of the nose. The patient should also avoid strenuously lifting objects and attempt to keep his or her head higher than the heart.

Many physicians suggest any of the following lubricating creams or ointments. A saline nasal spray will also moisten dry nasal membranes. These can all be purchased without a prescription: Vaseline, Bacitracin, A and D Ointment, Eucerin, and Polysporin. It may be necessary to administer as many as three applications a day, but typically every night at bedtime is enough.

Beyond dryness and weather, allergies and infections may also cause nose bleeds as they irritate the nose and lead to picking or nose blowing. Vary rarely, dangerous conditions such as a tumor may also cause nose bleeds, in which case immediate medical attention is required.

Nose Bleeds (#2)

Nose bleeds, or epistaxis, are a common disorder resulting in a rupture in the lining of the nose wherein blood runs either out of the nose or back into the throat. In the case of frontal nose bleeds, it is called anterior epistaxis. When the blood runs down the back of the throat and the bleeding occurs further back in the nasal cavity, it is posterior epistaxis. Posterior epistaxis is much more dangerous and requires medical attention as it can be fatal. Although of the 2.4 million deaths reported in the United States in 1999, only four came as a result of posterior epistaxis. The most famous case of death by nosebleed was that of Attila the Hun, who after consuming a large amount of alcohol on his wedding night, suffered a posterior nosebleed and was suffocated by the blood in his sleep.

The most common causes of epistaxis are inflammatory reactions, foreign bodies, and blunt trauma.

Inflammatory reactions result when the nasal pathways are irritated as a result of disease such as chronic sinusitis, allergic rhinitis, a respiratory tract infection or when an irritant enters the nasal pathway. The nose bleed in these cases typically occurs due to violent nose blowing or rupturing of nasal blood vessels due to increased pressure and swelling.

Foreign bodies cause epistaxis frequently as a result of cutting or rupturing blood vessels in the septum, the tissue that separates the two nostrils. This most commonly occurs when a finger nail cuts the septum during nose picking. In cold or dry conditions the problem is exacerbated as the septum is dry and prone to cracking. However, any foreign body can cause epistaxis if it enters the nasal pathway and damages the septum

Blunt trauma causes nose bleeds when the nose is struck, and the blood vessels in the nose rupture.

Less common causes of epistaxis such as anatomical deformities, the use of insufflated drugs (most commonly cocaine), nasal sprays, intranasal tumors, dry ambient environment, or otic barotraumas (such as when ascending or descending scuba diving or in an aircraft) will also result in either anterior or posterior nose bleeds.

The most common treatments for epistaxis are simple pressure on the nose to allow the point of trauma to clot with blood and cease blood flow. It is important that the victim keeps his or her nose tilted down to avoid swallowing too much blood as this can cause nausea and vomiting. In extreme cases, the care of a specialist, or an otolaryngologist, may be needed. If this is required, the physician may utilize chemical cauterization to stop bleeding or may back the nose with ribbon gauze or other absorbent dressing. There are many highly qualified otolaryngologists available in the New York and New Jersey areas.

Copyright ENT and Allergy Associates, LLP


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