EPISTAXIS

• The term epistaxis is derived from the Greek word epistazein (epi –above,over ; stazein– to drip)
• It is defined as the bleeding from the nasal cavity. Epistaxis is a common symptom of diverse conditions which may present as mild recurrent bleeds or severe life threatening rhinological emergency
• Epistaxis appears to occur more often in males than in females

Classification:

Epistaxis can be classified by its anatomical location into anterior & posterior

Anterior epistaxis

• is more common 
• More than 90% of episodes of epistaxis occur along the anterior nasal septum, which is supplied by Keisselbach’s plexus in a site known as the Little’s area
• Bleeding causes blood to flow out through the nsotrils

Posterior epistaxis

• Approximately 10% of episodes of epistaxis are posterior
• Generally arises from the posterior nasal cavity via branches of the sphenopalatine arteries
• Blood runs down the throat

Epistaxis can also be divided into primary or secondary

• Primary causes account for 85% of episodes and are idiopathic, spontaneous bleeds without any notable precipitant
• Bleeds are considered secondary if there is a clear and definite cause (e.g. trauma, anticoagulant use, post surgical)

Local causes

• Trauma (Digital, Nose blowing, Blunt, Penetrating, Iatrogenic, Chronic irritation)
• Mucosal dehydration (Deviated septum, Arid environment)
• Inflammatory diseases (Rhinitis, Sinusitis, Autoimmune disorders, Environmental irritants)
• Irritants (e.g. cigarette smoke)
• Neoplasia (uncommon)
  • Benign(Inverted papilloma, Juvenile nasopharyngeal angio fibroma)
  • Malignant (Nasopharyngeal carcinoma)

Systemic causes

• Age
• Hypertension
• Haemophilia
• Leukemia
• Coagulopathy
• Thrombocytopenia
• Alcohol
• Platelet dysfunction
• Renal failure
• Liver disease (e.g. cirrhosis)
• Hereditary Hemorrhagic Telangiectasia

Anterior epistaxis

• More common
• Mostly from Little’s area or anterior part of lateral wall
• Mostly occurs in children or young adults from Trauma
• Bleeding - Usually mild, can be easily controlled by local pressure or anterior pack

Posterior epistaxis

• Less common, usually seen after 40 years of age
• Mostly from posterosuperior part of nasal cavity; often difficult to localize the bleeding point
• Spontaneous; often due to hypertension or arteriosclerosis
• Bleeding - is severe, requires hospitalization; postnasal pack often required

• Rhinoscopy
• Systemic causes – Blood pressure etc

• First aid -Most of the time, bleeding occurs from the Little’s area and can be easily controlled by pinching the nose with thumb and index finger for about 5 min
• Cauterization
• Nasal packing

Surgery

• SMR operation
• Ligation of vessels

Ayurvedic Treatment

• Heavy bleeding - Emergency care

Internal medicines

• Drakshadi kashaya
• Vasaguduchyadi kashaya
• Guduchyadi kashaya
• Trivrut choorna
• Kalyanaka guda

Procedures

• Nasapichu - Durva gritha, Durva swarasa
• Siro lepa – Chandana + Raktachandana + Yashti + Lodra + Gairika
• Mukhalepa – Triphala + Yashti