Nose bleed is a commonly occuring phenomenon. Although nose bleed can occur at any age a bimodal incidence is seen with peaks within 2-10 yrs and 50-80 yrs. It is usually not seen in children less than 2 yrs of age. Nose bleed is a common problem that ranges from a minor nuiscance to a life threatening emergency, especially in elderly patients and in those with underlying medical problems.

Causes

  • Due to unknown cause
  • Trauma- Dry air especially in winter leading to finger picking causing nasal bleed. This is the most common cause and is especially seen in children.
  • Facial injury resulting in fracture nasal bones.
  • Cocaine abuse
  • Foreign body causes trauma once lodged in nose usually by patient seen in children.
  • Tumor Induced  - 

          (a)   Benign : Juvenile Nasopharyngeal Angofibroma this is a condition affecting mostly pre-pubescent boys

         (b)  Malignant : Occurs in elderly patients, Nasopharyngeal carcinoma

  • Underlying medical conditions : Hypertension typically causes bright red blood falling from nose in the elderly, use of aspirin
  • Inflammation of nose and paranasal sinuses

Common Facts About nose bleed

  • Bleeding is usually from one side of the nose and very rarely from both sides.
  • In a child having nose bleed just pinching his/her nose for 5 minutes will stop the nose bleed in a majority of cases.

Presentation

  • Anterior

         i)    From Keiselbachs plexus - arterial

        ii)   From Woodruffs area - venous

  • Posterior

         i)    From Sphenopalatine artery

  • Treatment
  1.   Anterior nasal pack. Usually removed in 48hrs.
  2.   Posterior nasal pack 
  3.   Surgical removal of  : Benign nasopharyngeal angiofibroma.
  4.   Radiotherapy in cases of nasopharyngel carcinoma.
  5.   Antihypertensive drugs