Epistaxis

What is Epistaxis (Nosebleed)?

Epistaxis is usually caused by a burst blood vessel in the nose. This is usually the case in children and in most adults. In many people, the front part of the nasal septum has many prominent blood vessels (telangiectasia) (Figure 1). These are benign and are not tumours or dangerous growths. We do not know why some people have more prominent vessels on the nasal septum but sometimes it can be hereditary (genetic). Often, when the child grows older, the vessels become less prominent and the frequency of nosebleed lessens. There are other local and systemic causes of epistaxis but fortunately these are less common.

The first thing that you should do if you have epistaxis is to pinch the nostrils of your nose together (soft part of your nose), tilt your head forward and breathe through your mouth (Figure 2). Do this in a sitting or standing position. This will help the blood clot in the front part of your nose. You should not tilt your head backwards or lie down as the blood will continue to flow to the back of your nose and down your throat. If you do this, you may end up swallowing the blood and feel nauseas or even vomit the blood out.

To make yourself more comfortable, you can place an icepack on your forehead while you continue to pinch your nose. You can also rinse your mouth off the blood with ice gargle (water or mouthwash through a straw and cup) to remove the blood that has gone down your throat and mouth.

If the bleeding does not stop, you should consult a doctor. Continue pinching your nose till you are seen by the doctor. For heavy bleed (e.g. does not stop after 20 minutes of pinching your nose), it is best to go to the Emergency Department in a hospital.

If you are not actively bleeding from the nose, your doctor will take a clinical history to find out more about the frequency, amount and possible causes of your nose bleed. A thorough ENT examination will be performed, which may include a nasoendoscopy.

The treatment of epistaxis depends on the underlying cause. If the cause of your epistaxis is due to prominent blood vessels in the nose, it is likely that your doctor will apply a stick with some chemical (silver nitrate cautery) in your nose to seal the blood vessels (Figure 3a-c) This is done after spraying a numbing agent (topical anaesthesia) to the front part of the nose. Silver nitrate application is a quick and relatively painless procedure (some patients may feel some mild discomfort or stinging sensation in the nose but most do not complain of pain). Over the next few weeks, there may be mild crust (dried mucous) and mild nosebleed or bloodstain in the mucous as the wound in the nose is healing. Your doctor may give you some medications to hydrate and moisturize your nose during this period.