One of the most frequent ear, nose, and throat (ENT) crises seen in the emergency room or primary care is Epistaxis (nosebleed). Nosebleeds are prevalent, and they can signify a severe medical problem. The rupture of blood vessels can cause bleeding in the front and rear of the nose. Because these blood arteries are so delicate, they bleed easily.
Summer is dry and hot, which is unpleasant for your nose. Low humidity in the summer can cause the protective mucus covering the nasal cavity to dry up. Your nasal cavity becomes dry due to the loss of mucus, which can lead to bleeding.
The heat has another negative consequence since summers tend to aggravate allergies, which might result in nosebleeds.
Nosebleeds can be avoided by washing your nose with cold water and avoiding exposure to direct sunshine. (Ref)
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Types of Nosebleeds
Anterior nosebleeds and posterior nosebleeds are the main types of nosebleeds or epistaxis.
The most prevalent type of nosebleed is an anterior nosebleed, which accounts for more than 90% of all nosebleeds. Blood loss from the blood vessels in the nasal septum – which houses a confluence of vessels – causes these nosebleeds. These nosebleeds are typically easy to manage and may be treated in the comfort of one’s own home.
It is commonly known that posterior nosebleeds are less prevalent and more likely to occur in the elderly than in the younger population. This type of nosebleed is caused by bleeding from an artery at the back of the nose.
In the majority of cases with a posterior nosebleed, hospitalization is necessary to stop the bleeding.
There are a variety of causes for recurrent nose bleeds. Due to the high temperatures that might cause the nerves to break, nose bleeds in the summer and nose bleeds in the winter are quite prevalent.
Extensive use of NSAIDs and other blood-thinning medicines that keep the blood from clotting easily, chronic alcohol or renal problems, vascular abnormalities in the nose, and a variety of other variables contribute to making the condition much more difficult to treat.
Preventive Measures for Nosebleeds in Summer
Nose bleeds are typically not significant and can be readily stopped, despite the fact that they can be a bit messy. If you are prone to nose bleeds throughout the summer, here are several simple fixes you may try.
In the summer, avoid going outside. If you can’t, wear a hat and cover your nose with a folded scarf or cotton cloth to keep hot air out.
Air conditioners and air coolers in the room help to keep the air humidified and prevent the nose from getting dry.
When your nose is clogged due to a cold, don’t blow it too forcefully.
Nasal bleeding can be controlled by rubbing ice on your nose. The ice aids in the reduction of blood vessel enlargement.
Make sure to consume vitamin C-rich meals. Blood clotting is aided by fruits and vegetables such as guavas, kale, mustard, parsley, oranges, strawberries, and lemons.
It is recommended that you maintain washing your face with cold water to keep your nostrils moist as well.
Steam is also beneficial because it cleans the respiratory passages, moisturizes and protects the nasal cavity, and minimizes nose discomfort.
Avoid alcohol, smoking, and hot beverages since they increase the number of blood cells in the lining of your nose.
Once the bleeding has stopped, the blood clots inside the nose. Cleaning the nose with a damp paper towel or when it is wet is recommended.
Seven Steps to stop nose bleeding
| S.No. | Steps to Stop a Bleeding | Description |
| 1. | Keep calm | Although bleeding noses might be frightening, they are seldom severe. |
| 2. | Lean Forward | If there is blood in your mouth, spit it out; do not swallow it. |
| 3. | Stay Upright | Avoid lying flat or leaning back in your chair. As a result, you can choke on blood. You may feel sick and vomit if you have blood in your stomach. |
| 4. | Skip foreign objects | To stuff the nose, do not use tissues or other household objects like tampons. This might make the bleeding worse. |
| 5. | Use a pinch | For 10 minutes, pinch the soft part of your nose shut. Using a clock makes it easy to keep track of time. After a few minutes, check to see if your nose has stopped bleeding. Dip a cotton ball in the nasal spray if the bleeding persists. For 10 minutes, pinch the bleeding nose with a cotton ball (use the clock to track the time). |
| 6. | Check your blood pressure | Nasal bleeds can be caused by high blood pressure. |
| 7. | Avoid exertion | It might take up to two weeks for a nosebleed to recover fully. Avoid lifting anything heavy, such as groceries, indulging in physical activity, or performing household chores. |
When to Seek Medical Help?
Seek medical help right away If:
- There is persistent bleeding from the nose after 30 minutes.
- There’s a lot of blood coming out of the front of your nose.
- Bleeding is accompanied by additional symptoms such as excessive hypertension, dizziness, chest discomfort, and/or a fast heart rate.
- Bleeding happens three to four times a week or more frequently than once a month.
Possible Treatment of Nosebleeds
Direct pressure for at least 10 minutes can be used to treat anterior bleeding. To try to stop the bleeding, have the patient apply consistent direct pressure by squeezing the nose over the cartilaginous tip (rather than the bony parts) for a few minutes. If it doesn’t work, you can try vasoconstrictors like oxymetazoline or thrombogenic foams or gels. Before attempting treatment, it is critical to remove any clots with suction. There are two reasons for this: The clot will restrict any medicine from reaching the artery, and if packing is required, the clot can be pushed into the nasopharynx and aspirated.
If topical therapies fail, do a nasal inspection to locate the vessel and cauterize it with silver nitrate. If this doesn’t work, anterior nasal packing is required. This can be done using surgical or fibrillar absorbable packing material or with devices like anterior epistaxis balloons or nasal tampons. To avoid septal perforation, exclusively use silver nitrate to cauterize a septal blood artery on one side of the septum. Thermal coagulation is a painful procedure that should only be done in an emergency.
Traditional petrolatum gauze can be utilized if balloons or tampons are not available.
The bleeding might occur from the superior or posterior nasal cavities if none of these works. Heavy bleeding from both nostrils and active bleeding in the posterior pharynx are possible symptoms. Longer (7.5cm) nasal tampons that give greater posterior pressure are available and can be used in this case. Because it necessitates hospitalization, telemetry observation, and occasionally intubation, formal posterior nasal packing should only be performed by competent personnel. It’s linked to an increased risk of consequences, including pressure necrosis, infection, or hypoxia, as well as the possibility of a nasal-cardiac reflex (Ref).
References:
- Fishman J, Fisher E, Hussain M. Epistaxis audit revisited. J Laryngol Otol. 2018 Dec;132(12):1045. [PubMed]
- Send T, Bertlich M, Eichhorn KW, Ganschow R, Schafigh D, Horlbeck F, Bootz F, Jakob M. Etiology, Management, and Outcome of Pediatric Epistaxis. Pediatr Emerg Care. 2021 Sep 01;37(9):466-470. [PubMed]
- Kitamura T, Takenaka Y, Takeda K, Oya R, Ashida N, Shimizu K, Takemura K, Yamamoto Y, Uno A. Sphenopalatine artery surgery for refractory idiopathic epistaxis: Systematic review and meta-analysis. Laryngoscope. 2019 Aug;129(8):1731-1736. [PubMed]
- Tabassom A, Cho JJ. Epistaxis. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435997/
