Nose Bleeds

Nosebleeds are a common clinical picture that worries our patients. It usually occurs in two ways: frequent and small amounts of bleeding in young and children; These bleedings are mostly 1 cm of the nose. they originate from behind. This is an area where blood vessels are very dense. The most common cause of nosebleeds in children is nose picking. Children confuse their noses, damage the area that is very dense from these capillaries and cause recurrent nosebleeds. Nosebleeds are also common in dry weather and in those with upper respiratory tract infections.

In our elderly patients, on the other hand, we see severe bleeding that does not stop spontaneously, mostly originating from the posterior regions of the nose, and which we often have to hospitalize. These hemorrhages mostly occur in blood pressure patients and in the use of blood thinners such as aspirin, heparin, coumadin, and plavix used by our patients and have a serious course.

Regional causes of nosebleeds include; blowing the nose, nasal fractures, facial and skull fractures, nose picking, cortisone drugs sprayed into the nose, and cocaine use can be counted. In addition, due to the curvature of the cartilage and bone in the nose, the air flows quickly from the narrow area, drying the nose, crusting occurs and nose bleeding can be observed. As we all observe, nosebleeds can often occur with infections such as upper respiratory tract infections, colds, flu, and sinusitis. Benign and malignant tumors of the nose, nasal cavities and nasal passages also cause intense nosebleeds. Vascular tumors seen in boys in adolescence can also cause severe bleeding.

Let’s come to the causes of nosebleeds that concern our whole body: coagulation problems, coagulation diseases such as hemophilia, von Willebrand, vitamin K deficiency, conditions that cause a decrease in blood clotting cells (platelets) due to drugs or diseases, liver diseases and alcohol intake cause nosebleeds. As a result of wrong teachings in our society, many people use aspirin whenever they think of it. As a result of the use of aspirin and similar blood thinners without the advice of a doctor, unstoppable bleeding occurs not only in the nose, but also in many areas, and our patients suffer from this. Aspirin prolongs the bleeding time by 1 week and during this period, coagulation problems are experienced in the treatment. We recommend that blood thinners are based on a diagnosis, the duration of treatment is determined by the physician, and the bleeding-coagulation parameters are checked regularly. It is recorded as high blood pressure (hypertension) and atherosclerosis, often causing bleeding in advanced ages. By the way, as an anecdote, it is an untrue belief that it is good for a patient with high blood pressure to have nosebleeds, so that he does not have a brain hemorrhage. Cerebral hemorrhage is observed in hypertensive patients even without epistaxis. Even in bleeding, which frightens our patients, the amounts are less than a glass of water. The situation will be better understood when the existence of a total of 5 liters of blood circulating in our body is remembered.

What should our patients do in case of nose bleeding before coming to the hospital?

If you want, let’s start with what not to do first; The head should not be thrown back, and whatever is nearby should not be stuck in the nose like cotton wool. This only ensures that the nosebleed comes from the nasal cavity, not from the front, it does not stop the bleeding. Wetting the head and putting ice on the neck are not very useful measures. The truth is, it is to clean the nose with cold water without blowing too much and press it hard on the wings of the nose with 2 fingers of one hand. If it is still bleeding after pressing for 5 minutes, it is necessary to clean the inside of the nose with cold water, remove the clots and stop the bleeding by pressing the wings of the nose with 2 fingers again. This process can be repeated several times. In this way, 90% of nosebleeds are stopped. For non-stop bleeding, an ENT specialist should be consulted.

What do we do when a patient with a nosebleed comes to the hospital?

Diagnosing is not always easy. Because the complaints of our patients are not specific to this disease. First of all, a detailed history should be taken from our patients, their diet, lifestyles, body mass indexes (weight/height2), smoking, alcohol, tea, coffee habits, stomach upsetting drug use, time between dinner and hospitalization, chocolate, nuts, bitters, vinegar. , hot sauces, fatty and sugary eating habits, their ability to cope with stress and stress, and even the use of narrow belts and clothing should be questioned. The previous stomach diseases of our patients, the drugs they used for these diseases and the surgical operations they had are also points that we need to know.

First of all, the patient should be calmed down, the bloody towels and similar cloths should be discarded, his face should be wiped and additional drugs should be administered if necessary, and his intense anxiety should be relieved. During the intervention, information should be obtained about the location, severity, frequency and amount of bleeding. The general condition of our patients before bleeding, the drugs they use, recent infections, smoking, alcohol habits, surgeries and coagulation-related diseases should be questioned. The patient’s blood pressure is measured, his head is tilted forward. Clots are removed by cleaning the nose with cold water. Bleeding is controlled by placing cotton pads that are impregnated with narcotic drugs and astringent drugs. The bleeding focus is determined. The nose and nasal passages are examined with appropriate light endoscopes. In the meantime, if the blood pressure is high, it is lowered and blood tests are done to understand the amount of bleeding and to detect the coagulation status. If bleeding still continues afterward, the bleeding vessels in the nose are burned by chemical or electrical means (cauterization). If the patient is using a blood thinner drug, burning cannot be done because it will increase the bleeding more. If necessary, various buffering materials can also be used to control bleeding. Nowadays, we prefer thick paper-like (spongostan, surgicel) materials that dissolve by themselves and contain substances that reduce bleeding. In recent years, we have been using balloons that can swell and apply pressure to the bleeding vessel in anterior and posterior nosebleeds in persistent bleeding that does not stop with these materials. We generally prefer these balloons for bleeding in the back of the nose. As in the past, we do not prefer the use of cloth tampons for meters into the nose. Because when removing these tampons, nosebleeds occur and the tissues inside the nose are damaged. If the cause of nosebleeds is due to simple reasons such as upper respiratory tract infection or nasal congestion, we usually recommend nasal sprays to moisturize the nose, creams to heal the nasal mucosa, and antibiotics if necessary. Nasal veins astringent sprays and creams should not be used for a long time.

Which patients do we have to hospitalize?

Bleeding from the back of the nose, patients using blood thinners, patients with recurrent bleeding, patients with hypertension, nasal breathing-blocking balloons, tampons, etc. Elderly patients with heart, lung and respiratory problems should be hospitalized and kept under close follow-up, necessary tests should be performed and appropriate drugs should be given. Of course, there are also patients who continue to bleed despite what has been said. In this very small percentage of our patients, necessary interventions are made in the operating room, and the bleeding vessel is ligated or operations to obstruct that vessel are required. If the patient’s bleeding is caused by the curvature of the nose, this curvature should not be corrected with surgery. As a result, nosebleeds are a result that should be considered. The reason for this result should be investigated and more serious diseases, if any, should be identified and treated.

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