Nosebleed

A nosebleed or nose bleed, medically known as epistaxis, is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the sinus and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause upset stomachs and vomiting.

Causes

There are several causes for the nosebleed including trauma (such as hitting the nose), fracture (broken nose), pressure (such as may be caused by altitude), anticoagulant (anti-clotting) medication, excessively dry air, excessive nose-picking, allergic rhinitis and high blood pressure among the elderly. Some rare diseases that may cause nosebleeds are Wegener's granulomatosis and hereditary hemorrhagic telangiectasia (HHT, Rendu-Osler-Weber disease); sarcoidosis, when it involves the nose, has been reported to cause nosebleeds. von Willebrand disease may cause nosebleeds. In some rare cases, the cause of a nosebleed can be cancer of the head and neck or nasal polyps.

Both the frequency of spontaneous epistaxis and the length and severity of bleeding can be increased by anticoagulants. These may include prescription medications such as warfarin or aspirin as well as herbal supplements such as ginkgo. Cultures with a diet rich in fish sources that include high levels of omega-3 fatty acids (especially the Inuit) have also been observed to experience a higher incidence of nosebleeds. Athletes and bodybuilders who supplement their diets with fish oil also report increased frequency of nosebleeds.

Pathophysiology

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause the tears, while inflammation, coagulation problems and other disorders may make the injury harder to repair.

Treatment

The flow of blood normally stops when the blood clots, which may be encouraged by direct pressure. Medical opinion is divided on whether the best position to apply pressure is the bridge of the nose or the fleshy part. It is also undecided as to whether it is better to tilt the head forward during this procedure (to drain the blood and prevent it from flowing down the throat and into the stomach) or backward (to minimize the volume of blood in the nose). Petroleum jelly is often used to stop the blood from seeping out, but should not be used; as it is petroleum based, it actually further dries out the nasal cavity .

Chronic epistaxis resulting from a dry nasal mucosa is often treated by spraying saline in the nose up to three times per day.

If pressure, ice on the bridge of the nose, application of a vasoconstrictor, or other techniques do not work, a nasal tampon is usually the next step. The nasal tampon stops the bleeding by applying pressure from inside of the nose and is usually kept in for 1-3 days.

Persistent epistaxis is an indication for urgent medical consultation. Nasal packing, cryosurgery, electrocautery or application of trichloroacetic acid are options that may be used in severe epistaxis.

It is uncommon to die from bleeding through nosebleeds. However, damage to the maxillary artery can lead to rapid blood loss via the nose and present difficulty in treatment, pressure, vasoconstrictor and rhinocort occasionally proving ineffective. Ligation of the artery, risking damage to the facial nerves, may be the only solution.

Nevertheless, severe protracted nosebleeds may cause anemia due to iron deficiency.

Famous nosebleeds

Attila the Hun, a legendary commander and the founder of an empire, is reputed by the contemporary historian Priscus to have died of a nosebleed after his wedding. However, the nosebleed only proved to be fatal as the blood ran down Attila’s throat causing him to choke to death. This occurred as a result of Attila the Hun being intoxicated and horizontal during the onset of the nosebleed.

Andrew W.K.'s debut album depicts himself with a bloody nose on the cover. Many music retailers covered the image with a black sticker.

Nosebleeds feature on the Icelandic band Sigur Rós's 2005 album, Takk.

Nosebleeds in fiction

In anime and manga, it is very common to see sexually aroused characters getting nosebleeds, sometimes brutal ones. This rarely occurs in real life, but is based on Japanese old wives' tales, which say that getting too sexually excited leads to a nosebleed. Such occurrences are generally played for laughs and signify loserhood and/or virginity.

In the second series of the dark British sketch show The League of Gentlemen, the central storyline was about a plague of lethal nosebleeds accidentally caused by Royston Vasey's butcher Hilary Briss, and his imports of "Special Stuff". Nearly everyone involved in the plague was arrested, except Hilary who escaped to the Caribbean, still trading in his "Special Stuff", and leading to a plague of nosebleeds over there.

External links

stop-nosebleeds.org - describes the Thumbs Up method of stopping nose bleeds

Otolaryngology | First aid | Injury | Symptoms