Epistaxis / Nosebleeds – Why? & Causes (2)

Our environment also plays an important part in causing nosebleeds.  Our nose should be moist, and not dry. If it is dry, the lining breaks down and we bleed.  So sudden changes in the environment make the nose drier and can cause bleeding. This happens if we fly especially for long journeys or go from a warm, humid climate to visit a dry climate like a winter skiing holiday in the Alps or if the temperature suddenly drops like during the Winter Solstice in Hong Kong. An underlying condition or drug may also cause dryness of the nose. Patients with radiotherapy to the nose for previous cancer or atrophic rhinitis (an inflammatory condition of the nose that has caused a reduction in the mucus secreting cells of the nose) will predispose the lining of the nose to easy breakdown and bleeding.

 

Interestingly also the internal passage size of our nose also affects our frequency of nose bleeding too, by creating a drier environment. If one’s nose is narrower on one side, there is more turbulence generated when we breathe normally. This turbulence causes local drying effects, lining breakdown and therefore bleeding. This narrowing can be caused by a deviated septum of the nose, enlarged turbinate from nose allergy or sinus polyps that narrow the passages themselves.

 

So epistaxis/nosebleeds are common. The cause/s of any nosebleed is varied and is the interplay between the anatomy of the nose, an underlying condition and environment factors. As mentioned earlier, most nosebleeds have no significant cause. However if any nose bleeding persists, recurs and/or is unusually heavy, it is always best to seek an assessment by your ENT Specialist to exclude all causes. Thankfully here too, most causes are easily treated.

Reference: www.entific.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Epistaxis / Nosebleeds – Why? & Causes (1)

“Epistaxis” is the Latin word for the nosebleeds. Nose bleeding is very common and every one of us has experienced it at least once in our lifetime. As common as it is, 90% of nosebleeds do not have an identifiable cause after investigation. This is not a bad thing as it means that most nosebleeds have no sinister causes.

Our nose is supplied by blood from an internal and external arterial system. The external vascular supply comes from the vessel that brings blood to our face; hence it enter the nose from outside, causes the bleeding from the front of the nose where we get most of the bleeding. The internal vascular supply is more elaborate, coming off the vessels that bring blood directly to the brain. They supply the nose from the back under higher pressure and therefore nose bleed from the internal system tends generally to be more heavier; this is because we cannot press and stop the bleeding at the back for the nose with our fingers and also as the arterial blood pressure is stronger too.

So what causes nose bleeding? Several factors affect and cause nose bleeds. Firstly we need a blood vessel as the source, preferably near the surface of the lining. Vessels in the front of the nose are nearer the surface as the lining is thinner so nose bleeds from the front is therefore commoner. Next we also need a condition that makes the vessel more prone to bleeding. So, for example, if there is an existing inflammation like a nose allergy, infection or sinusitis, there is inflammation of the vessel with an engorgement by blood. 

Perhaps the wall of the vessel might be weak and breaks easily; we sometimes see this as the sole reason in the elderly population. Trauma from an accident to the nose or repeated trauma by the patient picking his/her nose can break the vessel too. Obviously nasopharyngeal cancers, cancers of the nose and sinuses, vascular tumors and malformations can cause bleeding too. All tumor growths require a good blood supply to feed their growth and hence may present as a nosebleed early on.

Reference: www.entific.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

What is functional septorhinoplasty surgery? (2)

The bony cartilaginous septum is intimately connected to the upper and middle third external nose structures, and loosely via strong suspensory ligaments, to the lower “mobile” third. This intimate relationship determines appearance and airflow through the nose. Hence a deformity of this internal framework structure can deviate the external nasal structure, and functionally cause a block nose.

The intimate relationship between the different structures of the upper, middle and lower nose, together with the internal nasal septum, is relevant. They all influence the function of the other; so surgery on one structure can dynamically affect the position of the other. Hence in some cases of a blocked nose, a septo-rhinoplasty surgery may be recommended in one surgical session to primarily improve function, and consequentially, appearance. A stronger septal “tent” and support would mean a less obstructed middle and lower third of the nose, as well as an improved projection and nasal profile.

Functional septo-rhinoplasty surgery can be performed under open or closed (endonasal) approaches. The optimal approach should be discussed with your surgeon.





Reference: www.entific.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

What is functional septorhinoplasty surgery? (1)

Functional septo-rhinoplasty surgery is a “nose job” undertaken primarily to improve the function of the nose i.e. breathing through the nose. It is not a cosmetic nose job, which only enhances the aesthetics of the nose. However, it does realign the deviated / collapsed nasal structures whilst projecting them for an improved airway, and does result in a more aesthetically pleasing nose. In addition, the improved nasal airway improves sleep quality and sometimes snoring and adds a real life meaning to the cliché term “ beauty sleep “.

The structure of the nose consists of bony and cartilaginous elements. These form the upper, middle and lower nose as most people see on a person’s face. The internal nasal structure is however not visible. This consists of a midline strong bony cartilaginous septum which “tents” the outside nose, giving it projection, height and therefore also its aesthetic form. The nasal framework’s function is to tent and project the nose, and maintaining an air passage so that the nose remains open for air to pass through, during sleep and active exertion.

 

 

Bony and cartilaginous framework of the nose

Deviated internal nasal septum

 




Reference: www.entific.com.hk/

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.