Introduction

Epistaxis, or bleeding from the nose, is common in its frequency and varies in its manifestation. The true prevalence of epistaxis is not known because most episodes are self-limited and thus are not reported.

The cause of Nasal bleeding

1. local causes (e.g., trauma, mucosal irritation, septal abnormality, inflammatory diseases, And tumors)
2. systemic causes (e.g., blood dyscrasias, arteriosclerosis, and hereditary hemorrhagic telangiectasia)
3. idiopathic causes: Approximately 10% of patients with epistaxis have no identifiable causes even after a thorough evaluation.

Symptoms

Bleeds from the nose. A nosebleed is loss of blood from the tissue lining the nose. Bleeding most commonly occurs in one nostril only. The Kiesselbach plexus, or Little’s area, is located on the anterior cartilaginous septum and is the location of most anterior epistaxis. Many of the arteries supplying the septum have anastomotic connections at this site.

Diagnosis

1. Complete blood count
2. Nasal endoscopy (examination of the nose using a endoscope)
3. Partial thromboplastin time measurements
4. Prothrombin (PT)
5. X-rays of the skull

Treatment

1. Medical Care

Be sure to have sufficient illumination and adequate suction before evaluating a patient with epistaxis. All the necessary topical medications, cauterization and packing materials should be prepared ready. Remove all the nasal packing’s when the nasal bleeding is not active.

2. Surgical Care

In most patients with epistaxis, the bleeding responds to cautery and/or packing. For those who have recurrent or severe bleeding for which medical therapy has failed, various surgical options are available. (septomeatoplasty, SMT-t (submucosa turbinoplasty with CO2 laser cauterization), CO2 laser cauterization over nasal septum).

Prevention

1. Patients should avoid hot and spicy foods and drink plenty of fluids.
2. Patients should avoid strenuous activities, hot showers, and digital trauma.
3. Patients should use nasal saline spray liberally.
4. Digital pressure and ice packs are to be used as needed for minor recurrences.