Diagnosis | Nosebleeds

Diagnosis

Anyone who frequently suffers from nosebleeds should consult a doctor. Go to your family doctor or a specialist in ear, nose and throat medicine. In advance, your doctor will ask you a few questions about the frequency and triggering circumstances of your nosebleed.

He will take an interest in your lifestyle, i.e. exercise, diet and stimulant habits. Pre-existing conditions and the current intake of medication are also included in the list of questions. This is followed by a thorough physical examination including blood pressure measurement, inspection of the nasopharynx and the oral cavity.

During this examination, the examiner widens the front part of your nasal cavity with a nasal spreader and is thus able to visually inspect and assess structures such as the nasal septum, the turbinates and the lower and middle nasal passages. Dried blood crusts in the nasal entrance and possibly obstructed nasal breathing usually indicate nosebleeds from the vascular network of the locus Kiesselbachi of the front nose. Deeper and more distant sources of bleeding are diagnosed by the physician via the so-called posterior rhinoscopy.

In this procedure, a mirror is inserted through the mouth into the back of the nasopharynx, allowing him to see the back of the nostrils. The tongue is held down by pressure with a spatula. In addition to these easy-to-use examination methods, the diagnosis of nosebleeds using a so-called nasal endoscope can be used for complicated problems.

Under local anesthesia of the nasal mucous membranes, a tube-shaped flexible optical device is advanced over the nostrils, into the throat and up to the larynx.This allows the detection of specific sources of bleeding, but also changes in the mucous membranes. In the case of bleeding in the area of the paranasal sinuses and if a tumor is suspected, the doctor will have a special image taken of your face. Additional blood tests serve to clarify frequent nosebleeds and may reveal, for example, a deficiency or a changed composition of the coagulation factors.

What should be done first of all when having a nosebleed? Your head should be in an upright position during a nosebleed. Either sit straight on a chair or place a pillow behind your head when lying down.

Under no circumstances should you bend down in front of a sink. Then press the nostrils firmly together with your thumb and index finger. This pressure can be uncomfortable, but is the only way to stop the bleeding in the small mucous membrane vessels.

Hold this pressure for at least five minutes! A cold flap in the neck leads reflectorically to a narrowing of the vessels in the nasal mucosa. However, it should be really cold!

A moistened handkerchief has no effect. The blood should neither be swallowed nor inhaled. Just let it run out or spit it out!

Once the bleeding has stopped, avoid blowing your nose, rinsing your nose or tilting your head for the next ten hours. If the nosebleed does not stop, a doctor must be consulted or the emergency doctor must be alerted. What measures does the doctor take?

The ENT physician will stop the bleeding with a punctiform burn. The burn is done with a trichloroacetic acid or chromic acid bead. If the burn is not successful, an attempt is made to obliterate the nosebleed with electrocoagulation.

This is usually even more effective than chemical burns. If the bleeding cannot be stopped, the nose must be tamponaded. A cotton-wool tampon (Bellocq tamponade) remains for a maximum of four days and must then be changed if necessary. In rare cases, in the case of completely unstoppable bleeding, a vascular blockage must be performed. This is a surgical procedure under anesthesia, in which the main vessels (arteria maxillaris, A. carotis externa, A. ethmoidales) supplying the nasal mucosa are clamped.