Severe Nosebleed (Epistaxis)
Epistaxis is the medical term for nosebleed. It is a common problem that usually stops by itself or is easily controlled in a medical environment. However, in small groups of patients with more severe episodes of bleeding, it requires additional treatment.
Nose bleeding in such patients may be due to variety of reasons, such as:
- Hereditary hemorrhagic telangiectasia: Also known as Osler Weber Rendu syndrome, hereditary hemorrhagic telangiectasia is a genetically inherited condition. It is characterized by small blood vessel malformations, known as telangiectasias, which affect the skin and mucosal membranes. Nosebleeds are the most common symptom, with recurrent bleeds affecting 50-80 percent of patients.
- Spontaneous epistaxis: Spontaneous epistaxis, usually occurs in the fifth decade of life, and may be associated with hypertension or liver insufficiency. This type of nosebleed resolves without medical treatment; however, in some patients, the intensity or repetition of hemorrhages in a short period of time may require more invasive nosebleed treatment such as embolization.
- Tumor: Frequent nosebleeds later in life may be an indication of an underlining primary disease. Therefore, patients presenting with spontaneous epistaxis in the fifth decade of life should undergo CT examination to rule out possible nasal tumor.
- Vascular Malformations
Treatment Options for Epistaxis (Severe Nosebleeds)
The first step in treating this group is "packing" the nose, which should be performed by an appropriately trained physician. If bleeding cannot be stopped with packing alone, embolization of the blood vessels in the nose may be necessary. The physicians in the Cerebrovascular Center, have been highly successful in stopping bleeding from the nose, as well as from other parts of the head and neck, by using endovascular techniques.
Severe blood loss from a nosebleed can result in serious anemia or cardiac dysfunction and reduced quality of life. At Mount Sinai, we can use embolization to treat severe, recurring nosebleeds that cannot be controlled by traditional means, such as applying pressure, packing the nose, or cauterization.
In cases of extreme nosebleeds, we can investigate the source of the bleeding via angiography. After the doctor identifies the vessels responsible for the bleeding, he or she can go back in through a catheter and block the vessels to stop the bleeding (embolization). In some cases, this technique may even be lifesaving.
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