NOSE – Epistaxis

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What is epistaxis?

Epistaxis is bleeding from the nose most commonly arising from the Little’s area of the nose.. It is an old problem dating back to 5th century BC (Hippocrates).

About the Little’s area:

The Little’s area contains the Kiesel bach’s plexus. This plexus is formed by the following blood vessels:

●  Anterior ethmoidal artery

●   Superior labial artery

●   Sphenopalatine artery

●   Greater palatine artery

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What are the causes of epistaxis?

Common causes of epistaxis are as follows:

(A) Hereditary:

1. Trauma: To the nose, paranasal sinuses or head may result in epistaxis sometimes associated with cerebrospinal fluid rhinorrhea.

2. Inflammatory: Acute or chronic infections of the nose like.

●  Nasal diphtheria

●  Tuberculosis

●  Sinusitis

●  Rhinosporidiosis

●  Atrophic Rhinitis

(B) Local causes of epistaxis:

●  Osler’s Disease:

There is hereditary hemorrhagic telangiectasia of the nasal septum, lips, mouth and the gastrointestinal system. There is a lack of contractile elements in the vessel walls which accounts for persistent bleeding.

●  Bleeding disorders:

These disorders may lead to severe epistaxis and occasionally bleeding from other parts. Some of the diseases are Christmas disease, hemophilia and leukemia.

Tumors:

1.Benign: Nasopharyngeal angiofibroma, septal hemangiomas.

2.Malignant: Carcinoma of the maxilla, and ethmoidal sinuses.

●   Foreign Bodies: Maggots, Rhinolith

●   Aneurysms: In the extradural portion of the internal carotid artery.

(C) Systemic causes:

●   Hypertension: This is one of the most common causes of epistaxis in the elderly. Atherosclerotic changes in the blood vessels increase the bleeding.

●   Cirrhosis of liver

●   Chronic nephritis

●   Pyrexial illness

●   Bleeding disorders

(D) Miscellaneous:

●  Environmental: Turbinate epistaxis is common in places with low humidity.

●   Vicarious menstruation is a rare cause.

What are the clinical features of epistaxis?

Common symptoms of epistaxis are as follows:

●   Bleeding from the anterior part of the nose.Posterior bleeding may also present as Oral bleeding

●   Anxiety

●   Shock if severe and uncontrolled bleeding

What investigations are required for the diagnosis of epistaxis?

Following investigations are required for diagnosing the cause of epistaxis:

●   Monitoring of blood pressure

●   Bleeding Profile

●   Haemogram

●   CT Scan or Radiography