Rhinorrhea is both a common condition of nasal diseases and a symptom of certain systemic diseases or lesions of adjacent structures of the nasal cavity. The former is the most common. Since there are many causes of rhinorrhea, there are many variations in clinical manifestations. Most of the bleeding is unilateral, but it can also be bilateral, and it can be intermittent and recurrent, or it can be persistent, and the amount of bleeding varies.
The amount of bleeding varies. In mild cases, it is only blood in the nose, but in severe cases, it can cause shock or even death due to massive bleeding, and repeated bleeding can lead to anemia. Most of the bleeding can stop on its own or after pinching the nose tightly. Most of the bleeding sites are in the easy bleeding area under the anterior part of the nasal septum, almost all of them occur in this area in children, and in young patients, a few serious bleeding occurs in the posterior part of the nasal cavity.
How much blood from the nose is considered bleeding? There are also two views on this issue. One is that as long as there is bleeding, even if it is only a drop of blood, it is also considered nasal bleeding; the other is that a small amount of bleeding is of little clinical significance and should be defined as nasal bleeding if the bleeding is more than 30~50 ml. However, strictly speaking, as long as there is nasal bleeding, the lesser one only has blood in the snot, the more one bleeds in more than hundreds of milliliters at a time, all have certain different clinical significance and are not allowed.
I. Causes of rhinorrhea
The causes of rhinorrhea are many and complex, generally divided into local and systemic.
1, local factors are: trauma, such as trauma to the nose and sinus department, fractures, surgery, skull base fractures, etc.; nasal mucosa stimulation or injury, such as digging, severe coughing, sneezing, forceful pinching, nasal foreign body, chemical dust, smoke, gas, changes in air pressure (such as diving, high-altitude flight, hyperbaric chamber, etc.); inflammation, infection, such as acute and chronic rhinitis, sinusitis, dry rhinitis, atrophic rhinitis and special infection ; nasal septal deviation and ulcers, the most common causative factors of nasal bleeding; tumors, such as nasopharyngeal cancer, nasopharyngeal fibroadenoma, nasal hemangioma, malignant tumors of the sinuses; post-gas dryness can also lead to nasal bleeding.
2, systemic factors are: chronic nephritis, arteriosclerosis, emphysema, mitral stenosis, right heart dilatation, tumors of the thoracic mediastinum and neck can lead to increased venous blood pressure and nasal bleeding; blood diseases, such as hemophilia, aplastic anemia, blood leukemia, thrombocytopenic purpura, etc. can lead to nasal bleeding; liver and spleen diseases and rheumatism, nutritional and vitamin deficiencies, acute febrile diseases or infectious diseases The poisoning of chemicals can also cause rhinorrhea; hereditary hemorrhagic capillary dilation, with a family history of hereditary easy bleeding, dilated and ruptured bleeding nasal mucosal veins can cause recurrent rhinorrhea; other causes such as endocrine disorders and menstruation are all causes of rhinorrhea.
According to statistics, among patients with rhinorrhea, systemic causes account for 1/2, local causes account for 1/4, and unknown causes account for 1/4. Some statistics also show that systemic and local causes account for 1/2 each. the difference in results may be related to the different examination methods and categorization of each person.
When a person experiences rhinorrhea, how to consider the possible causes of the bleeding? Generally speaking, adolescents tend to have localized causes and febrile diseases, while the elderly or chronically ill tend to consider systemic causes, and there are ten nosebleeds for which it is difficult to find the exact cause.
When nosebleeds occur, the doctor should generally go to the hospital for examination. Based on the medical history and what is seen in the examination, the doctor should, on the one hand, stop the bleeding quickly and, on the other hand, find out the cause of the bleeding and treat the cause.
Treatment of rhinorrhea
Patients with nasal bleeding with clear causes and very little bleeding, such as digging the nose and blowing the nose with force, often do not get special attention and do not go to the hospital. Hospital treatment.
(A) Caulking method
1, nasal absorbable stuffing: for hematological or chronic liver and kidney diseases caused by nasal bleeding, with starch sponge, gelatin hemostatic sponge, hemostatic spirit or fibrin and other absorbable substances to fill the nasal cavity, the advantage of this method is that the stuffing can be absorbed by the tissue, can avoid re-bleeding of the nasal mucosa caused by the removal of the stuffing, the disadvantage is that the pressure on the nasal mucosa and hemostatic point is not large, should not be used for severe bleeding The disadvantage is that the pressure on the nasal mucosa and the hemostatic point is not great, and it is not suitable for those with severe bleeding.
2.Nasal gauze stuffing: It is a more common method to stop bleeding in hospitals, suitable for those who stop bleeding in the front of the nasal cavity, and can also be used for those who bleed in the back of the nasal cavity or whose bleeding site is unknown.
3.Posterior nostril stuffing: It is suitable for those whose nasal gauze stuffing fails to work or those whose posterior nostril bleeds. This method has the best effect on the posterior nasal bleeding.
It should be noted that nasal fillings should generally be removed within 3 days, eosinophilic too long can cause local pressure necrosis or infection, in addition, nasal fillings can cause a decrease in the oxygen content of the blood and increased carbon dioxide content, the heavier the pass causes heart, lung and brain complications, so it should be used with caution in elderly patients, and closely observed.
(B) vascular ligation method and embolization method
The ligation of the common carotid artery and the internal carotid artery often leads to impaired cerebral blood circulation or cerebral thrombosis, which is very dangerous and especially unfavorable to the elderly. For patients with serious bleeding and systemic conditions, digital subtraction angiography can also be used to understand the bleeding site and perform vascular embolization to stop the bleeding.
How to treat rhinorrhea
For a small amount of bleeding that occurs occasionally and has a clear cause, it is not necessary to pay much attention to it. For repeated small amount of bleeding or a large amount of bleeding that occurs at one time, you should go to the hospital promptly, especially for the latter.
IV. Prognosis of nosebleeds
In general, the prognosis of patients with rhinorrhea is mostly good. After active treatment, taking various methods to stop the bleeding, and supplemented with antibiotics, rehydration and even blood transfusion, most patients can recover their health.
The prognosis depends mainly on the cause of the nosebleed. Serious trauma such as skull base fracture and internal carotid artery, advanced chronic liver and kidney disease, advanced malignant tumor of nasal cavity, sinus and nasopharynx and hemorrhage caused by leukemia, the prognosis is often poor.
V. Prevention of nasal hemostasis
According to the cause of nasal bleeding, actively treat the original disease. Such as treatment of nasal mucosa inflammation, correction of nasal septal deviation, repair of nasal septal perforation, avoid nasal trauma, gentle and meticulous nasal and sinus surgery, and proper hemostasis.
Active treatment of systemic diseases, such as febrile diseases, blood diseases, hypertensive diseases and liver and kidney diseases, can play a certain preventive role. In addition, we should also pay attention to quit the bad habit of digging the nose, actively treat coughing and sneezing (such as allergic rhinitis), avoid blowing the nose with force; wash the face with cold water with gentle movements, avoid hot water washing face with rude movements, use hot water to soak the feet; actively treat diseases that cause rhinorrhea; avoid the stimulation of harmful gases, chemical irritant gases and dust in the work and living environment; keep the nose moist and clean, avoid drying (when dry, you can locally (when dry, you can use local oil drops); quit smoking and alcohol, avoid spicy and other stimulating food; keep bowel movements smooth; strengthen exercise, enhance physical fitness and prevent colds.