Pediatric rhinorrhea is strictly a common symptom in rhinology and is not the name of the disease. Often, lesions of the nasal-sinus and its adjacent organs, trauma, hypertension, and systemic chronic diseases causing rhinorrhea are its common causes. Since rhinorrhea is one of the rhinological emergencies, clinically, depending on the cause and the degree of bleeding, different management measures must be actively taken to avoid subsequent complications. The prognosis of nosebleeds in children is generally much better than that of adults. About 90% of nosebleeds can be stopped within a short period of time and mostly do not require hospitalization. For children with nosebleeds that cannot be stopped after first aid treatment, or those with recurrent bleeding, the following treatment methods are available: Local hemostatic treatment 1. Cautery method: For children with small bleeding volume, clear bleeding points, or recurrent nosebleeds, cautery methods such as 30% silver nitrate, 30% trichloroacetic acid, YGA laser, microwave, etc. can be used. Sometimes several intermittent cautery sessions are required and surface anesthesia should be used before cautery to reduce pain in the child. Cautery method is one of the most common treatment methods for rhinorrhea in children, and the efficacy is relatively certain.
2.Filling method: It is commonly used for diffuse rhinorrhea caused by systemic diseases or trauma. For nasal bleeding with a small amount of bleeding but the bleeding site cannot be determined, the anterior nasal cavity can be filled with gelatin sponge and absorbable swelling material, which is less painful for children; for bleeding with a larger amount and the bleeding site cannot be determined for a while, in order to achieve the purpose of timely hemostasis, the anterior nasal cavity can be filled with Vaseline gauze to achieve the purpose of hemostasis by compression. In general, the effect of hemostasis can be achieved in children, but this method has great discomfort for children, and it is recommended that the filling should not exceed 72 hours.
In recent years, we have used balloon dilatation pressure to stop bleeding, which has achieved better results, with less pain for the child and less damage to the nasal mucosa when the pressure is removed, which will not cause secondary bleeding; for nasopharyngeal bleeding, balloon hemostasis also has great advantages, and can replace posterior nostril oil gauze stuffing. However, balloon compression hemostasis is generally recommended under nasal endoscopy and must be performed after clarifying the site of nasal bleeding.
3.Vascular ligation method: For repeated bleeding despite the above treatment, or massive bleeding caused by trauma, or to prevent excessive intraoperative bleeding before nasopharyngeal hemangioma surgery, ligation of relevant vessels can be performed. Generally speaking, the following principles are followed: for bleeding below the inferior plane of the middle turbinate, ligation of the maxillary artery or external carotid artery; for bleeding above the inferior plane of the middle turbinate, ligation of the anterior sieve artery; for bleeding from the anterior nasal septum, ligation of the superior labial artery. Vascular ligation is only a kind of emergency treatment method, because the vessels often have the formation of collateral circulation, so the follow-up treatment should also follow, otherwise there is still the possibility of bleeding.
4.DSA vascular embolization method: It is a method of interventional treatment, especially for unexplained hemorrhage in the nasopharynx of the posterior nostril with clear diagnosis and treatment; for nasopharyngeal fibrovascular tumor with diagnosis and preoperative preliminary treatment. It has a bit of accuracy, safety and speed than the traditional vascular ligation, but there are very few children with complications such as transient hemiplegia and blindness, which need to be treated with caution.
In conclusion, for hemostasis of nasal bleeding, it is now advocated to use operation under nasal endoscopy before or during hemostasis to find the bleeding point first and then perform relevant hemostasis, which is both minimally invasive and intuitive and has achieved good results in clinical application.
Systemic medication Children with nasal bleeding tend to be nervous and panic, so sedatives can be used appropriately to slow down the bleeding. The use of hemostatic drugs should be carried out at the same time as emergency hemostasis, and the commonly used drugs include Lithopodium, Aniloxin, Hemostatin and Thrombin; while vitamin C, K and P should also be input intravenously at the same time. For those who have lost a lot of blood, the amount of bleeding should be counted and rehydrated in time. For patients who have already suffered from shock, in addition to timely correction of shock, attention should be paid to the possibility of multi-organ injury brought about by hypoperfusion and timely treatment. During the remission period of rhinorrhea, the child should also be actively treated for systemic diseases, such as hematological diseases and liver and kidney dysfunction.
Surgical treatment For older children with recurrent rhinorrhea, nasal septal scoring can be considered, and even submucoperiosteal dissection of the nasal septum can be performed over the age of 12. The injection of sclerosing agent is rarely used at present, and it is easy to cause damage to the nasal septum, such as nasal septal perforation.