What are nose bleeds?

The human nose is very vascular due to the rich blood supply it gets. Therefore a bleed from the nose can be very profuse and alarming to the person concerned, and to the family.

What causes a nose bleed?

There are many causes for a bleeding nose. The obvious cause is an injury to the nose, such as a fall or a blow on to the face. But more commonly the nose will bleed due to no apparent reason. This is called spontaneous bleeding or Epistaxis. inaddition to these causes nose bleeds may be the result of other diseases affecting the nose, sinuses or the body as a whole.

Who gets Epistaxis?

Any one can suffer from epistaxis, but there are some distinctive features when it occurs in children as compared to adults.

From which part of the nose do children bleed?

Children usually bleed from the front part of the nasal septum which is the most exposed part of the nasal cavity to the elements. Drying and crusting of this area can lead to bleeding which can happen quite suddenly. This can be facilitated by the presence of infection of the nose, such a s a common cold.

What can be done ?

As a first aid measure pressure can be applied on the bleeding area by gently, but firmly pinching the nose for a few minutes. This should be done after explaining to the child what you are going to do, and getting him to breath through his mouth. A household container can be kept under the nose and mouth to collect any blood dripping down. At the same time, ice or cold water can be applied over the nose. This helps to reduce the bleeding. Almost always the bleeding stops with this method. The main thing is for the adult dealing with the child to be calm.

What to do next?

It is important to get the child seen by the doctor when the first bleed occurs, as it maybe necessary to exclude any other cause for the bleed. In most cases the confirmation of spontaneous epistaxis is the result.

What are these other causes?

In children the presence of a foreign body in the nose is not an unusual cause of epistaxis. Also the possibility of congenital causes, such as telangectasia, and bleeding disorders must be excluded.

What medical treatment is possible?

In the occasional case of bleeding application of an antiseptic/antibiotic cream to the nasal septum is adequate. In the more troublesome case cauterisation of the bleeding point can be done under local or general anaesthesia. Either chemical cautery using strong silver nitrate, or coagulation with the bipolar diathermy is used.

What is different in adults?

The above discussion is also applicable to adults in the same way, but the adult tends to bleed also from the deeper, more inaccessible parts of the nose. The bleeding here can be very profuse, and may also become a potential health hazard unless controlled.

How can a profuse bleed be controlled?

Quite often it becomes necessary fir such a patient to be brought to a hospital. The main method of controlling such a bleed is by packing the nose with lubricated gauze strips to apply pressure on the bleeding point from inside the nose.

What other aspects are important?

Hypertension(elevated blood preasure) is the most commonly found association with severe epistaxis. This must be controlled. If there has been a major blood loss it should be replaced with appropriate fluids. The blood clotting studies are done to detect any abnormalities, and corrected. The possibility of infection in the nose and sinuses, and also neoplasms of benign or malignant nature must be considered.

If packing the nose is not successful what else can be done?

More effective packing can be done under general anaesthesia using a posterior nasal pack if necessary. In addition if the bleeding point can be seen it may be cautarized. Nowadays endoscopes can be used for a more effective examination of the nasal cavity, and thus more effective cautarization. In very refractory cases some feeding blood vessles to the nose can be tied off. These steps are not necessary in the good majority of cases.