EPISTAXIS

Dr M Lupascu
 INTRODUCTION
• CAUSES : Ranging from insignificant trauma to
malignancy
• BLOOD LOSS :Ranging from few drops to
massive loss (mild, moderate, severe)
• SITE : Anterior and/or Posterior, Uni/ Bilateral
 LOCAL CAUSES
• 1) Congenital: -Multiple telangiectases •
• 2) Traumatic : Injury, Post operative, Picking,
Foreign body
• 3) Inflammatory:
– ACUTE: -Vestibulitis , Rhinitis ,Sinusitis , Nasal diphtheria
– CHRONIC: Rhinitis , Sinusitis , T.B.,Syphilis,Leprosy-
Rhinosporidiosis

• 4)Tumors:
– Benign-Angioma of septum –Nasopharyngeal Angiofibroma
– Malignancy – carcinomas, melanomas …
 SYSTEMIC CAUSES
• Bleeding disorders: thrombocytopenia,
hemophilia A and B, von Willebrand disease
• Liver disease & Vitamin K deficiency,
• Distant cancers
• Sepsis
• Blood thinners & NSAIDS
 CLINICAL FEATURES
• 1) Ant. Rhinoscopy: site of bleeding:
• -Nasal Septum – Mostly Little’s Area (Kiesselbach’s
plexus
• -Inferior turbinate & nasal floor
• -Middle turbinate

• 2) Post. Rhinoscopy
• 3) Quantity of blood loss
• 4) B.P.
• 5) Shock
 INVESTIGATIONS
• 1) Hb, TC, DC
• 2) X-Ray PNS OR CT
• 3) Biopsy
• 4) Nasal Endoscopy
 TREATMENT
• First aid
• Local treatment
• Systemic treatment
• Treatment of specific cause
• Adjuvant therapy: pain killers, psychological
support, vitamins…
 First Aid
• Place in seated position with head slightly
bent forward
• Apply pressure on the nose
• Insert cotton plug with nasal decongestant
• Apply ice in case o trauma
 Local treatment
• Most important: STOP THE BLEEDING
• Anterior nasal packing with: cotton gauze,
resorbable sponge, p.v.a. sponges, balloon
catheters
• Anterior nasal packing is usually held in
place for 48 hours
 Local treatment
• Haemostatic balloon catheters cover posterior
bleedings as well
 Local treatment
• PVA tampon insertion
 Local treatment
• Posterior nasal packing
with cotton gauze
• Hold in place 48-72 hours
 Local treatment
• Cauterization :
» Chemical with silver nitrate
» Endoscopic surgery: Electrical with mono and bipolar
cauterysation, radiofrequency, LASER, Coblation …
 Surgical treatment
• Embolisation of select vessels (for tumors),
stenting of aneurisms or even Internal Carotid
a.
• Surgical ligation of internal maxillary artery,
endoscopic cauterization or ligation of
sphenopalatine artery or External Carotid a.
 Systemic treatment
• Treatment of hypertension and other
underlying diseases
• Treatment of hemorrhagic shock
• Procoagulant therapy when possible (Vit k,
Tranexamic acid, plasma, platelet concentrate,
coagulation factors)
• Antibiotic therapy to avoid sinusitis given by
nasal packing
• Pain medication and sedatives