Epistaxis (nosebleeds). Nosebleeds Persistent nosebleeds

Frequent cases of epistaxis, as well as heavy blood loss, require urgent specialist consultation, detailed diagnosis and proper treatment.

What could be the causes of frequent nosebleeds and how they can be cured, says Olga Pavlovna Soloshenko, an otorhinolaryngologist at the Semeynaya clinic.

If bleeding does not occur from injuries and recurs periodically, it is better not to delay a visit to the ENT specialist. After all, bleeding can be anterior or posterior - the second happens less often, but it is much more dangerous. With anterior bleeding, the blood flows only outward; with posterior bleeding, it flows into the mouth or stomach along the back wall of the pharynx. Posterior is usually caused by damage to larger vessels that are located deep in the nasal cavity. Stopping posterior bleeding without a doctor is very difficult.

Causes of nosebleeds:

• Injuries. Injury to the nose often results in cartilage fractures. As a rule, this is accompanied by swelling and pain.
• High blood pressure. A very common reason. Due to the sudden jump, the capillary walls easily burst. Blood pressure increases due to overload, as well as in the presence of diseases of the cardiovascular system.
• Sunstroke and any sudden increase in body temperature.
• Overwork.
• Changes in hormonal levels. Bleeding can occur in women during pregnancy or menopause, and in adolescents during puberty.
• Dry air. It causes dry mucous membranes.
• Poor blood clotting.
• ENT diseases. Sinusitis, sinusitis, rhinitis - all of them can cause bleeding, especially with constant use of medications that thin the mucous membrane.
• Problems with blood vessels. Even infectious diseases such as chickenpox, measles, influenza, etc. can lead to them.
• Polyps, adenoids, tumors. In addition to periodic bleeding, it simply makes breathing difficult.
• Foreign body entry- can damage the mucous membrane and blood vessels.
• Deficiency of vitamins K, C and calcium.

First aid rules for nosebleeds:

• Position yourself (or position the patient) with your legs down
• Tilt your head forward
• Place a cold compress on the bridge of your nose for a few minutes.
• Pinch your nose with your hand or insert a tampon previously soaked in hydrogen peroxide
• You can use drops to narrow blood vessels

Attention, this cannot be done!

• Throwing your head back (contrary to popular belief) - blood can enter the respiratory tract
• Blow your nose so as not to increase the bleeding.

What cases require immediate calling a doctor and an ambulance?

• In case of loss of consciousness
• If there is too much bleeding
• Blood flowing along with clear fluid (this can happen after an injury and indicate a basal skull fracture)
• If you vomit blood (this may indicate bleeding in the esophagus or stomach)
• Blood with foam (possible due to lung injury)
• If a patient has diabetes mellitus
• If the patient is known to have poor blood clotting

Treatment

Treatment of bleeding is carried out comprehensively. Often, an otorhinolaryngologist works together with a therapist, neurologist, endocrinologist and hematologist.

At the first examination, the doctor determines the type of bleeding - anterior or posterior. The patient is also required to undergo a general blood test and a coagulogram (analysis of blood clotting indicators). In addition, it is important to measure the pressure, because if it is higher than normal (the absolute norm is 120/80 mmHg, but these indicators change depending on age), the blood will not stop until it decreases.

If there is significant blood loss, the patient may be left in the hospital.

As a treatment for bleeding, it is possible to pack the nasal cavity, cauterize blood vessels (with drugs, laser, ultrasound, etc.) and remove polyps. If there is no result, surgical ligation of the vessels in problem areas is performed. In addition, medications that increase blood clotting are prescribed.

Prevention

• Taking medications that strengthen the walls of blood vessels
• Diet rich in vitamins and minerals
• Air humidification during the heating season
• Preventing Possible Injuries
• Monitoring blood pressure and taking medications that lower it

A nosebleed is not only unpleasant, but also dangerous. Therefore, as soon as it begins to bother you regularly, it is important to consult a doctor as soon as possible. It is better to exclude all the most terrible causes of this phenomenon as quickly as possible and then proceed with further treatment more calmly.

Making an appointment with an otolaryngologist

Be sure to consult a qualified specialist in the field of nasal diseases at the Semeynaya clinic.

Nosebleeds occur when the blood vessels of the nasal mucosa are damaged. Children under 10 years of age and adults over 50 years of age are most likely to experience nosebleeds.

Causes of nosebleeds

There are many reasons for bleeding. Weak nasal vessels are one of the most common. For some people, blowing their nose sharply or simply rubbing their nose is enough to cause their nose to bleed. This is not a rare occurrence for people with high blood pressure. Nosebleeds can also occur in a completely healthy person due to sudden changes in atmospheric pressure. Another common cause of bleeding is nasal trauma.

Nosebleeds can be caused by local or systemic factors

Local factors:

• inflammatory processes of ARVI, chronic sinusitis, allergic rhinitis, etc.);
• developmental anomalies of the vascular system of the nasal cavity;
• snorting drugs (especially cocaine);
• tumors of the nasal cavity;
• low relative humidity of inhaled air;
• use of a nasal oxygen catheter (dries out the nasal mucosa);
• use of certain nasal sprays;
• surgical intervention in the nasal cavity, etc.

System factors:

Types of nosebleeds

It is customary to distinguish between 2 types of nosebleeds - "front» And "back" .

"Anterior" bleeding not intense, can stop on its own (or as a result of taking the simplest measures) and does not pose a threat to human life.

For “posterior” nosebleeds, which arise as a result of damage to fairly large vascular trunks localized in the walls of the deep parts of the nasal cavity, a large amount of blood loss is possible. Such bleeding is intense, does not stop on its own, and therefore often requires professional medical attention.

There are also minor, mild, moderate, severe or massive degrees of blood loss during nosebleeds.

Nosebleeds in children

In the anterior section of the nasal septum there is a rather delicate area where many capillaries are located. It is from this part of the nose that nosebleeds in children occur in 90% of cases. These nosebleeds are not dangerous and can be stopped fairly quickly.

Sometimes the child may bleed from the large vessels of the nose. In such cases, quite strong and intense bleeding occurs. Therefore, it is urgent to call a doctor to help with nosebleeds.

It happens that a child has bleeding from the nose, but the source of bleeding is other organs - the trachea, bronchi, lungs, esophagus or stomach. This is why it is so important to understand the cause of nosebleeds in children. When you bleed from the nose, the blood is a normal color and flows down the back of the throat. Very dark blood, the color of coffee grounds, may indicate bleeding from the stomach.

Rapid and large blood loss is dangerous for the health and life of the child. With significant blood loss, the child may experience general weakness, dizziness, pale skin, noise and ringing in the ears; lines before the eyes, thirst and rapid heartbeat.

Then blood pressure decreases, the child may lose consciousness.

When bleeding from the back of the nose, the child may swallow blood, and only by vomiting with blood clots can one understand that he has a nosebleed.

Causes of nosebleeds in children

Damage to the vessels of the nasal mucosa can occur in a child in a variety of cases. Among the main causes of nosebleeds in childhood are the following:

• nasal injuries (fracture, bruise, damage to the nose by a foreign object stuck into it);
• medical operations performed on the nose;
• tumors, polyps, ulcers in the nose;
• rhinitis, sinusitis, adenoiditis;
• sun and heatstroke;
• sudden surges in pressure;
• physical activity that is intense for the child’s body;
• lack of calcium, potassium and vitamin C;
• low blood clotting;
• hormonal changes in adolescence;
• hepatitis, liver diseases, etc.

Diagnosis of nosebleeds

Diagnosis of nosebleeds in adults and children is carried out using an external examination, examination of the nasal cavity, nasopharynx and pharynx. Sometimes it is necessary to differentiate nosebleeds in adults and children from bleeding, the source of which is other organs - the lungs, esophagus or stomach. In such cases, blood enters the nasal cavity and then flows out of the nostrils. It is necessary to undergo examination by other specialists and identify the cause.

Treatment of nosebleeds

If you have a nosebleed, you need to stop the bleeding as quickly as possible to prevent blood loss. Next, it is necessary to eliminate the cause that caused the bleeding - for example, normalize blood pressure. It is necessary to prevent the possible consequences of acute blood loss (decrease in circulating blood volume, for example), to carry out hemostatic therapy.

First aid for nosebleeds

Stopping nosebleeds can be done in the following ways:

In case of “front” nosebleeds, it is necessary to sit the victim down or lie him down, slightly raising his head. It is not recommended to tilt the patient's head back too much: this could cause blood to enter the respiratory tract. A cotton or gauze swab moistened with a 3% solution of hydrogen peroxide must be inserted into the bleeding nostril, then, pressing the wing of the nose from the outside to the nasal septum with your fingers, hold it in this position for 10-15 minutes - this way the damaged vessel is thrombosed. Vasoconstrictor drops (Nazivin, etc.) can also provide a good hemostatic effect. In this case, the drops are not instilled into the nose, but are moistened with a tampon. Cold should be applied to the bridge of the nose.

If your efforts are unsuccessful, and you do not know how to stop a nosebleed on your own, you need to call an ambulance. You should also seek emergency medical help if blood flows from the nose in a stream, without clots.

Treatment of nosebleeds at MedicCity

MedicCity provides comprehensive treatment of nosebleeds using conservative and, if necessary, surgical methods.

Conservative therapy is aimed at stopping bleeding, restoring damaged tissues and erosive vessels of the nose, and preventing relapses. Homeostatic and metabolic vascular therapy is used using local and systemic drugs.

In case of heavy nosebleeds, the patient undergoes tamponade of the nasal cavity with gauze swabs, the duration of which can be up to 2 days. Hemostatic drugs are also prescribed. After removal of the tamponade, the nasal cavity is examined using endoscopic equipment, which makes it possible to determine the cause of the disease.
In order to prevent relapses, medications aimed at strengthening blood vessels are prescribed. The use of conservative treatment allows you to achieve optimal results in 7-10 days.

If the therapeutic effect is ineffective, surgical treatment is performed to coagulate the bleeding vessel.

For extensive destruction of blood vessels, we use radio wave and laser methods, manipulations are carried out under the control of endoscopic equipment.

Our methods allow you to treat nosebleeds on an outpatient basis in 1 day.

Nosebleeds are not only unpleasant, but also dangerous, as they can lead to significant blood loss. Therefore, if bleeding recurs repeatedly, or you are unable to stop the nosebleed on your own, contact a specialist! Our otolaryngologists will provide you with qualified assistance with nosebleeds and any other diseases of the ear, nose and throat!

General information

– bleeding from the nasal cavity due to a violation of the integrity of the walls of blood vessels. More often accompanies injuries and inflammatory diseases of the nose, and can be caused by diseases of the blood vessels and blood system. It is characterized by the outflow of scarlet blood in drops or streams from the nostrils, flowing down the back wall of the throat. May be accompanied by tinnitus and dizziness. Heavy recurrent nosebleeds cause a sharp drop in blood pressure, increased heart rate, general weakness, and can be life-threatening.

Nosebleeds are a widespread pathological condition. Patients with nosebleeds account for about 10% of the total number of patients hospitalized in ENT departments.

Causes of nosebleeds

There are general and local causes of nosebleeds.

Local reasons:

• Nose trauma is the most common cause of bleeding. In addition to ordinary household, industrial and road injuries, this group includes injuries to the nasal mucosa during operations, foreign bodies, and therapeutic and diagnostic procedures (nasogastric intubation, nasotracheal intubation, catheterization and puncture of the nasal sinuses).
• Pathological conditions accompanied by congestion of the nasal mucosa (sinusitis, rhinitis, adenoids).
• Dystrophic processes in the nasal mucosa (with severe curvature of the nasal septum, atrophic rhinitis).
• Tumors of the nasal cavity (specific granuloma, angioma, malignant tumor).

Common reasons:

• Diseases of the cardiovascular system (symptomatic hypertension, hypertension, atherosclerosis, malformations accompanied by increased blood pressure).
• Blood diseases, vitamin deficiency and hemorrhagic diathesis.
• Increased body temperature due to overheating, sunstroke or infectious disease.
• A sharp drop in external pressure (when climbing to great heights for climbers and pilots, and when quickly descending to depth for divers).
• Hormonal imbalances (during pregnancy, adolescence).

Classification of nosebleeds

Depending on which part of the nasal cavity the source of blood loss is localized, nosebleeds are divided into anterior and posterior.

The source of anterior nosebleeds in 90-95% of cases is the rich network of blood vessels of the so-called Kisselbach zone. In this zone there are a large number of small vessels covered with a thin mucous membrane, practically devoid of a submucosal layer. Anterior nosebleeds very rarely cause massive blood loss, and, as a rule, do not threaten the patient’s life. They often stop on their own.

The source of posterior nosebleeds are fairly large vessels in the deep parts of the nasal cavity. Due to the large diameter of the vessels, posterior nosebleeds are often massive and can pose a threat to the patient’s life. Such bleeding almost never stops on its own.

Blood loss during nosebleeds is assessed as follows:

• insignificant - several tens of milliliters;
• light – up to 500 ml;
• moderate severity - up to 1000-1400 ml;
• heavy – over 1400 ml.

Symptoms of nosebleeds

Symptoms of nosebleeds are divided into three groups:

• signs of bleeding;
• signs of acute blood loss;
• symptoms of the underlying disease.

In some patients, nosebleeds begin suddenly; in others, the bleeding may be preceded by dizziness, tinnitus, headache, or tickling or itching in the nose. An immediate sign of nosebleeds is the flow of blood from the nasal cavity to the outside or inside the nasopharynx. In the latter case, the blood drains into the oropharynx, where it is detected during pharyngoscopy.

With minor blood loss, pathological symptoms, as a rule, are not detected. Some patients may experience dizziness from the sight of blood. With mild blood loss, patients complain of dizziness, tinnitus, thirst, general weakness, and palpitations. In some cases, slight paleness of the skin may occur.

Moderate blood loss is accompanied by severe dizziness, a drop in blood pressure, acrocyanosis, tachycardia and shortness of breath. With severe blood loss, hemorrhagic shock develops. The patient is lethargic and may lose consciousness. During the examination, a thread-like pulse, pronounced tachycardia, and a sharp drop in blood pressure are revealed.

Diagnosis and differential diagnosis

To determine the location of the source of nosebleeds (anterior or posterior bleeding), the patient is examined, pharyngoscopy and anterior rhinoscopy. In some cases, with pulmonary and gastric bleeding, blood flows into the nasal cavity and simulates nosebleeds. Primary differential diagnosis is based on data from the external examination of the patient. With nosebleeds, the blood is dark red; with bleeding from the lungs, it foams and has a bright scarlet color. Stomach bleeding is characterized by the flow of very dark blood that looks like coffee grounds. It must be taken into account that severe nosebleeds may be accompanied by bloody vomiting with dark blood. The cause of vomiting in this case is the ingestion of blood flowing down the oropharynx.

Additional tests are performed to assess blood loss and identify the underlying disease that caused the nosebleed. The volume of blood loss is assessed based on the results of a general blood test and coagulogram. The tactics of the general examination are determined by the symptoms of the underlying disease.

Treatment of nosebleeds

When treating nosebleeds, you need to stop the bleeding as quickly as possible, take measures to prevent the consequences of blood loss (or compensate for blood loss) and carry out therapeutic measures aimed at combating the underlying disease.

In case of anterior nosebleeds, in most cases, in order to stop the bleeding, it is enough to put cold on the nose area, press the nostril for 10-15 minutes or insert a cotton ball soaked in a hemostatic agent or a weak solution of hydrogen peroxide into the nasal cavity. Anemization of the nasal mucosa is also carried out with a solution of adrenaline or ephedrine. If bleeding does not stop within 15 minutes, Anterior tamponade is performed on one or both halves of the nasal cavity.

Anterior nasal tamponade often has a good effect on posterior nosebleeds. If posterior nosebleeds cannot be stopped, posterior tamponade is performed.

If the above measures are ineffective and recurrent nosebleeds, surgical treatment is performed. The volume and tactics of intervention are determined by the location of the source of bleeding. If repeated nosebleeds are localized in the anterior sections, in some cases endoscopic coagulation, cryodestruction, administration of sclerosing drugs and other measures aimed at obliterating the lumen of small vessels of the Kisselbach zone are used.

Nose bleed- one of the most common emergency conditions in otorhinolaryngology, the treatment of which may require the involvement of doctors of other specialties.

Although usually nosebleeds harmless and associated with trivial reasons, sometimes they arise as a complication of serious, sometimes incurable diseases, are difficult to stop and can cause death. Therefore, the diagnosis and treatment of nosebleeds should be taken seriously. The most common sources of nosebleeds are listed below. Depending on the etiology, nosebleeds associated with local causes and those caused by a systemic disease are distinguished. The most clinically important diseases that can cause nosebleeds are listed below. The two most common sources of nosebleeds are:

1. Kisselbach gossip e (in approximately 90% of cases), localized in the anterior part of the nasal septum. The mucous membrane in this place is especially vulnerable, tightly fused with the underlying cartilage and therefore easily susceptible to mechanical damage and not sufficiently resistant to functional loads.

2. Another source of nosebleeds is capillary hemangiomas, which are sometimes localized in the anterior third of the nasal septum. It is believed that these benign angiomatous neoplasms, dark red in color with clearly defined boundaries, are formed as a result of mechanical irritation.

Causes of nosebleeds:

I. Local causes of nosebleeds:

a) Idiopathic nosebleeds. This is usually mild or repeated nosebleeds in children and adolescents.
b) Vascular. Microtraumas of the Kisselbach plexus.
c) Anterior dry rhinitis. Associated with chemical or thermal damage to the nasal mucosa or perforation of the nasal septum. Bleeding is often minor or in the form of blood in the nasal discharge. Feeling of dryness in the nose, crust formation.

d) Influence of environmental factors. Staying in high altitude conditions, low atmospheric pressure; dry conditioned air.
d) Trauma. Fractures of the nasal bones and septum, fractures of the facial skull or the base of the anterior cranial fossa. Profuse bleeding usually occurs, directly related to the injury. Damage to the internal carotid artery poses a direct threat to life or can lead to the formation of an aneurysm, which manifests itself in episodes of bleeding.
f) Foreign body of the nose or rhinolitis. They manifest themselves as slight bleeding from one half of the nose, a foul odor and prolonged purulent discharge.

g) Bleeding polyp of the nasal septum. According to its histological structure, it is a telangiectatic granuloma or hemangioma with a pronounced tendency to bleed, even with minor trauma.
h) Tumors. Malignant tumors of the nose and especially the paranasal sinuses often present with bloody nasal discharge. Tumors of the nasopharynx, especially angiofibroma, can cause profuse, life-threatening bleeding.

II. Causes of secondary nosebleeds:

a) Infection. Acute infectious diseases such as influenza, measles, typhoid fever, and catarrhal inflammation. Nosebleeds are usually short-lived and minor and usually occur in children and adolescents.
b) Diseases of the cardiovascular system. For example, atherosclerosis and arterial hypertension. Arterial bleeding, often pulsating and profuse, tends to recur, and is observed in middle-aged and elderly people.
c) Blood diseases and blood clotting disorders. Thrombopathy, eg thrombocytopenic purpura or idiopathic thrombocytopenic purpura (Werlhof's disease), sickle cell anemia, leukemia, thrombasthenia (Glanzmann's disease) and constitutional von Willebrand thrombopathy, myeloproliferative diseases (eg, essential thrombocythemia).

d) Coagulopathy. For example, hemophilia, Waldenström's disease, prothrombin deficiency or overdose of anticoagulants, fibrinogen deficiency and vitamin deficiency K and C.
e) Vasculopathy. For example, scurvy, scurvy of infants (Möller-Barlow disease), Henoch-Schönlein hemorrhagic vasculitis. Bleeding in these diseases is usually superficial, dark blood.

f) Uremia and liver failure.
g) Endocrine diseases. For example, vicarious menstruation associated with endometriosis, nosebleeds during pregnancy; pheochromocytoma, causing periodic hypertensive crises associated with the release of large amounts of catecholamines.
h) Hereditary hemorrhagic telangiectasia with typical changes in the mucous membrane (Rendu-Osler-Weber disease). Bleeding is recurrent, minor or moderate, often multifocal, mainly from the anterior and posterior part of the nasal septum; are not amenable to conservative treatment.

Diagnosis of nosebleeds. Below are the diagnostic steps for nosebleeds. In some patients, identifying the source of bleeding can be extremely difficult or even impossible. Bleeding from the back of the nasal cavity and from the middle and upper nasal passages is always associated with a serious pathology and requires immediate examination of the patient with the involvement of doctors of other specialties, if necessary, and the prescription of appropriate treatment. The source of such bleeding may be the anterior or posterior ethmoidal arteries or the sphenopalatine artery.

Stages of diagnosing nosebleeds:

1. Taking an anamnesis.

2. Establishing the source and cause of bleeding:
- Bleeding from the anterior part of the nasal cavity: nose picking, idiopathic bleeding, anterior rhinitis, infectious diseases.
- Bleeding from the middle and posterior parts of the nasal cavity: arterial hypertension, arteriosclerosis, fractures of the nasal bones, tumors.
- Superficial bleeding: hemorrhagic diathesis, blood coagulation disorders, Randu-Osler-Weber disease.

3. Measurement of blood pressure and examination of the circulatory system.

4. Blood coagulation study.

If necessary:
5. CT scan of the nose and paranasal sinuses (for example, if a tumor is suspected).
6. Examination by a therapist to exclude systemic diseases.

Differential diagnosis includes bleeding from the nose that occurs from a source located outside the nasal cavity, such as a tumor of the nasopharynx or larynx or lower respiratory tract (hemoptysis), bleeding from varices of the esophagus, and from damaged vessels in the base of the skull (for example, the internal carotid arteries) with bleeding through the sphenoid sinus or auditory tube.