Epistaxis

Epistaxis is the medical term for nosebleeds. Epistaxis usually refers to major nosebleeds that are difficult to stop or recurrent nosebleeds. Rare, easy to stop nosebleeds or simple blood tinged nasal secretions rarely come to the attention of the doctor. Most of these are caused by nasal dryness or minor trauma to the nose, such as frequent picking. Major or recurrent epistaxis may suggest a more serious cause or one that requires the intervention of a physician.

Epistaxis can be classified as anterior, when it arises in the front of the nasal cavity, or posterior, when it arises in the back of the nasal cavity. Fortunately, anterior epistaxis is more common. It is usually much easier to treat. The most common cause of anterior epistaxis is nasal dryness. Nosebleeds are most common in the winter months when the humidity is low and certain types of heating may further dry the air indoors. The second most common cause of anterior epistaxis and the most common cause of posterior epistaxis is vascular disease with or without high blood pressure. As blood vessels become damaged due to high blood pressure, high cholesterol or aging, they become brittle and break more frequently. If the blood pressure is high, the epistaxis will be more difficult to stop. Other causes of epistaxis are nasal trauma, nasal tumors, or abnormal blood clotting due to medicines, such as aspirin or Coumadin, or due to diseases, such as leukemia or liver failure.

The first step in treating epistaxis is to stop the bleeding. This is usually done in a stepwise fashion that may include the following: chemical cautery with silver nitrate, electrocautery, anterior nasal packing, posterior nasal packing, and surgery, such as septoplasty, further cautery and packing, or major vessel ligation. Once the bleeding is stopped, the goal is to determine the cause of the epistaxis and to attempt to prevent it from recurring. This may involve nasal endoscopy, lab work to check hematocrit, platelet count and function, clotting studies and liver functions, and possibly radiologic studies, such as CT scans or angiograms.

Nasal saline spray and a humidifier will help to keep the nasal mucosa moist and diminish the risk of nosebleeds. Nasal decongestant sprays, such as Neo-synephrine or Afrin, are often recommended for three to five days after epistaxis, to keep the blood vessels constricted until they can clot and heal. These sprays should not be used after five days because of the significant rebound congestion that will occur. Certain precautions such as refraining from nose blowing and strenuous activity are important to keep the blood pressure down. Of course, controlling the blood pressure is paramount, and any prescribed medication should be taken as directed. Direct pressure to the nostrils and nasal tip will stop most minor epistaxis. If it persists, then medical attention should be sought immediately.