Nosebleeds (epistaxis) can occur for various reasons and are not dangerous for many patients but also unpleasant, as many patients do not tolerate the taste and smell of blood well. Therefore, just as in the case of a very severe nosebleed, the primary goal is to stop the bleeding as quickly as possible. In addition to the classic nasal tamponades, there is another modern way to reduce bleeding.
This is the obliteration of one or more bleeding vessels using electric current. This procedure is called electrocoagulation. The method is often performed in a hospital as part of an operation, or on an outpatient basis in the case of very severe nosebleeds on a ward.
Procedure of sclerotherapy
The obliteration of blood vessels in nosebleeds is usually carried out by an expert doctor, in this case an ear, nose and throat specialist. The obliteration of vessels can be used for very severe nosebleeds or recurrent nosebleeds. Even in patients with a blood coagulation disorder, obliterating the bleeding vessels is a quick and easy way to remedy the problem.
Since it is a simple and small procedure, the obliteration can be performed on an ENT ward under local anesthesia. For this purpose, the patient sits in a slightly tilted special chair so that the doctor has a good view of the nasal cavities. In some patients, a short anaesthesia may be necessary for the procedure, so that the bleeding is stopped in the course of a small operation.
With both options, the doctor first tries to get a clear view of the nose, which can be more difficult depending on how much bleeding is present. With the help of a rhinoscope, the doctor spreads the nostrils open to get a better view. In addition, the doctor usually wears a head or headlamp, which gives him a better view.
First of all, the doctor aims to find the source of bleeding. Most of the bleeding is located in the frontal area at the tip of the nose. Under the skin there is a well-connected network of blood vessels called locus kiesselbachii.
Sclerotherapy can also take place there very easily, as bleeding in the front part of the nose can be reached very well with the equipment. While the doctor is still looking for the source of bleeding, he can already close possible open vessels with a bipolar, a device that generates heat by means of electric current and thus burns the vessels. In the case of very heavy bleeding, the actual source of bleeding is usually only then visible.
The device consists of two tips into which electrical current is injected via foot pedal. The tips can then be guided by the operating physician to grasp the hole in a vessel or vessel ends and burn them. In addition, the doctor can dab away any draining blood until the bleeding is stopped.
Some clinics have a laser in the operating area that can be used for various operations. It is also possible to obliterate the source of bleeding with a laser. In this case, the treating physician guides the laser head and targets the area to be sclerosed.
A prerequisite for the use of a laser is that the strength and thickness of the laser can be well adjusted and that the source of bleeding can be reached at all with the laser beam. Whether the vessel is closed or not can be seen whether blood is still draining from the nose directly or via the throat. Many doctors still insert tamponades into the bleeding nostril after coagulation.
The tamponades exert pressure on the nasal wall and the vessels. This prevents swelling and helps the wound to heal and stay closed. The swabs are often additionally soaked in Otriven Nose Drops. The nasal drops have a constricting effect on the vessels, which helps to stop the bleeding, and at the same time their ingredients prevent the nasal mucosa from swelling due to the manipulation.
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