Epistaxis

– Bleeding from the nose.

Causes and Incidence

Epistaxis may be caused by a variety of factors, such as irritation, trauma, underlying coagulation disorders, or localized or systemic infections. At least 10% of the population is thought to have suffered at least one episode of epistaxis. Children and men are more susceptible, and winter is the time of most frequent occurrence.

Disease Process

Bleeding results when damage interferes with the vascular integrity of the superficial vessels in the fragile mucosa of the nasal passages. Most bleeding originates in the anterior portion of the nose from Kiesselbach’s plexus, a highly vascular network in the anterior nasal septum. Posterior bleeding usually originates from the turbinates or lateral nasal wall.

Symptoms

Bleeding from the nostrils.

Potential Complications

Pooled blood may cause sinusitis and otitis media. Large blood loss can cause anemia or interfere with cerebral and cardiopulmonary tissue perfusion. In individuals with an altered mental status, aspiration of blood also is a possible complication.

Diagnostic Tests

Inspection with a nasal speculum to determine the site of bleeding; x-ray films to locate fracture if trauma is the cause.

Treatments

Surgery
Reduction and fixation of nasal fractures; ligation of the internal maxillary artery for uncontrolled posterior bleeding; split-thickness skin grafts to correct chronic bleeding in Rendu-Osler-Weber syndrome.

Drugs
Analgesics for pain; if posterior chamber is packed, antiinfective drugs to prevent sinusitis and otitis media; if a large amount of blood was swallowed, nonabsorbable antibiotics to prevent breakdown of blood and ammonia absorption.

General
Upright position; pinching of the nose with thumb and forefinger for 5-10 minutes (anterior bleeding); cauterization of site if pressure fails; packing of nasal cavity to apply pressure (posterior bleeding); blood replacement if anemia is evident.