1. What is epistaxis?
Epistaxis (in medicine, Also known as epistaxis n) is one of the emergency diseases requiring emergency treatment in otolaryngology. Refers to the blood from the nasal cavity forward (outside) outflow or backward (inside) flow into the inlet. Epistaxis can be manifested as repeated intermittent hemorrhage, but also can be manifested as sustained hemorrhage. The amount of hemorrhage varies, the mild is only the nasal mucus with blood, the severe can cause excessive blood loss, resulting in blood pressure reduction, shock and life-threatening, long-term repeated hemorrhage can lead to anemia.
Is epistaxis a disease?
Epistaxis is a symptom, can be caused by a variety of reasons. Epistaxis can not only be one of the common symptoms of nasal cavity and paranasal sinuses (small cavity inside the skull around the nasal cavity), but also can be the local manifestations of some systemic diseases (such as a small amount of hemorrhage and blood diseases that cannot normally stop on their own), which are more common before. Bleeding is mostly unilateral and bilateral hemorrhage is rare.
Is epistaxis serious?
Epistaxis can be caused by different diseases, and the amount and intensity of hemorrhage are different, so the severity is different. As far as the clinical manifestations of hemorrhage are concerned, mild cases may only show blood in the nasal discharge or blood-sucking nasal discharge, or only a small amount of blood dripping from the anterior nostrils, which is not very serious. However, especially for older epistaxis accompanied by moderate to severe hypertension, systemic diseases such as blood system diseases (anemia, leukemia, etc.), or accompanied by head and nose trauma, iatrogenic injury, nasal-paranasal sinus tumors or nasopharynx and nasal skull base tumors, etc., it should not be underestimated, which may lead to serious conditions, shock and even death.
4. Which diseases can cause epistaxis?
There are many causes of epistaxis, which are generally divided into two categories. One is the cause of nasal cavity and paranasal sinuses themselves, and the other is the systemic cause. Specific:
(1) Local etiology
1) Nasal and paranasal sinus trauma or iatrogenic injury: nasal bone, nasal septum or paranasal sinus fracture and sudden change of paranasal sinus pressure, nasal or paranasal sinus surgery, nasal intubation, nasal excavation, hard blowing of nose, severe sneezing, nasal cavity foreign bodies, etc., can all damage nasal mucosal blood vessels and cause hemorrhage.
2) Inflammation of nasal cavity and sinus: All kinds of nasal cavity and sinus infections can bleed due to mucosal lesions and vascular damage.
3) Nasal septum lesion: Nasal septum deviation, nasal septum erosion, ulcer or perforation are one of the common causes of hemorrhage.
4) Tumors: Bleeding from benign and malignant tumors of nasal cavity, paranasal sinuses and nasopharynx flows through the nose. Rupture of intracranial hemangioma near the top of nasal cavity can cause fatal epistaxis.
5) Climate factors: The climate in plateau area is dry, and nasal mucosa is dry and scabbed, resulting in epistaxis.
(2) Systemic causes: Epistaxis can occur in all systemic diseases that can cause abnormal fluctuation of blood pressure, blood dysfunction or damage to blood vessel wall.
1) Cardiovascular diseases: hypertension, arteriosclerosis, pulmonary heart disease, etc. are the most important systemic factors causing epistaxis.
2) Rheumatic fever: Epistaxis is an early symptom of rheumatic fever, which is mostly seen in children. Increased vascular fragility in rheumatic fever patients is the cause of hemorrhage.
3) Blood diseases: diseases with abnormal coagulation mechanism, such as hemophilia, fibrinogenesis disorder, abnormal proteinemia (such as multiple myeloma), collagen diseases after extensive application of anticoagulants, etc.; Diseases with too few platelets or abnormal function, such as thrombocytopenic purpura, leukemia, aplastic anemia, etc.
4) Liver and kidney diseases: cirrhosis and abnormal liver function affect the synthesis of prothrombin and fibrinogen, and uremia is easy to cause small blood vessel injury.
5) Nutritional disorders or vitamin deficiency: vitamin C, K, P or calcium deficiency.
6) Poisoning or drug side effects: Chemical substances such as phosphorus, mercury, arsenic and benzene can destroy hematopoietic system. Long-term administration of salicylic acid drugs can reduce prothrombin in blood, which may also occur when anticoagulants are needed to prevent thrombosis but lack monitoring of blood indexes.
7) Hereditary hemorrhagic telangiectasia: This disease is also common in family members because of lack of contraction of blood vessel walls, resulting in hemorrhage.
8) Endocrine disorders: mainly seen in women, epistaxis and aura epistaxis can occur during menstruation in puberty, epistaxis can also occur during menopause or the last 3 months of pregnancy. In addition, epistaxis caused by endometriosis is also related to endocrine.
9) Acute febrile infectious diseases: influenza, hemorrhagic fever, measles, malaria, nasal diphtheria, typhoid, hepatitis, etc.
10) Abuse of alcohol can reduce the synthesis of coagulation factors, resulting in bone marrow suppression, platelet inhibition and vitamin deficiency.
(3) Idiopathic epistaxis: In addition to the above causes of epistaxis, some patients with epistaxis can often be found clinically. Possible causes of epistaxis cannot be found in the whole process of the disease, and epistaxis does not bleed again after control. Such hemorrhage is called idiopathic epistaxis.
5. What should I do when I have epistaxis?
Epistaxis generally needs emergency treatment. Don’t be nervous and afraid. You can simply handle it at home, such as washing your nose with cold water, local cold compress, and pinch your nose to the middle on both sides. After that, it is recommended to go to the hospital to see a doctor, so that the doctor can clearly understand the cause of bleeding. It is even more so when frequent nosebleeds or each bleeding is not easy to stop.
Attention, don’t look up to stop bleeding, so blood will flow back into pharynx, easy to cause choking cough and even suffocation.
6. Is it feasible to treat epistaxis with folk prescription?
There are many kinds of folk remedies for epistaxis, Some apply traditional Chinese medicine to apply local rubbing, and some make specific postures and movements of limbs (lifting arms, pulling hands at each other, etc.). Most of these have not been verified by long-term medical science and cannot be believed. It may be effective for some minor epistaxis, but it is not suitable for all cases. If other methods cannot be adopted, try to use them cautiously.
7. Can epistaxis be treated at home?
For teenagers, Epistaxis is mainly located at the front end of nasal cavity, The amount of bleeding is generally small, After simple treatment such as cold compress, pinch bilateral nasal alar can also stop bleeding, can temporarily not to the hospital treatment. But if a large amount of bleeding, should immediately to the hospital, cannot delay, so as not to appear danger. Other cases of epistaxis, should be timely to the hospital. If epistaxis recurs, it is recommended to go to the hospital as soon as possible to clarify the reason.
8. Need hospitalization for epistaxis in what?
Mainly according to the patient’s own situation, the amount of bleeding, the degree of bleeding ferocity, whether there are more serious complications, whether it is the first bleeding to decide whether to need hospitalization. For the first small amount of bleeding of young patients, can temporarily not be hospitalized.
However, most elderly patients are accompanied by hypertension, diabetes, cardiovascular and cerebrovascular diseases, etc. For those with mild symptoms, doctors may suggest staying in hospital for observation for several hours. For those with more serious symptoms, they may suggest hospitalization for diagnosis and treatment to find out the cause of the disease. When necessary, hemostasis treatment will be carried out under emergency endoscopy to prevent hemorrhagic shock caused by uncontrollable epistaxis.
Other patients with epistaxis complicated with hematological diseases such as anemia and leukemia, as well as chronic kidney diseases and liver diseases, must be hospitalized as soon as possible.
9. What tests should be done when epistaxis occurs?
Epistaxis needs to be clear about the bleeding site, find out the cause of bleeding, and understand the whole body condition so as to stop bleeding as soon as possible. Therefore, a comprehensive examination is required. The details are as follows:
(1) Blood examination: Blood is drawn to test blood routine, coagulation mechanism, blood biochemistry, etc. to determine whether there is anemia, blood diseases, etc.
(2) Endoscopic examination: Using specially designed instruments to enter the nasal cavity for examination can accurately find out the bleeding location and carry out local treatment.
(3) Imaging examination: X-ray radiography, CT, MR, etc. of nasal cavity and paranasal sinuses are carried out to exclude tumors, etc.
(4) Surgical exploration: For intractable epistaxis, surgical exploration can be carried out to find out the potential risks.
(5) Other examinations: Angiography (contrast agent is used to show the blood vessels at the bleeding site) and other examination methods will be adopted when necessary.
10. What methods will doctors use to stop bleeding after hospitalization? Nasal cavity packing and nasal endoscope treatment is how to return a responsibility?
Epistaxis requires emergency treatment by doctors. While stopping bleeding, the cause of bleeding should be found as soon as possible.
(1) General treatment:
1) Quickly evaluate the general condition. Patients are agitated and can be injected with sedatives so as to cooperate with the treatment. Routine monitoring of blood pressure.
2) If there are shock symptoms, the patient shall be treated according to shock first, pay attention to heat preservation, make the patient lie on his side, inhale oxygen in time, carry out intravenous infusion, and prepare for blood transfusion.
3) For epistaxis caused by trauma, attention should be paid to respiratory tract conditions, which can be properly treated according to severity and priority. For those with respiratory tract obstruction, it should be relieved first.
4) Use different hemostatic drugs.
(2) Specific hemostasis methods: Sitting position or semi-sitting position should be adopted (shock patients should lie down with low head), and appropriate methods should be selected for hemostasis according to the bleeding situation and bleeding location.
1) Mild epistaxis: Most of them are hemorrhage in the anterior part of the nasal cavity, which does not cause systemic conditions. The method of pressing the nasal alar by fingers (pinching the nasal alar can also be adopted), electrocoagulation hemostasis (destroying the tissue of the bleeding site, which is blood vessel sealing or coagulation), submucosal injection of drugs, etc.
2) Moderate epistaxis: It is suitable for the situation with large amount of hemorrhage. There are mainly various nasal cavity packing methods, which are handled by specialists. The packing method is to use gauze and other nasal cavity packing to compress the bleeding part, so that the ruptured blood vessels form thrombus and achieve the purpose of hemostasis. The success rate of packing under nasal endoscope is above 90%. The main methods are:
① Anterior nostril tamponade: After the anterior nasal mirror was used to identify the bleeding site, Doctors will fill their nostrils with vaseline gauze, Repeatedly overlap stuffing in the nasal cavity, maintain a certain pressure. This method is used for nasal septum and nasal anterior bleeding, with good effect. During the operation, the doctor will perform nasal mucosal surface anesthesia, the patient does not have too much pain, and most of them can tolerate it. After the stuffing is completed, the patient should pay attention to moderate activities, eat semi-liquid diet, and do not blow your nose and sneeze hard.
(2) punctate packing method: This packing requires a specially designed nasal endoscope to enter the nasal cavity, Can see the bleeding site clearly on the monitoring screen. The doctor aligned the hemostatic materials (such as various hemostatic sponges), Direct and accurate compression of bleeding points, Avoid oppressing other normal parts as much as possible. This method overcomes the blindness of packing, It is suitable for bleeding in various parts of nasal cavity, including posterior nostril bleeding. The effect is excellent and worthy of clinical promotion. This kind of situation also generally adopts nasal mucosal surface anesthesia, with little pain and basically tolerable to patients. The matters needing attention after completing tamponade are the same as the anterior nostril tamponade method.
3) Severe hemorrhage and repeated intractable hemorrhage: Posterior nostril tamponade can be applied.
Posterior nostril tamponade: From the anterior and posterior ends of the nasal cavity, Before and after [attack], The effect is definite. The doctor first inserted a guide tube back from the nostril on the bleeding side, Then to the pharynx, Pull it out of the mouth. Then fasten a conical hemostatic gauze ball. At this time, the guide tube in the nostrils is pulled out, In this way, the conical hemostatic gauze ball is pulled to the posterior nostril and tightened. Then the anterior nostril tamponade is performed. The posterior nostril tamponade method has definite curative effect, but the patient suffers greatly, and some patients need to be operated under general anesthesia. The posterior nostril tamponade method is prone to infection, severe headache and other complications, and has gradually been replaced by endoscopic counterpoint tamponade.
4) Surgical treatment: It is suitable for epistaxis caused by various tamponade treatments that are ineffective and tumors. According to the bleeding site, different blood vessels are ligated or tumors are removed at the same time.
5) Interventional therapy: It is suitable for epistaxis caused by hemangioma and other diseases, with less damage to patients but more cost.
11. Is it painful to stop bleeding by stuffing nose?
Nasal tamponade can cause varying degrees of pain, In particular, choanal tamponade can cause severe pain, Common manifestations include: Headache, facial distension, sore throat, choking cough, fever, etc. Patients have different tolerance, The degree and way of pain expression are also different, and they can generally tolerate and adapt to it. Now, with the promotion of nasal endoscopy, the appearance and use of various new packing materials have greatly reduced the pain of packing. If the pain is unbearable, you can ask a doctor to apply drugs for symptomatic treatment to relieve the pain so as not to affect the whole body condition.
12. Does epistaxis require blood transfusion?
Epistaxis requires less blood transfusion. If it is due to the lack of coagulation factors, the amount of bleeding is large. More blood loss, anemia and even hemorrhagic shock, need timely blood transfusion. Monitoring blood indicators is decisive to guide blood transfusion. If anemia and other blood system diseases already exist before epistaxis, more actively prepare for blood transfusion.
13. Does epistaxis need surgery?
Generally, it is not required, but if the following two situations occur, surgical treatment needs to be considered.
(1) Severe hemorrhage or repeated intractable hemorrhage requires vascular ligation and interventional surgery. If the patient’s tolerance is poor, nasal packing also needs to be performed under general anesthesia.
(2) Need to remove bleeding tumors, such as nasopharyngeal hemangioma, etc.
14. Do you need to pay attention to what when eating epistaxis?
Pay attention to one [supplement] and one [taboo]. We should not only supplement nutrition, but also avoid irritating diet.
(1) Pay attention to supplement foods rich in nutrition, especially vitamins, pay attention to the temperature should not be too high, soft fluid is good. You can eat more fresh vegetables such as shepherd’s purse, celery, lotus root, etc. These vegetables are rich in vitamin A, vitamin C and vitamin E, which is helpful for hemostasis.
(2) Pay attention to avoid spicy and irritating food. No drinking or smoking. Do not eat fried or barbecued food, so as not to aggravate dryness and cause epistaxis.
15. Can you move when you have epistaxis?
A small amount of epistaxis can be properly moved, but no strenuous exercise can be carried out. If epistaxis is more frequently treated by nasal packing or surgery, the doctor’s advice should be strictly observed, and no self-movement should be carried out to avoid causing bleeding again. When activities are allowed, they should also be carried out step by step, gradually increasing the amount of activities, and do not rush for success.
16. Does hypertension cause epistaxis?
Hypertension is a single factor affecting the process of epistaxis. Hypertension itself can cause epistaxis. Even if epistaxis is caused by other factors, Such as colds, However, if hypertension is combined, it is more difficult to stop bleeding. Therefore, No matter what causes epistaxis, Be sure to strictly measure and control blood pressure. It should be noted that higher blood pressure can not only cause epistaxis due to vascular rupture in nasal cavity, but also cause epistaxis due to vascular rupture in brain, thus causing cerebral hemorrhage. For hypertension patients, blood pressure fluctuation and epistaxis are very noteworthy early warning.
17. Can epistaxis cause blood sugar fluctuation?
Epistaxis process is relatively urgent, can cause systemic stress reaction, thus affecting blood sugar. If epistaxis patients themselves have diabetes, or older, it is necessary to monitor blood sugar to prevent hypoglycemia or rapid rise of blood sugar, causing coma and other complications.
18. Can a cold cause epistaxis?
Common cold is the common name of acute rhinitis. Inflammatory reaction occurs in nasal mucosa when catching a cold. On the one hand, runny nose, nasal obstruction, headache and other symptoms occur. On the other hand, blood vessels of nasal mucosa will be damaged, causing epistaxis.
19. Can tumors cause epistaxis?
Tumors in nasal cavity and sinuses and adjacent areas, Whether benign or malignant, All may cause epistaxis. Benign tumors can cause local vascular density increase, varicose and other bleeding. However, malignant tumors can directly destroy blood vessels and cause ulcers to cause stubborn hemorrhage. Therefore, When epistaxis is necessary, CT, MRI and other examinations should be carried out to investigate tumors. In addition, hematological tumors, such as leukemia and aplastic anemia, affect the normal function of blood, and the generation of coagulation factors can also cause epistaxis when liver tumors lead to serious damage to liver function. Epistaxis is rare due to tumors of other systems.
20. Why are children prone to epistaxis?
Children are in a period of relatively rapid physical development, Epistaxis is more common. If it is combined with partial eclipse and dry air, It is more likely to lead to dryness and erosion of nasal mucosa. Plus, children like to dig their noses, It is more likely to cause vascular rupture, Epistaxis occurs. Children’s epistaxis is mostly located at the front end of the nasal cavity, and can achieve good results through simple compression and nasal cavity front end tamponade treatment. Therefore, children’s epistaxis generally does not have too big a problem. However, attention should be paid to eliminating important causes such as anemia, leukemia, etc. Pay attention to diet balance at ordinary times.
21. Why is it difficult to stop epistaxis in the elderly?
The blood vessels of the elderly are brittle, and the bleeding position is mostly at the posterior end of the nasal cavity. It is difficult to determine the bleeding point and the nasal cavity is difficult to fill in place. In addition, it is often complicated with hypertension, diabetes and even other systemic diseases, which increases the difficulty of treatment. Therefore, the elderly should be doubly vigilant and careful when epistaxis occurs.
22. What should be paid attention to during epistaxis during pregnancy?
Pregnant epistaxis should be more careful. Pay attention to the safety of various drugs, including local drugs, when performing hemostasis treatment. If epistaxis is serious, the pros and cons should be weighed and obstetricians and gynecologists should be consulted to choose the best treatment plan.
23. How long does it take to recover from epistaxis after hemostasis?
Ruptured blood vessels are generally closed for about 72 hours, and the recovery time for the elderly is longer. When the nasal cavity is stuffed with hemostatic materials removed, attention should still be paid to diet control and appropriate activities. Individual serious cases, especially when accompanied by primary diseases, may take longer to recover.
24. Is epistaxis easy to repeat?
Epistaxis is not easy to recur after effective treatment and recovery. However, recurrence of hemorrhage may occur in the following situations:
(1) Bleeding caused by tumor.
(2) Bleeding caused by blood system diseases.
(3) Patients with hypertension.
(4) Epistaxis caused by craniocerebral trauma.
(5) Epistaxis patients with severe abnormal liver and kidney functions, etc.
25. How takes care of epistaxis patients?
Patients with epistaxis are generally nervous and suffer from treatment, especially nasal tamponade and surgery. Therefore, careful and comprehensive care is needed. When taking care of patients with epistaxis, the following aspects should be done well:
(1) First of all, comfort the patient, keep quiet and relieve the patient’s fear.
(2) Help patients clean facial blood, change clothes and bedding, and be careful and thoughtful.
(3) Pay attention to keep indoor air humidity, dry air is not conducive to hemostasis.
(4) If they are treated in hospitals, they should actively cooperate with medical staff.
26. How should pay attention to prevent epistaxis at ordinary times?
Whole body health is the most important basis for preventing epistaxis. Pay attention to the following points:
(1) Pay attention to strengthening physical fitness in daily life, diet control, combination of work and rest, drinking more water, keeping defecation and urination unobstructed, and avoiding excessive force during defecation.
(2) Keep the indoor air clean and moist.
(2) Hypertensive patients should pay attention to regular blood pressure measurement and control blood pressure not to fluctuate up and down.
(4) Patients suffering from blood system diseases should be actively treated and their blood status should be monitored.
(5) Pay attention to the study of relevant medical knowledge, so as to be prepared for emergencies.
27. Is picking nostrils easy to cause epistaxis? What if your nostrils are dirty?
Accidental picking of nostrils generally does not cause epistaxis. However, if you pick your nostrils repeatedly or improperly, It is possible to damage the mucosa in the nasal cavity and cause epistaxis. Nasal cavity mucosa is also easy to cause hemorrhage when inflammation occurs. If nostrils are dirty, normal saline can be applied to clean the nasal cavity, which not only cleans the nasal cavity, but also moistens the nasal cavity, protects the nasal cavity mucosa and reduces the possibility of epistaxis.
28. Wrestling Collision Causes Epistaxis Need to Be Alert to what?
Epistaxis caused by wrestling, basketball and other strenuous sports injuries to the nose and face is more common. Mainly nasal cavity mucosal laceration, nasal bone surrounding nasal cavity scaffold and other fractures tear blood vessels, The occurrence of epistaxis is mostly not too serious. However, we need to be alert to the possibility of skull base fracture, because skull base fracture can cause large blood vessel injury, leading to fierce hemorrhage and not easy to stop bleeding in a short period of time, even damaging dura mater, cerebrospinal fluid rhinorrhea, causing life danger.
29. What is the bleeding of ear and nose at the same time?
Simultaneous bleeding of ear and nose is relatively rare, generally with the following conditions:
(1) Serious trauma, at the same time injured the ear and nasal cavity or the skull structure connected with the ear and nose are seriously damaged, blood flows out of the pipeline, causing hemorrhage.
(2) Lesions in the middle ear cause hemorrhage. Blood can flow out of the external auditory canal or pass through the eustachian tube (the pipeline connecting the middle ear cavity and the posterior end of the nasal cavity) to reach the posterior part of the nasal cavity, resulting in epistaxis.