Episyaxis

1. EPISTAXIS
BY
DR PULLA UMA MAHESWARI
DEPARTMENT OF
PAEDIATRICS
PG PART - II

2. • Bleeding from inside the nose is called
epistaxis.
• Seen in all age groups.
• Epistaxis is a sign and not a disease per se.
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INTRODUCTION

3. CAUSES OF EPISTAXIS
• Divided into :
Local, in the nose or
nasopharynx.
General
Idiopathic
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4. Local causes
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NOSE :
1) Trauma
2) Infections
 Acute : viral rhinitis, nasal diphtheria, acute
sinusitis.
 Chronic : All crust-forming disease, e.g.
atrophic rhinitis, rhinitis sicca.
3) Foreign bodies.
 Non-living: Any neglected foreign body,
rhinolith.
 Living: Maggots leeches.
4) Neoplasms of nose and paranasal
sinuses.
 Benign: Haemangioma, papilloma.
 Malignant: Carcinoma or sarcoma
5) Atmospheric changes.
 High altitudes, sudden
decompression.
6) Deviated nasal septum.

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Nasopharynx :
1)Adenoiditis
2)Juvenile angiofibroma
3)3) Malignant tumours

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B) GENERAL CAUSES :
1) Cardiovascular system. Hypertension, arteriosclerosis.
2) Disorders of blood and blood vessels.
3) Liver disease, Hepatic cirrhosis
4) Kidney disease. Chronic nephritis.
5) Drugs. Excessive use of salicylates and other analgesics anticoagulant therapy
6) Mediastinal compression. Tumours of mediastinum (raised venous pressure in
the nose).
7) Acute general infection.
8) Vicarious menstruation (epistaxis occurring at the time of menstruation).

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SITES OF EPISTAXIS :
1) Little’s area. In 90% cases.
2) Above the level of middle turbinate.
3) Below the level of middle turbinate.
4) Posterior part of nasal cavity.
5) Diffuse. Both from septum and lateral nasal wall.
6) Nasopharynx

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9. Classification
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 Anterior epistaxis
 Posterior epistaxis

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ANTERIOR EPISTAXIS POSTERIOR EPISTAXIS
More common Less common
SITE
Mostly from Little’s area or anterior part
of lateral wall
Mostly from posterosuperior part of
nasal cavity
AGE
Mostly occurs in children or young adults After 40 years of age
CAUSE Mostly trauma Spontaneous; often due to
hypertension or anteriosclerosis
BLEEDING Usually mild, can be easily controlled by
local pressure or anterior pack
Bleeding is severe requires
hospitalisation; postnasal pack
often required

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In any case of epistaxis, it is important to know :
1) Mode of onset.
2) Duration and frequency of bleeding.
3) Amount of blood loss.
4) Side of nose from where bleeding is occuring.
5) Whether bleeding is of anterior or posterior type.
6) Any known bleeding tendency in the patient or family.
7) History of known medical ailment (hypertension, leukaemias, mitral valve
disease, cirrhosis, nephritis).
8) History of drug intake (analgesics, anticoagulant, etc.)
MANAGEMENT

13. FIRST AID
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 Pinching the nose with thumb and index finger for
about 5 minutes.
 This compresses the vessels of the Little’s area.
 In Trotter’s method patient is made to sit, leaning a
little forward over a basin to spit any blood, and
breathe quietly from the mouth.
 Cold compresses to the nose to cause reflex
vasoconstriction.

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 If bleeding is profuse and/or the site of bleeding is difficult to localise, anterior packing
should be done
 Ribbon gauze soaked with liquid paraffin.
 About 1 metre gauze (2.5 cm wide in adults and 12 mm in children) is required for each
nasal cavity. First, few centimetres of gauze are folded upon itself and inserted along the
floor, and then the whole nasal cavity is packed tightly by layering the gauze from floor to
the root and layering the gauze from floor to the roof and from before backwards.
 One or both cavities may need to be packed.
 Can be removed after 24 hours if bleeding has stopped.
 If it has to be kept for 2 to 3 days; systemic antibiotics should be given to prevent sinus
infection and toxic shock syndrome.
ANTERIOR NASAL PACKING

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For patients bleeding posteriorly into the throat.
A postnasal pack is prepared by tying three silk ties to a piece of gauze
rolled into the shape of a cone.
Patients requiring postnasal pack should always be hospitalised.
Folley’s catheter can also be used.
 Nasal balloons are also available.
POSTERIOR NASAL PACKING

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ANTERIOR NASAL PACKING POSTERIOR NASAL PACKING

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RUBRICS

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THANK YOU