Epistaxis – Common Nosebleeds
Nasal bleeding, known as epistaxis, is a common occurrence that nearly everyone encounters at some point in life. Roughly one in ten individuals faces nosebleeds at least once a year, experiencing so called recurrent episodes, often at least 4 times every year. This issue, though typically harmless, can be bothersome and impact the Quality of Life (QoL) of both patients and their families.
A Shared Nose Experience
Despite its prevalence, many individuals try to manage nosebleeds at home, work, school, during leisure activities, or wherever they may be, often without seeking medical attention. The consequences of nosebleeds include insecurity, fear, irritation, and the staining of clothes, towels, bedding etcetera. Nosebleeds are more frequent among individuals younger than 20 and those older than 55, with men being slightly more prone than women.
Underlying Causes
Nose dryness and nosebleeds often go hand in hand. External factors such as dry air, exposure to particle-laden irritants, nasal congestion, and nasal surgeries, alongside internal factors like aging, dehydrating medications including common cold nasal sprays, can lead to a dry nose. However, the most influential factor is often iatrogenic, involving nose picking and forceful nose blowing. Trauma to the nose, blood-thinning medications including alcohol, vascular and blood-related disorders, all contribute to an elevated risk of nosebleeds.
The link between high blood pressure and epistaxis is a subject of debate, with no consensus reached thus far. Although bleeding momentarily increases blood pressure, there's no evidence that pressure itself triggers nosebleeds. Nonetheless, individuals with hypertension experience recurrent nosebleeds, possibly due to the chronic impact of the disease on blood vessels.
Usually in common nosebleeds, the front portion of the nose is affected, including the nasal openings which can become sore and irritated. Dryness in the nose also disrupts airflow and causes nasal congestion. Research indicates that a relative humidity of at least 40% is optimal for the eyes and nasal mucosa, preventing dryness.
However, indoor air humidity in modern buildings with mechanical ventilation, especially in the northern hemisphere, is often below 30%, leading to about one in three individuals reporting issues related to dry air. In wintertime and certain environments like aircraft cabins, the air can become exceptionally dry.
Typical Presentation of Nosebleeds
The overwhelming majority of nosebleeds, more than 90%, originate from the anterior part of the nose, primarily from a small, delicate mucosal area known as the Kiesselbach plexus or Littles area. This network comprises five arteries supplying the nasal septum.
Despite this knowledge, a plethora of advice and home remedies have circulated worldwide, many of which are either ineffective or inaccurate. Surprisingly, only a small portion of the population knows how to correctly manage a nosebleed, and even among medical students, a minority can demonstrate the accurate method of pinching the nose.
While no clinical studies determine the average blood loss during nosebleeds, clinical experience suggests that both the individual experiencing the bleed and bystanders tend to overestimate the amount of blood lost. In reality, the actual blood loss is usually just one or a few milliliters.
Managing Nosebleeds
Given the current incidence rates, it's estimated that over 30 million people in the USA will experience nosebleeds annually due to dry nose. This number is rising with age, as mucous membranes become more fragile, more individuals use blood-thinning medications, and exposure to dry and air-conditioned environments increases. Despite the prevalence of nosebleeds, most individuals manage them incorrectly, often feeling hurried and stressed. Up to recently, existing self-care solutions lack the quick and effective bleeding cessation, and breathing possibility desired by individuals.
Self-Care
Dealing with a nosebleed can be distressing, so maintaining a calm demeanor is crucial for both the individual experiencing the bleed and those around them. Compression is the key, as is the case with all forms of bleeding. The commonly recommended self-care approach outside of healthcare facilities involves using a rolled-up cotton pad or gauze coated with cooking oil, petroleum jelly, or paraffin. This can be combined with decongestant nasal drops or sprays, followed by gently pinching the bleeding nostril's tip and the soft part of the nose for 10-20 minutes. Ideally, the person should sit slightly forward to prevent blood from flowing into the throat and stomach, which could lead to nausea or vomiting. Any coagulated blood should be carefully removed, or preferably rinsed off using warm saline before applying the cotton pad. If bleeding persists for more than 20 minutes despite adequate self-care or if the bleed occurs after a head injury or presents with adverse general symptoms, seeking immediate medical attention is recommended. Commercially available hemostatic products like gelatine sponges, plastic strips, or glycine and calcium gels are available in pharmacies and stores. However, these lack compression effects and may only maintain bleeding, and leading to nasal congestion.
Medical Intervention
In medical settings, bleeding is often stopped using coagulation methods like chemical etching (using a silver nitrate stick), electrocoagulation (diathermy), cooling, or hemoglobin-absorbing lasers. It's important to note that these methods provide temporary relief and recurrent nosebleeds are common among susceptible individuals. In cases of severe acute bleeding, scattered vessel bleeding, or bleeding further back in the nose, healthcare professionals often employ internal compression methods such as tightly packed tamponades, synthetic sponge-like tamponades, catheters, or expandable medical balloons. In severe cases where these methods fail, surgical or radiological interventions may be necessary, involving ligating or embolizing arteries supplying the nose with blood. In rare instances, sewing the nose shut may be employed as a life-saving measure to stop the blood flow.
Preventive Measures
As a preventive measure, lubricating oil is the primary choice, and avoiding nose picking is essential. Maintaining a nasal environment with fewer irritants, quitting smoking, and maintaining optimal humidity levels can help prevent nosebleeds. Having a NosePlug® on hand, either in your pocket or first aid kit, will also be beneficial.
Special Considerations
Hospitalization for children due to nosebleeds is rare, and underlying factors are unusual. However, foreign objects lodged in the nose, such as small toy beads, are not uncommon. Individuals experiencing recurrent nosebleeds, easily bleeding wounds, or unexplained bruising should consider investigations for bleeding disorders. In adolescent males, particularly those with recurrent unilateral nosebleeds accompanied by nasal obstruction, more thorough investigation by an Ear, Nose, and Throat (ENT) specialist is recommended.
Introducing the NosePlug®
Our patented NosePlug® presents a superior and unique alternative to conventional self-care methods for halting common nosebleeds.