Nosebleeds are most often caused by local trauma but can also be caused by foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. Tumors and vascular malformations are also potential causes of nosebleeds, but they are rare. Spontaneous nosebleeds are fairly common, especially in children. When the mucous membrane a mucus-secreting tissue inside the nose dries, crusts, or cracks and is then disturbed by nose-picking, it is likely to bleed.
Because the nose is full of blood vessels, any minor injury to the face can cause the nose to bleed profusely. Nosebleeds are also common in people taking anticoagulants blood-thinning medications, such as Aspirin , as well as in older people whose blood may take longer to clot.
If the person taking anticoagulants, has hypertension high blood pressure , or a blood-clotting disorder, the bleeding may be harder to stop and could last over 20 minutes. In anterior nosebleeds , the bleeding comes from the wall between the two nostrils. This part of the nose contains many delicate blood vessels. Anterior nosebleeds are easily treated at home; this is likely to be the type of nosebleed seen in a child.
In posterior nosebleeds , the bleeding originates further back and higher up the nose in an area where artery branches supply blood to the nose; this is why the bleeding is heavier. Posterior nosebleeds are often more serious than anterior nosebleeds and may require medical attention.
They are more common in adults. Osler-Weber-Rendu disease — a rare condition, affecting 1 in 5, people; it is a genetic disorder of the blood vessels that leads to excessive bleeding. Factor X deficiency Stuart-Prower factor deficiency — a condition caused by a protein deficiency. Glomerulonephritis nephritis — acute kidney inflammation, commonly caused by an immune reaction.
Von Willebrand disease — a bleeding disorder due to a deficiency of von Willebrand factor. Idiopathic thrombocytopenic purpura — a condition in which the blood does not clot correctly. Individuals experience excessive bleeding and bruising. Deficiency of factor II, V, or VII — these rare conditions affect blood clotting and increase the chances of nosebleed. The main symptom of a nosebleed is blood coming from the nose, which can range from light to heavy.
Ongoing allergies and environmental irritants eg: cigarette smoke may be a cause. Diagnosis of sinusitis can be difficult as its symptoms can mimic those of a common cold. A doctor will discuss the nature and duration of symptoms, and perform a physical examination including looking in the ears, throat, and nose.
In recurrent and chronic cases, a referral to an ear, nose, and throat ENT specialist for additional investigation may be necessary. Treatment aims to relieve symptoms and restore the normal flow of air and mucus through the sinuses.
Antibiotics are used to treat bacterial infection. A 7- to day course of medication is usually prescribed. Longer courses may be needed for cases of recurrent or chronic sinusitis. Decongestants relieve nasal congestion by drying up the mucus. These can be in the form of tablets and nasal drops or sprays. Care must be taken as decongestants can excessively dry the nasal mucous membranes, which leads to further swelling and congestion.
It is important to clearly follow the medication instructions when using nasal decongestants. Corticosteroid medications such as prednisone may be prescribed, in conjunction with an extended course of antibiotics, to treat cases of chronic sinusitis.
Corticosteroid nasal sprays may also be prescribed. Other treatments that aim to relieve the symptoms include pain-relieving medications, such as paracetamol and ibuprofen, steam inhalers, saline nasal sprays, and the application of heat or cold packs to the area surrounding the sinuses. Drinking plenty of fluids helps to thin the mucus so that it drains more easily. Avoiding allergens allergy-producing irritants and taking antihistamines medications to reduce allergic reactions may also prove effective.
If allergies contribute to the sinusitis, treatment that gradually builds up immunity to allergens desensitisation therapy may be recommended. Surgery may be recommended for cases of recurrent or chronic sinusitis where non-surgical treatment has not been effective.
This type of nosebleed can be easy for a trained professional to stop. Less commonly, nosebleeds may occur higher on the septum or deeper in the nose such as in the sinuses or the base of the skull. Such nosebleeds may be harder to control. However, nosebleeds are rarely life threatening. Repeated nosebleeds may be a symptom of another disease such as high blood pressure, a bleeding disorder, or a tumor of the nose or sinuses.
Blood thinners, such as warfarin Coumadin , clopidogrel Plavix , or aspirin, may cause or worsen nosebleeds. It may help to apply cold compresses or ice across the bridge of the nose. Do not pack the inside of the nose with gauze. Lying down with a nosebleed is not recommended.
You should avoid sniffing or blowing your nose for several hours after a nosebleed. If bleeding persists, a nasal spray decongestant Afrin, Neo-Synephrine can sometimes be used to close off small vessels and control bleeding. The provider will perform a physical exam.
In some cases, you may be watched for signs and symptoms of low blood pressure from losing blood, also called hypovolemic shock this is rare. You may need to see an ear, nose, and throat ENT, otolaryngologist specialist for further tests and treatment. Philadelphia, PA: Elsevier; chap Savage S. Management of epistaxis. In: Fowler GC, ed.
0コメント