A nosebleed, also known as epistaxis, is an instance of bleeding from the nose.[ Blood may also be forced to flow up and through the nasolacrimal duct and out of the eye, producing haemolacria.]
Risk factors include trauma, including putting the finger in the nose, anticoagulants, high blood pressure, alcoholism, seasonal allergies, dry weather, and inhaled corticosteroids.[ There are two types: anterior, which is more common; and posterior, which is less common but more serious.][ The diagnosis is by direct observation.][
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Prevention may include the use of petroleum jelly in the nose.[ Tranexamic acid may also be helpful.][
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About 60% of people have a nosebleed at some point in their life.[ Nosebleeds are rarely fatal, accounting for only 4 of the 2.4 million deaths in the U.S. in 1999.]
Cause
Nosebleeds can occur due to a variety of reasons. Some of the most common causes include trauma from nose picking, blunt trauma (such as a motor vehicle accident), or insertion of a foreign object (more likely in children).[
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Most causes of nose bleeding are self-limiting and do not require medical attention. However, if nosebleeds are recurrent or do not respond to home therapies, an underlying cause may need to be investigated. Some rarer causes are listed below:
Coagulopathy
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Thrombocytopenia (thrombotic thrombocytopenic purpura, idiopathic thrombocytopenic purpura)
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Von Willebrand's disease
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Hemophilia
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Leukemia
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HIV
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Chronic liver disease—cirrhosis causes deficiency of factor II, VII, IX,& X
Dietary
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Sulfur dioxide (sulphur dioxide) E220 (as a food preservative used particularly in wines and dried fruits)
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Sulphites as food preservatives
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Salicylates naturally occurring in some fruits and vegetables
Inflammatory
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Granulomatosis with polyangiitis
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Systemic lupus erythematosus
Medications/Drugs
Neoplastic
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Squamous cell carcinoma
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Adenoid cystic carcinoma
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Melanoma
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Nasopharyngeal carcinoma
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Nasopharyngeal angiofibroma
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Nosebleeds can be a sign of cancer in the sinus area, which is rare, or tumors starting at the base of the brain, such as meningioma. Due to the sensitive location, nosebleeds caused by tumors are typically associated with other symptoms, such as hearing or vision problems.
Traumatic
Vascular
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Hereditary hemorrhagic telangiectasia (Osler–Weber–Rendu disease)
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Angioma
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Aneurysm of the carotid artery
Pathophysiology
The nasal Mucous membrane contains a rich blood supply that can be easily ruptured and cause bleeding. Rupture may be spontaneous or initiated by trauma. Nosebleeds are reported in up to 60% of the population with peak incidences in those under the age of ten and over the age of 50 and appear to occur in males more than females.
The vast majority of nosebleeds occur in the front anterior (front) part of the nose from the nasal septum. This area is richly endowed with blood vessels (Kiesselbach's plexus). This region is also known as Little's area. Bleeding farther back in the nose is known as a posterior bleed and is usually due to bleeding from Woodruff's plexus, a venous plexus situated in the posterior part of inferior meatus.[
The Journal of Laryngology & Otology (2008), 122: 1074–1077] Posterior bleeds are often prolonged and difficult to control. They can be associated with bleeding from both nostrils and with a greater flow of blood into the mouth.
Sometimes blood flowing from other sources of bleeding passes through the nasal cavity and exits the nostrils. It is thus blood coming from the nose but is not a true nosebleed, that is, not truly originating from the nasal cavity. Such bleeding is called "pseudoepistaxis" (''[[wikt:pseudo-#Prefix|pseudo]]'' + ''epistaxis''). Examples include [[blood coughed up|hemoptysis]] through the [[airway]] and ending up in the nasal cavity, then dripping out.
Prevention
People with uncomplicated nosebleeds can use conservative methods to prevent future nosebleeds such as sleeping in a humidified environment or applying petroleum jelly to the nasal Nostril.
Individuals who suffer from nosebleeds regularly, especially children, are encouraged to use over-the-counter nasal saline sprays and avoid vigorous nose-blowing as preventative measures.
Treatment
Most anterior nosebleeds can be stopped by applying direct pressure, which helps by promoting blood coagulation.
Chemical cauterization
This method involves applying a chemical such as silver nitrate to the nasal mucosa, which burns and seals off the bleeding.
Nasal packing
If pressure and chemical cauterization cannot stop bleeding, nasal packing is the mainstay of treatment.
Dissolvable nasal packing materials stop bleeding through use of thrombotic agents that promote blood clots, such as surgicel and gelfoam.
Traditionally, nasal packing was accomplished by packing gauze into the nose, thereby placing pressure on the vessels in the nose and stopping the bleeding. Traditional gauze packing has been replaced with other non-dissolvable nasal packing products such as Merocel and the Rapid Rhino.
Surgery
Ongoing bleeding despite good nasal packing is a surgical emergency and can be treated by endoscopic evaluation of the nasal cavity under general anesthesia to identify an elusive bleeding point or to directly ligate (tie off) the blood vessels supplying the nose. These blood vessels include the sphenopalatine, anterior and posterior ethmoidal arteries. More rarely the maxillary or a branch of the external carotid artery can be ligated. The bleeding can also be stopped by intra-arterial embolization using a catheter placed in the groin and threaded up the aorta to the bleeding vessel by an interventional radiologist.[ MedlinePlus Medical Encyclopedia: Nosebleed U.S. National Library of Medicine Medline Plus service. Retrieved 2010-03-15.]
Tranexamic acid
Tranexamic acid helps promote blood clotting.
Other
The utility of local cooling of the head and neck is controversial.
Society and culture
In the visual language of Japanese manga and anime, nosebleeding often indicates that the bleeding person is sexually aroused.
In American and Canadian usage, "nosebleed section" and "nosebleed seats" are common slang for seating at sporting or other spectator events that are the highest up and farthest away from the event. The reference alludes to the propensity for nasal hemorrhage at high altitudes, usually owing to lower barometric pressure.
The oral history of the Native American Sioux tribe includes reference to women who experience nosebleeds as a result of a lover's playing of music, implying sexual arousal.
In the Finnish language, "picking blood from one's nose" and "begging for a nosebleed" are commonly used in abstract meaning to describe self-destructive behaviour, for example ignoring safety procedures or deliberately aggravating stronger parties.
In Filipino people slang, to "have a nosebleed" is to have serious difficulty conversing in English with a fluent or native English speaker. It can also refer to anxiety brought on by a stressful event such as an examination or a job interview.[ OMG! Nosebleed! Say what?! Retrieved 28 August 2013]
In the Dutch language, "pretending to have a nosebleed" is a saying that means pretending not to know anything about something.
Etymology
The word epistaxis is from epistazo, "to bleed from the nose" from ἐπί epi, "above, over" and στάζω stazo, "to drip from".
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