otorhinolaryngology - Understanding the Cause, Signs, Diagnosis and Treatment of Epistaxis
Hello, I am glad to have you around again, and in this stem post, I will be talking about a topic that falls under otorhinolaryngology. First, for a quick explanation, Otorhinolaryngology is a medical area or specialty that deals with the diagnosis and treatment of conditions that relate to the ear, nose, and throat, as well as structures of the head and neck. If you are in the hospital, you might be hearing ENT, otorhinolaryngology is commonly referred to as ENT, and Practitioners in the field are referred to as otorhinolaryngologists or ENT specialists. That said, I will be creating a post on Epistaxis. In simple words, Epistaxis is nosebleeds. So I will be discussing the causes and management of Epistaxis.
As I said, Epistaxis is referred to as a nosebleed, and it can happen as a result of so many things, including deadly diseases like Ebola. Yes, I remember when Ebola was an epidemic in West Africa, Any form of bleeding from a friend even when it is as a result of a minor accident was treated with caution. Anyways, I am not saying all nosebleeds are Ebola-related, I am only saying that nosebleeds should not be taken with levity because while they might be very common, they can also be a result of underlying medical conditions. This said, there are two types of Epistaxis. These are the Anterior Epistaxis and the Posterior Epistaxis.
**Anterior Epistaxis is a more common type of nosebleed that usually occur in younger children, as a result of mucosa dryness, inserting foreign bodies into the nose and mouth or hand picking of the nose, and this type of Epistaxis is less significant. On the other hand, Posterior Epistaxis is a less common type of epistaxis, which occurs in older patients, especially in hypertensive patients.
Patients that suffer from Epistaxis can have blood coming out of their nostrils, blood can also come out of the lacrimal ducts some of like shedding bloody tears (the Nasclacrimal duct drains into the inferior meatus of the nose), blood can also come out of the mouth, the anus (dark blood in stool) but it is in extremely rare cases. In these cases, the blood comes from the nasal cavity, since they have a connection to the nose, and cases where the blood goes down the throat or to other region around the woodruff'd plexus usually occur in posterior epistaxis.
Epidemiology, if it is common in children, then you should already know that it will be found in children of age less than 10 years. It can also be found in adults who are above 50 years old. 90% of anterior nosebleeds source is within Kiesselbach's plexus on the anterior nasal septum with most of the causes being nose picking, foreign object, allergies, upper respiratory tract infections, cold and dry environment, frequent and forceful blowing of the nose. in severe cases like Blunt trauma, and RTIs (Chronic sinusitis, and rhinitis). It can be a result of Thrombocytopenia, von Willebrand's disease, hemophilia, leukemia, granulomatosis with polyangiitis, Systemic lupus erythematosus (SLE), use of anticoagulants such as warfarin and heparin, taking insufflated drugs like cocaine, prolonged use of nasal sprays (nasal steroid), neoplastics such as melanoma, squamous cell, adenoids cystic carcinoma, nasopharyngeal carcinoma, in cases of truama like blunt trauma, anatomical deformities (like septal spurs), nasal bone fracture, other vascular issues like angioma, carotid artery aneurysm and angiofibroma.
Diagnosing Epistaxis can be done vis visualization with anterior bleeding with the use of a light source and nasal speculum, while diagnosisng epistaxis, the oral cavity shoulr be checked as well for signs of a posterior epistaxis. When measures to control anterior bleeding have failed, the clinician can start to perform diagnosis for posterior epistaxis, and this can be confirmed when the bleeding is going into the posterior pharynx eith no possible source identifier. Using an endoscope can help to find the source of bleed in the case of a posterior epistaxis. Labs sucb as Complete Blood Cell Count (CBC) may also be done if necessary, imagings such as X-rays, may not be readily helpful in rgant cases but can be useful to find the underlying cause in the long run. Coagulaopathy can also be considered in cases where the bleeding isn't stoping quickly. Differential diagnosis such as diagnosis for Nasal tumor, Hemophilia, DIC, Rhinitis, Foreign body in the nose, Drug toxicity, and Von Willebrand disease an be done to indentify causes of bleeding.
Management of Epistaxis can be done by managing and ensuring that the airway is patent and stable. Help patients sit upright in 90 degree and tilt head forwards, preventing bleeding backwards into the pharynx. Applying pressures to the soft area of the nasal bones with the tumb and fingers, and person who is bleeding should be breating with the mouth and not the nose. while pressureis being held in the nose. Ice packs can also be applied to cheeks, nasal bridges and back of the neck. Patients can be administered nasal decongestants like oxymetazoline, anesthetics like lidocaine, and vasoconstrictor like phenylephrine.
In posterior Epistaxis, deep packing with absorbent material is needed. Looking for signs of aspiration or obstructionsof the airway is also great. Finding the underlying cause of the bleeding is very important. In caseswere surgery is needed, surgeries such as arterial ligation can be done.
Reference
https://www.uptodate.com/contents/approach-to-the-adult-with-epistaxis
https://www.ncbi.nlm.nih.gov/books/NBK435997/
https://www.osmosis.org/answers/epistaxis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096213/
You know, there is a boy in my street who always comes bleeding in his nose. I have always helped with first-aids whenever I am around but I have told his mum to take him to the hospital. He always has this bleeding after engaging in sporty activities like running, or football. He also usually has this bleeding if he places his head downwards for a very long time. I guess it is more than an anterior Epistaxis.
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