Epistaxis overview

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Editor in Chief: Liudvikas Jagminas, M.D., FACEP [1] Phone: 401-729-2419

Overview

An epistaxis is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting. It only accounts for .001% of all deaths in the U.S.

Pathophysiology

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair.

Risk Factors

Occasionally, nosebleeds may indicate other disorders such as bleeding disorders or high blood pressure. Frequent nosebleeds may also be a sign of hereditary hemorrhagic telangiectasia (also called HHT or Osler-Weber-Rendu syndrome). Blood thinners such as Coumadin, Plavix, or aspirin may cause or worsen nosebleeds.

Diagnosis

CT

A CT scan of the nasal area and sinuses may be indicated.

Treatment

Surgery

A nasal balloon or Foley catheter for posterior bleeds can be indicated.

Primary Prevention

A cooler house and a vaporizer, to return humidity to the air, help many people with frequent nosebleeds. Nasal saline spray and water soluble jelly (such as Ayr gel) can help prevent nosebleeds, especially during the winter months.

References


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