Epistaxis (Nosebleed)

Recognising Symptoms

While the primary symptom is bleeding from one or both nostrils, accompanying symptoms like prolonged bleeding, frequent recurrence, or bleeding accompanied by headache or fever can signal a more serious condition.

When to Seek Help from an Ear Nose and Throat Specialist

Immediate medical attention is warranted if the bleeding does not stop after 20 minutes of direct pressure, if it’s the result of a head injury, or if it occurs in patients with high blood pressure (hypertension) or a bleeding disorder.

Diagnosis

Management & Treatment

For at-home care, remain calm and adopt the strategies for controlling an active nosebleed, which include sitting upright, leaning forward slightly, and pinching the soft part of the nose. Avoid lying flat or tilting the head back, as this can result in blood running down the throat. If bleeding persists after 20 minutes despite initial measures, seek medical attention.

Our ENT doctor will usually recommend non-invasive medical intervention, such as the prescription of medication (e.g. topical vasoconstrictors), and nasal packing (inserting gauze or sponge-like materials into the nostrils to apply pressure and stop bleeding).

For severe cases, one or more of the following surgical interventions to correct anatomical contributors to epistaxis may be necessary.

Endoscopic Sphenopalatine Artery Ligation: Effective for Controlling Intractable Posterior Epistaxis

Endoscopic sphenopalatine artery ligation involves tying off the artery that supplies blood to the nose’s back area. This surgical treatment effectively stops severe nosebleeds that originate from the back of the nose

Direct Cauterisation: A Surgical Technique for Posterior Epistaxis Management Using Endoscopic Methods

Direct cauterisation refers to using heat or chemicals to seal off bleeding blood vessels. This surgical technique is specifically used through endoscopic methods to treat nosebleeds from the back of the nose

Transnasal Endoscopic Sphenopalatine/Posterior Nasal Artery Ligation: Utilised in Endoscopic Management of Posterior Epistaxis

Transnasal endoscopic sphenopalatine/posterior nasal artery ligation involves tying off or cauterising the blood vessels at the back of the nose using an endoscope. This approach is part of endoscopic management for nosebleeds originating from the back of the nose

Preventive Measures

Preventing nosebleeds involves maintaining nasal moisture through the use of humidifiers and nasal saline sprays, avoiding nasal irritants, and gentle nose blowing. Keeping fingernails short and discouraging nose picking, especially in children, can also reduce the risk.

Conclusion

Epistaxis, while commonly benign, requires proper understanding and management to prevent and address effectively. Recognising when a nosebleed is a sign of something more serious is crucial, as is knowing how to respond when one occurs. By staying informed and prepared, individuals can minimise the impact of epistaxis on their daily lives, ensuring swift and effective resolution when nosebleeds occur.