22
Epistaxis
What is Epistaxis?
Epistaxis is the medical word for a nose
bleed. Epistaxis is a common condition
and has many causes. The most common
bleeding site occurs from the anterior
nasal septum, from thin-walled blood
vessels at the front of the nose, also
known as Little’s area. However, epistaxis
can also arise from the posterior nasal
cavity.

Who is likely to suffer from epistaxis?
 Slightly more common in men than
women.
 Tend to affect the elderly but are
also very common in children.

What causes epistaxis?
 High blood-pressure and drinking a
lot of alcohol may increase the risk
of epistaxis. It is sensible for all
patients to have their blood
pressure checked regularly,
especially if they are having
repeated epistaxis.
 Nosebleeds are a common sideeffect of medications such as
Aspirin and Warfarin. These
medications change the way blood
clots in the body and are commonly
prescribed for patients with heart
disease. If you are taking any of
these medications and you develop
epistaxis, do not stop taking your
medication unless advised to do so
by a doctor.


Nose-picking can damage the lining
of the nose, leading to epistaxis.
In young people, epistasxis can be
caused by problems in blood
clotting. Patients should be aware
of prolonged bleeding after any
minor cuts, tooth extractions or if
the skin bruises easily. Some
simple blood tests may be required
under these circumstances.
Infection in the nose i.e. allergic
rhinitis.
Drying of the inside of the nose e.g.
in the winter.
What should you do if you have an
epistaxis?
Initial treatment to stop the bleeding is to
forcefully pinch the nostrils (‘fleshy’ part)
firmly together for 10-20 minutes, just
below the nasal bones. You should keep
your head bent forward during the bleed
and to cough up rather than swallow any
blood as this may cause nausea and you
may vomit the swallowed blood, and to
also prevent aspiration. Breathing through
your mouth will help a clot to form.
Application of an ice pack to the forehead
or bridge of the nose and the back of the
neck can also be helpful.
The cold
encourages the blood vessels to narrow
and this reduces bleeding.
If this is the first time you have had an
epistaxis and the bleeding stops after 15
minutes with pressure, no further
treatment or tests are likely to be needed.
You should avoid straining on the toilet
and strenuous exercise for a few days
22
after you have had an epistaxis.
Following an epistaxis
 Do not pick your nose. It takes
seven to ten days to completely
heal the torn blood vessels. If you
pick your nose you will peel the
scab off and cause another
epistaxis.
 Cut down on smoking (if you
smoke). Smoking dries out the
nasal membrane, which makes the
blood vessels in them more prone
to bleeding. Stopping smoking will
keep them moist.
 If you are prone to regular epistaxis
it may be wise to avoid aspirin,
which thins the blood. If you need
to take it regularly, discuss this with
your GP.
When to see a doctor?
If the bleeding is severe and continues
after applying pressure for 15 minutes then
you need to attend accident and
emergency immediately.
If the bleeding always stops with pressure
but happens repeatedly, you should
consult your own GP for advice.
How do doctors treat epistaxis?
There are a number of different ways that
doctors can treat epistaxis. In most
circumstances, modern technology allows
doctors to look for the bleeding point inside
your nose and ‘seal it off’ (cauterise). This
can be a fast and effective treatment for
nosebleeds. The doctor will do this by
applying a chemical called ‘Silver Nitrate’
to the lining of your nose. This is usually
done after putting some local anaesthetic
solution into the nose. This procedure is
not painful and is an effective treatment.
If the epistaxis is severe, it may be
necessary to apply constant pressure to
Epistaxis
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© Chesterfield Royal Hospital NHS Foundation Trust
Reviewed Date: March 2014
Next Planned Reviewed Date: March 2016
Division: Surgical Specialties
stop the bleeding. This can be done using
nasal packing. There are various types of
nasal packs that can be used that are
made of material or sponge and are
placed inside your nose to stop the
bleeding. The type of packing used is the
preference of the doctor and the extent of
the bleeding. Sometimes, both sides of
the nose are packed to apply as much
pressure as possible. Nasal packing is
very uncomfortable, but very effective. It
takes about 5 minutes.
When the nasal pack is in place you will
only be able to breathe through your
mouth, which will make the mouth and
throat dry. The pack also blocks drainage
from the sinuses so you may experience
headaches. Packs are usually kept in for
24-48 hours and then removed.
If
bleeding continues different packs may be
used or you may have to be taken to
theatre for an operation.
Will an operation be required to treat
epistaxis?
Very occasionally the treatments
described above are not successful. The
next option for ENT doctors is to perform
an operation to stop the bleeding. There
are several different types of operation that
can be performed to stop epistaxis.
ENT doctors can use telescopes and
diathermy to stop bleeding from areas
deep within the nose. Another operation
(called Sphenopalatine Artery Ligation)
involves sealing off the main blood vessel
in the nose. This blood vessel is located
behind your cheek.
CONTACT NUMBERS
If you experience any difficulties or wish to
discuss it any further please telephone the
ENT department between the hours of
9am and 5pm Monday to Friday. Tel. No.
01246 512098.