Epistaxis

Epistaxis refers to bleeding from the nose and is a common complaint with both adults and children. The exact incidence is hard to determine as most cases are minor and patients do not seek treatment. Patients may complain of per-oral bleeding or bloodstain sputum as well since blood can flow backwards and down the throat.

Less common causes of Epistaxis

Occasionally, epistaxis may herald uncommon conditions such as the following:

• Blood coagulation disorders
• Excessive anti-coagulation
• Vascular malformations
• Auto-immune disorders

• Little’s Area Epistaxis: By far, the most common cause of epistaxis is the rupture of small blood vessels (Kiesselbach’s Plexus) at the Little’s Area of the nose. This is often precipitated by minor trauma, such as nose-picking or rubbing, but can sometimes occur spontaneously in dry air, resulting the breaking of the overlying mucus membrane of the Little’s Area.
  
• Trauma: Blunt trauma can result in nasal contusion or nasal bone/ cartilage fractures. Patients can experience epistaxis immediately after the trauma and the bleeding may persist indefinitely until some first aid measures are instituted. Most of such cases will cease without a need for any surgical intervention.
  
• Sinonasal Infections/ Inflammation: Conditions such as allergic rhinitis and infective rhinosinusitis can cause inflammation of the nasal mucosa, sometimes resulting in breakage and bleeding.
  
• Cancer: Nasopharyngeal cancers (NPC) is the most common cancer of the nose. Common symptoms of NPC include blood-stained nasal drainage, blocked ears and nose, loss of weight and pain over facial area. It is commonly linked with infection by the Epstein-Barr virus (EPV), smoking and inherited characteristics.
  
• Nasal Tumours: Nasal tumours are abnormal growth in the nose. It can occur as a benign or malignant tumour. Associated symptoms of numbness or pain, swelling in areas of the face or lymph nodes in the neck, change in symmetry of the eyes or face and visual changes are cardinal signs to be investigated.