When is a nosebleed a reason to make an appointment with an ENT doctor?

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 trauma to the nose.

Nosebleeds can be caused by local or systemic factors

Local factors:

• nasal injury;
• foreign body in the nose;
• 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.

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Help with nosebleeds in MedicCity

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System factors:

• allergy;
• arterial hypertension;
• physical activity, sunstroke, overheating;
• colds;
• side effects of medications;
• alcohol consumption (causes vasodilation);
• blood diseases;
• liver diseases;
• heart failure;
• increased vascular permeability during severe infections (measles, influenza), hypovitaminosis C, hereditary diseases, etc.;
• professional activities associated with sudden changes in barometric pressure (pilot, diver, climber, etc.);
• hormonal disorders (for example, during pregnancy), etc.

When is a nosebleed a reason to make an appointment with an ENT doctor?

From dry mucous membranes due to insufficient air humidity to cancer, from taking aspirin to liver diseases... Why does nosebleed? Just listing the reasons will take a lot of time.

Start to panic when it occurs or treat it as a minor incident? And finally, what to do if it happens?

With questions about the problem of nosebleeds, we came to an appointment with our permanent expert, otolaryngologist at Clinic Expert Kursk LLC, Alexandra Nikolaevna Emelyanova.

－ Alexandra Nikolaevna, how common is the problem of nosebleeds in your patients?

Doctors encounter this pathology quite often. According to public information from domestic and foreign researchers, nosebleeds have occurred at least once in 60% of people’s lives. 6% of them visited doctors, about 1.6 out of 10,000 required inpatient treatment. According to other sources, approximately 5-10% of people have an annual episode of nosebleeds. Less than 10% of them go to the doctor, and only 1% of these 10 require hospitalization.

－ Is nosebleeds somehow reflected in ICD-10?

Yes, its code is R04.0

－What are the reasons for nosebleeds? When can nosebleeds occur at night?

Most often, this is not an independent disease, but a manifestation of some other pathology or impact.

What can cause nosebleeds? The causes can be divided into two groups: local and general (systemic).

The first includes trauma to the nasal mucosa (including digital), foreign bodies, operations, infectious diseases of the airways, allergic processes, nasal polyps, low air humidity, neoplasms (in particular, juvenile nasopharyngeal angiofibroma, nasal hemangioma, papilloma, esthesioneuroblastoma ), inhalation of irritating substances (including cocaine).

The second group includes increased blood pressure, disorders of blood coagulation processes (including those associated with liver diseases, chemotherapy and anticoagulant therapy), acquired disorders of platelet function (for example, after using acetylsalicylic acid and other similar drugs), uremia, vascular pathology , hereditary hemorrhagic telangiectasia, pathological changes in collagen, vasculitis, systemic infections (for example, typhoid fever, nasal diphtheria, congenital syphilis, tuberculosis and others).

Thus, nosebleeds can be a sign of serious pathological conditions and therefore require mandatory clarification of the cause that caused it.

There are no specific reasons for nocturnal nosebleeds.

－ Are the causes of nosebleeds the same in children, adolescents and adults? Or are they different?

In principle they are the same. However, there are some features, such as juvenile angiofibroma or bleeding, associated with changes in hormonal status during adolescence. In addition, compared to adults, bleeding is more common in childhood due to trauma to the nasal mucosa (for example, digital), infectious pathologies, and leukemia (leukemia).

－ Alexandra Nikolaevna, do you need to see a doctor for every nosebleed?

If it is minor, occurred once, and was successfully stopped at home, then there is no reason to immediately consult a doctor to stop the bleeding.

But even here, finding out the cause of bleeding is mandatory, not to mention all other cases (insignificant in volume, but often repeated, or simultaneous heavy bleeding). Why? Because without this it is impossible to be completely sure how dangerous the cause that caused it is. Therefore, in any case, a person cannot do without a trip to the doctor.

－ What research methods are used to clarify the cause of nosebleeds?

These are various laboratory and instrumental methods.

Laboratory methods are aimed, in particular, at searching for disorders of the blood coagulation system (studying its plasma and platelet components).

Instrumental include examination of the nasal cavity (rhinoscopy), including using endoscopic technology, magnetic resonance and computed tomography of the nasal cavity and nasopharynx.

Of course, a rational algorithm for diagnostic search and necessary research should be selected by the doctor depending on the specific clinical situation.

－ How can you stop nosebleeds at home?

First aid for nosebleeds involves pinching the nose (pressing the wings of the nose against the nasal septum) for 5-20 minutes. If you have nasal vasoconstrictor drops, you can first put a little cotton wool or, preferably, gauze soaked in 3-4 drops of this drug into the nasal cavity, and then pinch your nose.

It must be remembered that vasoconstrictor drops can increase blood pressure (therefore, be sure to check the instructions for specific drops), and therefore may be contraindicated for hypertension. Therefore, if you are bleeding from the nose and have high blood pressure at the same time, these drops should not be used.

－What should you not do if you have a nosebleed?

When your nose is bleeding, you should not throw your head back. This is one of the most common mistakes. Why shouldn't this be done? This can lead to blood entering the esophagus and then the stomach, causing bloody vomiting, or into the respiratory tract, followed by suffocation. For the same reason, you can't lie down.

During bleeding and for some time after, you should not drink hot drinks or food.

It is necessary to exclude the influence of the factor that allegedly caused the nosebleed: for example, go into the shade if it happened in the sun, stop working, especially if it was physical activity.

－ How to properly prevent nosebleeds?

It is necessary to ensure proper hygiene at home and in the workplace. First of all, it is cleanliness and normal air humidity. If there are occupational hazards in the form of polluted air, use personal protective equipment. It is mandatory to undergo scheduled medical examinations and preventive examinations. If an episode of bleeding occurs, you should see an ENT doctor to find out the cause of the bleeding and follow his recommendations.

For reference:

Emelyanova Alexandra Nikolaevna

Candidate of Medical Sciences, otolaryngologist at Clinic Expert Kursk LLC.

Graduate of Kursk State Medical University. She completed her primary specialization in residency in the specialty “otorhinolaryngology”. She completed her full-time postgraduate studies at the same educational institution.

Other interviews with Emelyanova A.N.:

How to treat sinusitis at home?

Why can't my ear hear?

Your nose is stuffy, but you don’t have any drops on hand?

Types of nosebleeds

It is customary to distinguish between 2 types of nosebleeds - “anterior ” and “posterior” .

“Anterior” bleeding is 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.

With “posterior” nosebleeds, which occur 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.

Preventive actions

Following simple recommendations by parents will help eliminate unpleasant moments associated with blood loss:

• Trim your child’s fingernails regularly to prevent injury to his nose;
• moisturize the nasal mucosa using saline solutions or special ointments;
• maintain optimal humidity in the room, use a humidifier;
• treat colds in a timely manner; do not blow your nose too often or too much during treatment;
• do not overuse vasoconstrictor drugs to prevent thinning of the mucosa.

We remind Kaliningrad residents that you can make an appointment with an otolaryngologist by making a preliminary application by filling out an online form, or by calling one of our clinics at the phone numbers listed on the website.

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.

Symptoms

The main symptom of epistaxis is blood coming out of the nostrils or entering the oral cavity from the upper part of the pharynx. In more severe cases, accompanying symptoms are revealed:

• weakness, nausea, disturbance of spatial orientation;
• feeling of fullness in the ears;
• headache;
• tachycardia;
• hypotension;
• pallor of the skin.

If blood ends up in the stomach, vomiting with blood clots occurs, and the stool becomes dark in color.

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;
• deviated nasal septum;
• 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.

Prevention

Parents are able to prevent the development of epistaxis. Preventive measures for nosebleeds in children include adequate nasal hygiene, organization of a favorable indoor microclimate and timely treatment of hemostasis disorders.

For treatment of nosebleeds, contact the RebenOK clinic. Patients are treated by certified ENT doctors with extensive practical experience. The clinic is equipped with expert class equipment. The instruments and technical means used are designed for pediatric patients.

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.

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Diagnosis and methods of treating pathology

In the process of examining the child and interviewing the parent, the doctor needs to obtain as much information as possible about the causes of frequent blood loss. In this regard, he is interested in answers to the following questions:

• What was the obvious cause of the bleeding: injury, illness, or blowing your nose?
• How often do blood losses occur and how were they stopped?
• What medications is the patient taking? Do they include drugs that prevent blood clotting?
• What diseases does the child (parents, relatives) suffer from?

The doctor examines the child's skin for bruises and small capillaries, confirming the fragility of the blood vessels. Additionally, the child may be prescribed the following examinations:

• general blood and urine tests;
• coagulogram;
• electrocardiography;
• X-ray of the sinuses;
• computed tomography (CT).

The doctor's first task is to stop blood loss. To do this, a specialist can use conservative methods, such as:

• anterior (posterior) tamponade;
• taking hemostatic drugs.

If this method is ineffective, surgical procedures are used that involve cauterization of bleeding vessels:

• using electric current (electrocoagulation);
• liquid nitrogen (cryocoagulation);
• high frequency radio waves;
• a narrow laser beam.

After the bleeding stops, the causes are identified and work is done to eliminate them. If there are pathologies in the form of a deviated nasal septum, surgery to correct it is indicated. If there is an obvious infectious component, antibacterial therapy, etc. is prescribed.

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 will thrombose. 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.