Causes, diagnosis and treatment of nosebleeds

Nosebleeds are something that many people have experienced, especially children. There are many reasons for nosebleeds, and the amount of bleeding varies. Some are caused by diseases, and some are caused by climate reasons. Generally, most of the bleeding is unilateral nostril, and very rarely, bleeding may occur on both sides at the same time. Some people just have blood in the nasal cavity or in the nasal mucus. Generally, no treatment is required and the bleeding will improve naturally. If the amount of bleeding is heavy, you should go to the hospital for examination and treatment.

Causes

There are many reasons for nosebleeds, which may be caused by diseases of the nasal cavity itself, or by diseases around the nasal cavity or systemic diseases.

Local causes

(1) Nose injury ① Mechanical trauma: such as trauma, nose picking, etc., are common causes of nosebleeds. ② Barotrauma: during high-altitude flying or diving. ③Radiotherapy damage: The nasal mucosa becomes congested and edematous, and nose bleeding may also occur.

(2) Deviated nasal septum: It often occurs near the bony ridge or spine (rectiform process) or on the convex surface of the deviated nasal septum. The mucosa in this area is thinner and the direction of air flow changes here, so the mucosa becomes dry, causing blood vessels to rupture and bleed. Patients with nasal septum perforation may suffer from recurrent nosebleeds due to dryness, erosion and shedding of the mucosa at the edge of the perforation.

(3) Nasal inflammation: ① Non-specific nasal inflammation: Acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. are prone to cause nose bleeding, but the amount of bleeding is generally not much. ② Specific infections of the nose: Specific infections such as tuberculosis, lupus, syphilis, leprosy and diphtheria can cause nose bleeding due to mucosal erosion, ulcers, granulation tissue and nasal septum perforation.

(4) Tumors of the nasal cavity, paranasal sinuses and nasopharynx: The most likely to cause nosebleeds are septal hemangioma, nasopharyngeal angiofibroma, hemorrhagic nasal polyps and malignant tumors of the nasal cavity and paranasal sinuses. Minor nose bleeding or blood in the mucus is one of the main early symptoms of malignant tumors.

(5) Foreign bodies in the nasal cavity: Common in children, mostly unilateral nosebleeds. Because foreign bodies remain in the nasal cavity for a long time, they can cause erosion and bleeding of the nasal mucosa.

Systemic causes

(1) Bleeding diseases and blood diseases (relatively rare): ① Diseases caused by defects in the structure and function of the vascular wall: such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura, von Willebrand disease, etc. ② Diseases with platelet quantity or function disorders: such as idiopathic thrombocytopenic purpura, secondary thrombocytopenia caused by various reasons, etc. ③Coagulation factor disorders: such as various types of hemophilia, vitamin K deficiency, etc. ④ The blood's own anticoagulant effect is too strong: such as improper use of anticoagulants, the presence of anticoagulant substances such as antifibrinogen in the blood circulation, or excessive or accelerated fibrinolysis, such as disseminated intravascular coagulation.

(2) Acute febrile infectious diseases: such as upper respiratory tract infection, influenza, hemorrhagic fever, scarlet fever, malaria, measles and typhoid fever. It is mostly caused by high fever, toxic damage to blood vessels, congestion, swelling and dryness of the nasal mucosa, resulting in rupture and bleeding of capillaries. Generally, the amount of bleeding is small, mostly occurs during the fever period, and the bleeding site is mostly located in the front of the nasal cavity.

(3) Cardiovascular system diseases: ① Hypertension and arteriosclerosis; Hypertension and arteriosclerosis are important causes of nosebleeds in middle-aged and elderly people, and vascular sclerosis is its pathological basis. Increased blood pressure, especially when constipated, overexerting or emotionally excited, can rupture blood vessels in the nose and cause nosebleeds. In addition, sneezing, coughing hard, vigorous nasal breathing or nasal massage are also factors that cause nosebleeds to recur and become difficult to control. ② Increased venous pressure: Diseases such as emphysema, cor pulmonale, mitral valve stenosis, and space-occupying lesions in the neck or mediastinum can cause superior vena cava hypertension. The nasal cavity and nasopharyngeal veins of these patients are often distended and congested. When the patient coughs violently or due to other inducements, the blood vessels may rupture and bleed. The bleeding site is mostly located in the distribution area of ​​the nasopharyngeal vein at the posterior nostril.

(4) Other systemic diseases: Pregnancy, premenopause and menopause can all cause nose bleeding, which may be related to increased capillary fragility. Patients with severe liver disease may experience nosebleeds due to impaired liver synthesis of coagulation factors. Uremia can also cause nose bleeding. Nosebleeds can be one of the early symptoms of rheumatic fever.