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Running head: EPISTAXIS

Epistaxis

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EPISTAXIS 2

Epistaxis

Introduction

Epistasis is a condition that affects many people. It is also referred to as nose bleeding. Nose bleeding is a common occurrence that is usually noticed when blood drains through the nostrils. Statistical evidence shows that the condition affects approximately 5-10%. It is a condition that is surrounded by different mythology but the real cause is medical conditions.

What is Epistaxis ?

Epistaxis is a mainly defined as bleeding of nasal mucosa. It is also the most common emergency in otorhinolaryngology. The prevalence of the condition is estimated to be 5% to 12% in the population (Seccbi et al, 2009). Generally, the condition is associated with different factors like systemic arterial hypertension, trauma or just coagulopathy. Clinically, the condition can be divided into anterior and posterior where major differences between the two are mainly in manifestation and prognosis.



Epistaxis mainly occurs due to injury in the nasal membrane (Mitchel, 1959). In most cases, it will occur when the membranes lining the inner part of the nasal cavity are disturbed or when they are irritated enough in a way to cause abnormal bleeding.

Breakdown in the membrane lining the nose may be caused by different factors including dry air or probing, bumping, picking, or by hard rub into the nose (Seccbi et al, 2009). In addition, blowing the nose hard is also likely to trigger nose bleeding especially in cases


EPISTAXIS 3 where the nasal membrane is already inflamed due to allergic reactions or due to a given infection. Etiology of the condition is mainly divided into local and systemic causes.

Among the local causes include inflammatory-infectious including rhinitis and rhinosinusitis. Another local cause that leads to the condition is traumatic conditions including digital, fractures, nasal surgeries, and others (Seccbi et al, 2009). In addition, anatomic factors like septal deviation and perforation can also lead to the condition. In the recent past, research has also indicated different nasal tumors including nasoangiofibroma, nasal polyposis, inverted papiloma, carcinoma, and others as major causes of Epistaxis. There are different systemic causes that lead to the condition. The most prevalence systemic factor leading to Epistaxis is arterial hypertension. It is associated with blood dyscrasia, drugs like acetylsalicyclic acid, anticoagulants, nonhormonal anti-inflammatory, antibiotics, and others (Seccbi et al, 2009). In diagnosis, it is important to locate the exact site of bleeding and clearly define its etiology in order to indicate the best treatment. However several Epistaxis that is attributed to systemic arterial hypertension and coagulopathy can sometimes require surgical procedure. Proper diagnosis is important to chart the best way to treat the condition.



Anterior and posterior nose bleeding shows different symptoms. Anterior

Epistaxis including bleeding that stops and then starts or a bleeding this is constant out of the front part of the nose. In this case, blood may flow from one or from both nostrils and sometimes it may also flow into the throat (Seccbi et al, 2009). On the other hand, symptoms of posterior nosebleed may include bleeding that starts and stops, frequent and


EPISTAXIS 4 rapid bleeding from the back of the nose, or it may include slow and steady ooze. In some cases, the blood will flow back into the throat. This type of Epistaxis is serious because one may lose blood quickly.

There are different procedures that are used to diagnose anterior and posterior nose bleeding (Seccbi et al, 2009). The rate and site of bleeding can be best diagnosed when one is sitting and leading forward. In addition, the pulse and blood pressure can be used to determine the risk of nose bleeding while a blood sample can check for anemia.

How to treat Epistaxis

The flow of blood from the nostrils will normally stop only when the blood clots.

This means that the best way to deal with Epistaxis is through facilitating blood clotting.

This may be achieved through different ways but the most important is by applying direct pressure on the nostrils (Kucik & Clenney, 2005). This may be accomplished by pinching the soft and fleshy part of the nose. This will help in applying pressure to the Little’s area, famously referred to as Kiesselbach’s area. This area is the major source of nose bleeds and pressure applied direct to this area will promote clotting faster compared to other areas. In carrying out this procedure, pressure should be firm but not hard, and should be applied for a minimum of five and a maximum of 20 minutes. While carrying out the procedure, tilting the head in a forward position is important because it helps to decrease the chances of nausea and possible obstruction of the airways (Butler, 2008).

During nose bleeding, the chances of swallowing blood are quite high and can lead to stomach irritation leading to nausea and vomiting.




EPISTAXIS 5

In addition, applying an ice pack to the forehead has been used as another method of treating Epistaxis (Kucik & Clenney, 2005). This method has gained increased use in the recent past. However, it is not backed by any scientific evidence and has been shown not to have any important effect on stopping blood flow from the mucosa.

Another method involves application of vasoconstrictive agent. A wide range of vasoconstrictive agents have been show to reduce Epistaxis especially in cases of benign nose bleeding (Kucik & Clenney, 2005). For example, drugs like oxymetazoline, phenylephrine, and others are nasal sprays that can be obtained over the counter especially in treating allergic rhinitis.

If the above simple methods fail, it is important to seek the help of an otolargyngologist.

In this case different procedures can be performed including chemical cautery of the bleeding vessel, packing the nose with ribbon gauze, absorbent dressing, and others.



Conclusion

Epistaxis is nose bleeding. The condition affects 5-12% of the population. It is a condition that is cased by different factors including local and systemic factors. Local factors include trauma, foreign bodies, inflammatory reactions, and others. Systemic factors include allergies, infectious infections, hypertensions, drugs, and others. Epistaxis is grouped into anterior and posterior Epistaxis. Anterior Epistaxis occurs at the front part of the nose while posterior Epistaxis takes place at the back of the nose. There are different methods for treating Epistaxis. The basic method involves facilitating blood clotting that can be achieved in different ways. The wide ranges of methods that can be


EPISTAXIS used include pinching the nose, applying ice bags and others. Other methods that can be used include use of vasoconstrictive agent or seeking medical assistances from an otolargyngologist.



Reference

Butler, C. (2008). Nose bleed (Epistaxis). International Boxing Association , June 2008

Kucik, C. & Clenney, T. (2005). Management of Epistaxis. American Family Physician

71(2), 305-311

Mitchel, J. (1959). Nose-bleeding and high blood pressure. Medical Journal January

1959

Seccbi, M., Indolfo, M., Rabesquine, M., & Castro, F. (2009).Epistaxis: prevailing factors and treatment. International Archeology of Otorhinolaryngoly 13(4), 381-

385

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