What is epistaxis?

Epistaxis is the medical word used to describe bleeding from the nose.

Who is likely to suffer from nosebleeds?
Nosebleeds affect both males and females and may affect all age groups, but are common in the elderly and children. More than half of children aged 5 to 15 years may experience nosebleeds on regular intervals. Elderly patients suffering from hypertension are more likely to have nosebleeds.

What are the causes of nosebleeds?
Epistaxis occurs when a fragile blood vessel within the nose is damaged, perhaps after minor injury or infection. Conditions such as high blood pressure and excessive consumption of alcohol may increase the risk of nosebleeds. If repeated nosebleeds do occur, it may be sensible to attend the family doctor’s practice or local clinic for evaluation of the blood pressure.

Patients using medication such as Warfarin or Aspirin, may experience nosebleeds as a side-effect of their medication. These medications are commonly prescribed for patients with heart disease, and work by “thinning” the blood or changing the ability of the blood to clot. If the prescription includes either Warfarin or Aspirin and nosebleeds do occur, do not stop taking the medication unless advised to do so by a doctor.

Young patients may suffer from a condition called haemophilia, a hereditary genetic disorder that impairs the body’s ability to control blood clotting or coagulation, which may result in regular nosebleeds. A patient experiencing prolonged bleeding after minor cuts or tooth extractions, or suffer from frequent skin bruises, should be tested for haemophilia. Diagnosis is confirmed by a blood test.

Nose picking, which is a common habit in children, may easily damage the lining on the frontal part of the nasal septal mucosa, an area where numerous small veins meet, causing recurrent nosebleeds. These children’s noses are prone to the formation of crusts inside the nose, which is usually caused by a minor mucosal staphylococccal bacterial infection. This may give rise to recurrent nosebleeds.

What should you do if you experience a nosebleed?
It is important to remain calm. Leaning slightly forward and pressing for 10 – 15 minutes on the “fleshy” part of the nose can often control small nosebleeds. Pressure to the hard bony upper part of the nose will not help to stop the bleeding. If the bleeding stops after applying pressure to the “fleshy” part of the nose, the patient should be fine. If thick clots may form in the nose, conservative management by mere observation should suffice. The nose should not be blown straight away, as bleeding may start again. Avoid straining at the toilet or doing any strenuous exercise for a day or two after nosebleeds.

If regular and repeated nosebleeds are experienced, your family doctor should be consulted for advice. Incessant bleeding of the nose despite taking measures such as pressing on the nose necessitates consulting a doctor rather urgently.

What advise may be received from the family doctor?
If your family doctor is convinced that the recurrent nosebleeds result from crusting and infection within the nose, he may prescribe an antibiotic and/or antiseptic cream. Repeated treatments with cream for several weeks at a time may effectively cure the nosebleeds, especially in children. When this treatment fails, the family doctor will most likely refer you or your child to an ENT specialist.

What treatment is needed for nosebleeds not responding to localized pressure?
Nosebleeds can be managed by packing the side of the nose where the bleeding vessel is located with a special sponge or other material to stop the bleeding. “Packing” of the nose may be effective, but can be fairly uncomfortable to the patient, and may require admission to hospital for a few days. If the nosebleeds occurred as a side-effect of the use of anti-coagulating medication (Warfarin, aspirin), the dosage of the medication may need adjustment once blood tests measuring the coagulation ability of the blood has been monitored.

An ENT specialist will most likely cauterize (seal off) the bleeding blood vessel inside the nose. An endoscope (a small rigid lens system with an eye piece at the end used to examine hollow spaces) may be used to identify the bleeding vessel, or to rule out rare causes of nose bleeds such as tumours. The bleeding vessel may be cauterized in two ways, either by chemical cautery by applying silver nitrate to the mucosal lining surrounding the bleeding vessel, if the vessel is located to the front of the nose, or by electro-cautery if the bleeding vessel is located in the deeper part of the nose. Electro-cautery of the bleeding point is performed by passing a weak electric current across the blood vessel. This procedure is also referred to as diathermy. Applying a local anaesthetic to the mucosal lining of the nose will prevent the patient from experiencing any pain or discomfort during the diathermy. Electro-cautery may also be applied to bleeding vessels located to the front of the nose. Cautery of bleeding vessels in children’s noses may often be performed under general anaesthesia.

On rare occasion the above-mentioned treatment may not effectively stop the nosebleeds. The specialist may then opt to perform an operation to stop the bleeding. Several types of operations are available to stop nosebleeds. The ENT specialist will explain specific procedures, if indeed an operation is necessary.

Disclaimer
The information contained within this brochure is for informative purposes only and does not necessarily reflect the official position of the South African Society of Otorhinolaryngology, Head and Neck Surgery on this specific subject, as treatment modalities may differ between specialists.