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25 Jul, 2017

Epistaxis is the most common ENT emergency. The most common cause of bleeding from the nose is idiopathic followed by other causes such as neoplasms, trauma, iatrogenic.

The bleeding from the nose can also be broadly classified as anterior nasal bleed and posterior nasal bleed.

Most of the anterior nasal bleeds can be managed on the outpatient basis without requiring admission. The bleeding from the anterior part of the nose is often due to trauma caused by habitual nose picking. This area, commonly traumatized by nose picking is referred to as the little’s area or Kiesselbach’s plexus is a highly vascular area which is being supplied by the anastomosis from the internal and external carotid artery systems.

Nose being highly vascular due to extensive supply from both the external and internal carotid artery system and is thereby vulnerable to bleeding from various sites. Most of the bleeds from the nose can be managed by rigid nasal endoscopy and bipolar cautery. The bleeder can be identified by nasal endoscopy and under local anaesthesia the site can be managed with bipolar cautery.

However, in some cases of post nasal bleed especially where the view of the posterior regions is obscured by deviated septum or sharp nasal spur, the bleeder may not be identified. In such cases there may be a need for nasal packing with posterior and anterior nasal packs. In such situations, the patient needs to be admitted and sometimes after pack removal requires rigid endoscopy under general anaesthesia for identification and management of the posterior bleeders

While dealing, with epistaxis it is important to take into account the overall health of the patient. It is important to elucidate any history of bleeding disorders, similar history in the past, history of nasal surgery, nasal blockage, systemic conditions such as hypertension diabetes mellitus, etc.

History of bleeding in young males, associated with nasal blockage may be due to condition known as Juvenile nasopharyngeal angiofibroma. Systemic condition such as Wegner’s Granulomatosis may also be associated with repeated episodes of epistaxis. Patients who are on anticoagulant medications can also present with severe bleeding. The management of such patients would require transfusion of fresh frozen plasma and platelet units along with reduction of anti-coagulant medication.  Bleeding can also occur following nasal surgeries such as septoplasty, functional endoscopic sinus surgery and skill base procedure. Such episodes can be managed by direct visualization and using Bipolar suction cautery.

Epistaxis in paediatric population is a common cause of concern amongst the parents. The most common cause of bleeding in children being habitual nose picking. Using lubricating nasal ointments and gels can present such episodes. However some severe cases may warrant use of chemical cautery (silver nitrate or phenol) or sometime bipolar cautery.http://www.bestentspecialistindelhi.com/epistaxis- bleeding- from- nose

Epistaxis being a common cause of otolaryngology emergency can be managed effectively without requiring cumbersome nasal packing and hospital admission.

Categories: Nose and Sinus