Medicosnext
Dr. Anand Ghimire
He is an ENT specialist with extensive expertise in Rhinology and Endoscopic Sinus Surgery. He holds an MS in ENT and Head & Neck Surgery from B.P. Koirala Institute of Health Sciences (BPKIHS), Dharan, and has completed a prestigious fellowship in Rhinology and Endoscopic Sinus Surgery from AIIMS, New Delhi. With a rich academic and clinical background, Dr. Ghimire has previously served as an Associate Professor at BPKIHS, Dharan, and Chitwan Medical College (CMC), Bharatpur. He is particularly focused on advancing techniques in endoscopic nose and ear surgery, contributing significantly to this specialized field. As the Head of the ENT and Head & Neck Surgery Department at Grande International Hospital, Dr. Ghimire continues to provide exceptional care to his patients while actively contributing to the growth of otolaryngology in Nepal.
Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of the general population. It can occur at any age but is twice as common in children due to their habit of nose-picking. It is more prevalent during the dry and cold season. In winter, indoor heating systems also cause the air to become dry, dehydrating the nasal membranes. This dryness may lead to crusting, cracking, and bleeding.
Why Does the Nose Bleed So Frequently?
The nasal cavity has a rich and highly varied blood supply arising from the major blood vessels (internal and external carotid arteries) with multiple anastomoses (cross-connections between various blood vessels). Little’s area, also known as Kiesselbach’s plexus, is a highly vascularized region of the nasal septum. The nasal septum is the membrane-covered bone dividing the nasal cavity into two vertical parts. Little’s area is situated in the anterior part of the nose, and 90% of nasal bleed occur in this area.
What Causes a Nosebleed?
Most nosebleeds start from the anterior part of the nasal septum, where the blood vessels are fragile and can rupture easily with minimal trauma. Sometimes, nosebleeds are associated with general medical conditions or medications that either increase blood pressure or impair the blood clotting mechanism.
Causes of Nosebleeds
– Injuries to the Nose:
Fingernail trauma (nose-picking habits)
External injury to the nose (physical assault, accidents, foreign bodies, especially in children, blowing the nose too hard, and violent sneezing)
– Infections: Viral, bacterial, or other infections can increase blood flow and cause fragile blood vessels in the nasal mucosa, leading to nosebleeds.
– Tumors: Various tumors and nasal cancers can cause nasal bleeding.
– Environmental Factors: Extreme cold or hot weather, dry air, high altitudes.
– Medications:
– Acting locally (e.g., nasal sprays, cocaine).
– Acting systemically (e.g., aspirin, NSAIDs like ibuprofen and diclofenac, and anticoagulants like heparin).
– Other Diseases: Liver disease, kidney disease, blood disorders like leukemia, and infections such as dengue.
Types of Nosebleeds
There are two types of nosebleeds:
– Anterior Nosebleeds: The most common type. They start in the front of the nose, with blood usually dripping out of the nostrils. Most can be managed by simply pinching the nose.
– Posterior Nosebleeds: Less common but more severe. They start in the back of the nose, with blood often running down the throat. Posterior nosebleeds are harder to stop and generally require expert intervention.
Primary Management of Nosebleeds
Nosebleeds often occur at home or the workplace, and while they can be stressful, remaining calm and following simple measures is usually sufficient to manage them.
Steps to Manage a Nosebleed:
1. Stay calm, as agitation can worsen the situation.
2. Sit upright and bend slightly forward. Avoid lying down or tilting the head backward, as this can cause blood to flow into the throat, worsening the situation.
3. Use your thumb and forefinger to pinch all the soft parts of the nose firmly. (Applying pressure to the hard, bony part of the nose will not stop the bleeding.)
4. Breathe through your mouth and avoid swallowing blood. Spit it out gently into a tissue or bowl.
5. Hold the pressure for at least 10 minutes without checking if the bleeding has stopped. This gives the blood time to clot.
6. Apply a cold compress, such as ice cubes wrapped in cloth, to the nose and forehead.
7. After 10 minutes, release the grip slowly.
If the bleeding stops, follow preventive measures. If it persists, repeat the steps up to 3–4 times. If bleeding still does not stop, visit the nearest hospital emergency department.
