NOSE - Epistaxis

What is epistaxis?

Epistaxis is bleeding from the nose most commonly arising from the Little's area of the nose.. It is an old problem dating back to 5th century BC (Hippocrates).

About the Little's area:

The Little's area contains the Kiessel bach's plexus. This plexus is formed by the following blood vessels:

  • Anterior ethmoidal artery
  • Superior labial artery
  • Sphenopalatine artery
  • Greater palatine artery

What are the causes of epistaxis?

Common causes of epistaxis are as follows:

(A) Hereditary:

  • Oslers Disease:
    There is hereditary haemorrahagic telengietasia of the nasal septum, lips, mouth and the gastrointestinal system. There is a lack of contractile elements in the vessel walls which accounts for persistent bleeding.
  • Bleeding disorders:
    These disorders may lead to severe epistaxis and occasionally bleeding from other parts. Some of the diseases are, Christmas disease, haemophilia and leukemia.

(B) Local causes of epistaxis:

  1. Trauma: To the nose, paranasal sinuses or head may result in epistaxis sometimes associated with cerebrospinal fluid rhinorrhea.
  2. Inflammatory: Acute or chronic infections of the nose like.
    • Nasal diphtheria
    • Tuberculosis
    • Sinusits
    • Rhinosporidosis
    • Atrophic Rhinitis
  3. Tumours:
    • Benign: Nasopharyngeal angiofibroma, septal hemangiomas.
    • Malignant: Carcinoma of the maxilla, and ethmoidal sinuses.
  4. Foreign Bodies: Maggots, Rhinolith
  5. Aneurysms: In the extradural portion of internal carotid artery.

(C) Systemic causes:

  • Hypertension: This is one of the most common causes of epistaxis in the elderly. Atherosclerotic changes in the blood vessels increase the bleeding.
  • Cirrhosis of liver
  • Chronic nephritis
  • Pyrexial illness
  • Bleeding disorders

(D) Miscellaneous:

  • Environmental: Turbinate epistaxis is common in places with low humidity.
  • Vicarious menstruation is a rare cause.

What are the clinical features of epistaxis?

Common symptoms of epistaxis are as follows:

  • Bleeding from anterior prat of nose.Posterior bleeding my also present as Oral bleeding
  • Anxiety
  • Shock if severe and uncontrolled bleeding

What investigations are required for the diagnosis of epistaxis?

Following investigations are required for diagnosing the cause of epistaxis:

  • Monitoring of blood pressure
  • Bleeding Profile
  • Haemogram
  • CT Scan or Radiography

What is the treatment for epistaxis?

Management of epistaxis can be classified into general and specific management.

(1) General management of epistaxis:

  • Ice pack over nose and head
  • Head high position
  • Pinching of the nostrils
  • Blood transfusion if so necessary
  • Treatment of the medical cause if any
  • Coagulants like vitamin K, vitamin C if any deficiency

(2) Specific management of epistaxis:

  • Anterior nasal packing with ribbon gauze or nasal tampons
  • Posterior nasal packing: This is usually done under general anaesthesia. A foley's catheter can be used for this purpose
  • Local cautery with 50% trichloroacetic (TCA) required rarely
  • Endoscopy with cauterization of the bleeders.

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