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Q?: "... What would cause my 10 year old son to have frequent nose bleeds? It doesn't matter what time of the year it is, so I don't think its allergies, and they don't happen daily, but it still concerns me when they last 5-8 min. Any suggestions? ..."

Dr. Keti:
2 November, 2002

Nosebleed or Epistaxis is defined as acute bleeding (hemorrhage) from the nostril, nasal cavity, or nasopharynx (3)
According to Robert A. Weatherly, MD, in the article on EPISTAXIS , "Approximately 5-10% of the population experiences an episode of active nasal bleeding each year."


Causes:
The most common cause is local trauma, ie nose picking, followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air.
If the normal nasal airflow is discontinued or disturbed in any case, as in deviated nasal septum, that may also cause epistaxis.
A common source of so called anterior epistaxis is Kiesselbach's area, a network of vessels on the anterior portion of the septum. Posterior bleeding, originates in the posterior nasal cavity or nasopharynx. Epistaxis typically originates from the nasal septum when the nasal lining, or nasal mucosa, overlying a dilated blood vessel is injured. Most nosebleeds stop spontaneously within 5 minutes with or without pressure to the forehead, nose, or upper lip.

Epistaxis may, however, signal an underlying condition such as a coagulation disorder.

Incidence of epistaxis reaches peaks in those aged 2-10 years and 50-80 years. Children usually present with epistaxis due to local irritation or recent upper respiratory infection (URI). Nasal bleeding occurs most commonly during colder months and in dry colder climates. In addition around 90% of all nosebleeds can be visualized in the anterior portion of nasopharynx.


Most cases of epistaxis do not have an easily identifiable cause. Epistaxis may be a symptom of the following conditions:

  • Patients with AIDS may have splenomegaly, thrombocytopenia, or platelet disorders.
  • Hypertension - Despite a strong association with nasal hemorrhage, elevated blood pressure is rarely a direct cause of epistaxis. Vascular fragility secondary to chronic hypertension probably increases occurrence of epistaxis in these patients.
  • Septal malformations such as septal perforation, deviation.
  • Chemical irritants.
  • Vascular abnormalities, sclerotic vessels, hereditary hemorrhagic telangiectasia, arteriovenous malformation. Go to my answer: blood in urine ...
  • Malignancies or Neoplasms; Go to my answer: Low White Blood Count...
  • Coagulopathy; Go to my answer: What can cause spontaneous bruising?
  • Liver disorders; Endometriosis etc

Other causes include nasogastric and nasotracheal intubation, referred as iatrogenic causes, as they are caused by treatment procedures.(1)

Treatment

The proper treatment for epistaxis is dependent upon the cause.
In active and healthy looking people, sport related trauma and various other causes make epistaxis a common condition, therefore physicians must be alert to potentially serious causes of the same.
In most cases a bleeding nose is merely a nuisance.

Most nosebleeds are controlled with direct pressure applied by pinching the nose for about 10 minutes, while continue breathing through the mouth.
Some doctors ask a patient to forcefully blow the clots out of the nostrils; for example, they give patients long rolls of 'Kleenex' tissue, and they'll make sure to stand away from the patient to avoid the blood shower on their clothes and surroundings. Although the whole scene may look quite dramatic to the patient and the inexperienced ones, this simple step itself, seems to stop the trickle of bleeding. Although there is no satisfactory explanation as to why clot removal in some cases, like here is therapeutic, it's still worth trying it.

Other doctors believe in prescribing an antibiotic ointment to stop bleeding. In their view the infection is the cause of nose bleeding, therefore the applied antibiotic allows to control the bleeding. Sometimes, doctors would place gelatin sponge in the area of bleeding to stope nosebleeds. (4)

If this fails, the Emergency department must be attended where other different methods to stop bleeding will be applied.
These methods vary and may include:
 · Inserting pledgets soaked with an anesthetic-vasoconstrictor solution into nasal cavity;
 · Gentle chemical cautery performed after adequate topical anesthesia or if that fails;
 · Nose packing, including traditional nasal packing, an epistaxis balloon, or a prefabricated nasal sponge.Ref(3)


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