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Nose Bleeds
 
A nosebleed occurs when the membranes lining the inner nose are disturbed or irritated enough to cause abnormal bleeding. The medical term for nosebleed is epistaxis. There are two types of nosebleeds: anterior and posterior. If the bleeding is near the front of the nose, it is an anterior nosebleed. A posterior nosebleed occurs in the back of the nose and is not always characterized by rapid bleeding but may be slow, steady ooze.

Causes                        

  • A breakdown in the membranes lining the nose. This can be triggered by poorly humidified air or probing, bumping, picking, or rubbing your nose.
  • Blowing the nose forcefully can also cause a nosebleed, especially if the nasal lining is already inflamed because of a virus, bacteria, or allergy.
  • Injury to the face or nose.
  • Scars and damage from previous nosebleeds that reopen and bleed.
  • High blood pressure.
  • Medicines that slow the time normally required for the blood to clot.

Symptoms
Symptoms of anterior nosebleed include intermittent or constant bleeding out of the front of the nose. Blood can flow from one or both nostrils and can flow into the throat.
Symptoms of posterior nosebleed include bleeding that stops and starts, rapid bleeding from the back of the nose, or a slow, steady ooze. Sometimes the blood flows back into the throat. Especially with posterior nose bleeding, one can lose blood quickly.

Treatment                    

First Aid for Nosebleeds:
  • Most common nosebleeds will stop after the application of first aid by the patient.
  • When your nose starts bleeding, sit up and lean forward to prevent blood from passing into your throat, which may cause choking.
  • Pinch the nose firmly together between the thumb and index finger, just below the nasal bones, and hold it for 10 minutes.
  • Moisten a cotton ball or pad with a saline nasal spray and press it against the bleeding part of the nose if possible.
  • If a nosebleed does not respond to first aid or lasts for more than 20 minutes, it is necessary to see an ENT specialist.

Cautery:
Cauterization is a procedure used to force the blood to clot (coagulate) at the site of the bleeding. Cautery may be done with silver nitrate or with an electrocautery instrument. Electrocautery is usually reserved for more severe bleeding and posterior nosebleeds, and usually requires the use of local anesthesia.

Nasal Packing           
Nasal packing may be used to treat nosebleeds not responsive to cautery. Packing for anterior nosebleeds (near the front of the nose) is relatively simple. Packing for posterior nosebleeds (in the back of the nose) can be more difficult and uncomfortable. For posterior nosebleeds, rolled gauze or inflatable balloon devices may be used. If a posterior pack is placed, an anterior pack will also be used as well. Patients will receive antibiotics to prevent infection. Patients should never remove their dressing packs as it may lead to severe bleeding and improperly handled packing can be fatal.

Surgical Treatment of Nosebleeds:
While most nosebleeds stop with cautery and/or packing, severe or recurrent bleeding may require surgical treatment. Procedures may include:

  • Endoscopic examination under general anesthesia and Septoplasty (surgical reconstruction of the nasal septum): Packing may fail because of lack of cooperation (especially among children) or from problems such as a deviated septum. An endoscopic exam under general anesthesia may be performed, bleeding sites may be cauterized, deviated septum may be straightened, packing may be replaced, and arterial ligation may be performed during the same procedure, if necessary.
  • Arterial Ligation: Arterial ligation involves constricting specific blood vessels in order to stop bleeding. Procedures may require local or general anesthesia.
  • Embolization for Nosebleeds: Embolization entails the introduction of a substance into a blood vessel in order to close it and prevent bleeding.

Prevention

  • When you have a nasal infection, keep your nose well coated with a petrolatum- based ointment or an antibiotic ointment until your nose heals (usually 3 to 5 days).
  • Avoid injuring the nasal mucosa with nose-picking, rubbing, or forceful blowing.
  • Use a saline nasal spray to keep the nose moist.
  • Keep children's fingernails short to discourage nose picking.
  • Quit smoking. Smoking dries out your nose and also irritates it.
  • Open your mouth when you sneeze.