Epistaxis (Nosebleeds), its Cause Manifestation and Homoeopathic Management
Epistaxis is defined as bleeding from the nostril, nasal cavity, or nasopharynx. Nosebleeds are due to the bursting of a blood vessel within the nose.
This may be spontaneous or caused by trauma .
Nosebleeds can be divided into 2 categories, based on the site of bleeding: anterior (in the front of the nose) or posterior (in the back of the nose).
The cause of nosebleeds are typically idiopathic (unknown), but they may also result from trauma, medication use, tumors, or nasal/ sinus surgery.
Causes of epistaxis can be divided into local causes (eg, trauma, mucosal irritation, septal abnormality, inflammatory diseases, tumors), systemic causes (eg, blood disorders, arteriosclerosis, hereditary hemorrhagic telangiectasia), and idiopathic (unknown) causes.
Local trauma is the most common cause; followed by facial trauma, foreign bodies, nasal or sinus infections, and prolonged inhalation of dry air. Tumors and vascular malformations are also important causes of nose bleeds. Epistaxis is also associated with septal perforations (holes in the nasal septum).
Trauma or injury to the turbinate mucosa and septum is a frequent cause of epistaxis. Nose picking and repeated irritation caused by the tips of nasal spray bottles commonly give rise to many anterior bleeds. Certainly, traumatic deformation and fractures of the nose and surrounding structures can cause bleeding.
Another common cause of nosebleeds is due to infection and mucosal inflammation. Sinusitis, upper respiratory tract infections, and allergies can damage the respiratory lining to the point that it becomes irritated. Additionally, septal deviations (bends in the wall that divides the nose into two sides), nasal fractures, and septal perforations (holes through the septum) can be a cause of irregular nasal airflow causing dryness and bleeding in some cases.
Causes due to medical treatment such as after endoscopic sinus surgery, skull base surgery, and orbital surgery can also be a cause of severe epistaxis.
Hypertension, hereditary hemorrhagic telangiectasia, use of anticoagulants such as aspirin, clopidogrel, warfarin, and a variety of conditions causing vasculitis such as Wegener's granulomatosis are common systemic factors associated with epistaxis.
Epistaxis is also associated with blood disorders, patients with lymphoproliferative disorders, immunodeficiency, and liver failure. Thrombocytopenia (low platelet levels) is associated with nasal bleeding. There can be spontaneous mucous membrane bleeding at platelet levels of 10-20,000. Platelet deficiency can also result from the use of chemotherapy, antibiotics, malignancies, hypersplenism, and some drugs. Platelet dysfunction can occur in patients with liver failure, kidney failure, vitamin C deficiency and in patients taking aspirin and NSAIDs.
Clotting factor abnormalities can result in frequent, recurring epistaxis. Bleeding disorders such as Von Willabrand's disease (most common), Factor VIII deficiency (Hemophilia A), Factor IX deficiency (Hemophilia B), and Factor XI deficiency are all common primary coagulopathies.
Direct pressure is usually effective for stopping epistaxis by applying pressure to the front of the nose. Nasal decongestants such as oxymetazoline or neosynephrine may also be used.
Gently applying Vaseline or another ointment to the front of the nose with a Q-tip on a daily basis helps to moisturize the nose and prevent nose bleeds due to dryness. It is also very important to avoid any trauma to the nose after a nose bleed by picking healing scabs or blowing the nose too aggressively.
In homoeopathy, we have about 314 remedies in Synthesis Repertory , but we prescribe according to individual symptoms rather than the name of disease / complaint of person.