Rhinorrhea is one of the common emergencies in otolaryngology. It can occur throughout the year, more often in dry climates. It is especially common in children. Nasal bleeding is easy to diagnose, but because the nose is located in the middle of the face, watching the blood flowing out often makes people panic or delay treatment due to improper handling. The bleeding can be stopped on its own if the amount of bleeding is small, but if the amount of bleeding is large, you should go to the hospital immediately.
Causes and characteristics of nosebleeds
There are many causes of rhinorrhea, which can be caused by diseases of the nasal cavity itself, or induced by diseases around the nasal cavity or systemic diseases. They are broadly classified into two types: local and systemic.
There are three local causes.
1, trauma. Mechanical trauma such as nose digging, nasal foreign body, deviated nasal septum, etc.; nasal bleeding caused by injury in surgery.
2, Various bright benign and malignant tumors can appear nasal bleeding, such as malignant tumors of nasal cavity and sinuses, etc.
3.Nasal inflammation, such as rhinitis and special infection of nasal cavity, etc.
Systemic causes, such as bleeding diseases and blood diseases, influenza, measles, typhoid, uremia, vitamin deficiency, endocrine disorders and other diseases can cause rhinorrhea.
Nasal bleeding is mostly manifested by blood flowing from the front nostrils or to the pharynx through the posterior nostrils, and both conditions can occur at the same time in case of heavy bleeding. Sometimes the nosebleed flows to the pharynx, which may appear as “vomiting blood”. When the nosebleed is serious, more blood is swallowed, which can cause abdominal pain, pallor, sweating and vomiting of coffee-like substance after stimulating the stomach, which is due to the reaction between stomach acid and blood and turns into coffee color. Some children may also have black stools. When the amount of bleeding is too large, it can cause hemorrhagic shock, which can be life-threatening. Long-term recurrent bleeding can also cause anemia, which should be taken seriously.
What tests should be done after a nosebleed?
First of all, we must exclude nasal bleeding caused by hematological and systemic diseases (such as high fever, uremia, long-term use of anticoagulant drugs, etc.); secondly, for children with repeated nasal bleeding and heavy bleeding, nasal endoscopy should be performed to exclude bleeding tumors in the nasopharynx and nasal cavity; furthermore, long-term chronic rhinitis and sinusitis can also cause inflammation of the nasal mucosa, capillary dilation and mucosal The bleeding is caused by vesiculation.
The vast majority of pediatric bleeding sites are in the bilateral nasal septum of the Richter area, and examination reveals mucosal erosion in the Richter area, capillary dilation, and sometimes pulsating bleeding spots and broken ends of blood vessels.
If adults have recurrent unilateral bleeding nasal and nasopharyngeal neoplasia should be considered. Female patients should pay attention to the relationship with the menstrual cycle. Hypertension, arteriosclerosis, and pulmonary heart disease should be considered for nasal bleeding in middle-aged and elderly patients. Attention should be paid to the patient’s general status, the presence of anemia, shock and other emergencies.
How to treat nosebleeds in children
The principles of treatment for nosebleeds are: clarify the bleeding point, stop the bleeding quickly, and treat the cause. Nasal bleeding is an emergency, and patients are often emotionally tense and fearful because of bleeding; therefore, doctors should be calm and reassure patients and their families. It is important to avoid the patient’s blood pressure rising due to mental factors, which will aggravate the bleeding. In special cases, sedative drugs, such as diazepam and promethazine, can be used to reduce bleeding; or cold compresses can be applied to the head, neck and collar to reduce bleeding as well.
Before local treatment, we should pay attention to the systemic condition, prevent and control shock, carefully examine the nasal cavity, and choose suitable hemostatic methods to achieve the purpose of hemostasis.
The treatment of rhinorrhea is generally divided into general treatment (also called local treatment) and systemic treatment.
Local treatment is based on the bleeding situation and bleeding site, and appropriate methods are chosen to stop the bleeding. The following methods are commonly used.
(1) Acupressure method: If the bleeding is small, let the child sit down, use the thumb and forefinger to press firmly on both sides of the child’s nose, press to the nasal septum, temporarily let the child whistle with his mouth, and at the same time put a cold water towel on the forehead of the child, generally compress for about 5 to 10 minutes, the bleeding can be stopped.
(2) Cautery method: Applicable to repeated small amounts and clear bleeding points. The traditional cautery method is to use chemical drugs or electrocautery. In recent years, YAG laser, radiofrequency or microwave cautery is used.
(3) Compression and filling method: If the bleeding is large, or if the bleeding cannot be stopped by the above method, the method of compression and filling can be used to stop the bleeding. Specific practice is: use skim cotton rolled into a strip as thick as the nostril, to fill the nasal cavity. Do not loosely fill the pressure, because this does not achieve the purpose of stopping the bleeding.
Note: When pinching the nose to stop bleeding, comfort the child not to cry, open the mouth wide and do not tilt the head back too much to avoid blood flow into the throat. After the above treatment, the general nasal bleeding can be stopped. If the bleeding does not stop, the child should be sent to the hospital in time; in addition to continuing to stop the bleeding, the cause of the bleeding should be identified.
Treatment of the cause: The cause of the nosebleed should be clearly identified, and the original cause should be treated to stop the nosebleed again. The most common causes of rhinorrhea in children are allergic rhinitis and sinusitis, which require regular treatment.
In terms of treatment, in addition to surgical treatment (such as nasal septal surgery, nasal endoscopic probing hemostasis, etc.) there are the following treatment methods for reference.
1.Search for the cause of bleeding and carry out etiological treatment.
2, compound peppermint oil nasal drops (peppermint brain, ice chips, vitamin AD oil) with pain and itching, antibacterial effect, keep the nasal cavity moist, good effect on epistaxis. And the method is simple and easy to be accepted by parents and children, so it is worth promoting the application at the grassroots level.
3.Give enough vitamin C (300~900ml per day), K (12~24mg per day), P (100~200mg per day), etc., and appropriate amount of sedative.
4.Appropriate application of hemostatic agents, such as thrombin, anti-fibrinolytic aromatic acid, aminocaproic acid, phenolsulfonamide, Yunnan Baiyao, etc.
How to prevent pediatric rhinorrhea
Regarding prevention, the following programs can be referred to.
1, control strenuous activities, avoid nasal trauma, but also let children develop good habits, do not pick the nostrils at will.
2, in the diet should pay attention to a light diet, less fried fatty food, eat more fresh fruits and vegetables, and pay attention to replenish water.
3, the indoor temperature should not be too high and too dry.
4, the prevention of acute infectious diseases of the whistle tract: cold, sinusitis, allergic rhinitis and other infectious diseases, can easily lead to congestion and swelling of the nasal mucosa blood vessels, and even cause bleeding capillary rupture. Therefore, the prevention of rhinorrhea, inhalation tract diseases can not be ignored.
5, frequent nosebleeds can be prevented with compound peppermint oil nasal drops (menthol, ice chips, vitamin AD oil).