Nosebleeds (epistaxis) are very common as up to 50-60% of people suffer from at least one episode in their lifetime with as many as 6% needing medical treatment.
An anterior nosebleed begins in the lower part of the septum, the wall that separates the two nostrils of the nose. The septum contains blood vessels that can be broken by a blow to the nose. This type of nosebleed comes from the front of the nose and begins with a flow of blood out one nostril when the patient is sitting or standing. An anterior nosebleed most commonly occurs in children and is rarely of major consequence.
A posterior nosebleed is more rare and can begin high and deep within the nose and flow down the back of the mouth and throat regardless of the patient’s position. This kind of nosebleed most often occurs in adults and can be life-threatening. As posterior nosebleeds can have major consequences and require a physician’s care, it is important to distinguish it from an anterior bleed.
Posterior nosebleeds are more likely to occur in older people, persons with high blood pressure, and in cases of injury to the nose or face. Anterior nosebleeds are common in dry climates or during the winter months when heated, dry indoor air dehydrates the nasal membranes. Dryness may result in crusting, cracking, and bleeding.
Medical treatment of a nosebleed begins with local pressure and nasal spraying of decongestants, a process which causes the blood vessels to constrict. Nasal packing (and blood transfusion) may be needed if the bleeding does not stop. If these treatments do not work and the bleeding continues, the physician can possibly identify the site of bleeding by examination and cauterize the vessel. If the bleeding site cannot be found or does not respond to these treatments, or if the bleeding is too severe, then a procedure to block off the bleeding vessels may be required. In this case, a catheter is inserted into an artery at the groin, and is threaded through the vessels leading up to the ones supplying the nose. Once at the site, material is injected through the catheter to plug the bleeding vessel, allowing it to clot and heal.
Juvenile nasopharyngeal angiofibromas (JNAs) are tumors that arise at the back of the nose and account for .05% of all head and neck tumors. Typically benign, these tumors are almost always seen in adolescent boys, with the highest incidence rate between seven and 19 years of age. JNAs are rare in patients older than 25 years of age.
Given this condition’s predisposition to boys, it is thought that hormones may play a role in its development. Some specialists suggest these tumors are sensitive to hormone levels and stimulated to growth by the onset of puberty.
The most common symptom of a juvenile nasopharyngeal angiofibroma is nasal obstruction (occurring in 39 to 90 percent of all cases). These tumors also cause recurrent nosebleeds in 45 to 60 percent of cases. Other symptoms may include sinusitis, otitis (ear infection), loss of sense of smell, facial swelling, headache and double vision.
The definitive treatment for juvenile nasopharyngeal tumors is surgical removal. This can be difficult depending on the size of the tumor and where it has spread. Additionally, these tumors usually have a large blood supply, which further complicates surgery. In order to decrease the amount of bleeding during surgery, endovascular treatment can be performed prior to surgery by inserting a catheter into the blood vessels supplying the tumor and injecting materials to block off the blood supply to the tumor. This procedure, called embolization, is usually done within a few days in advance of the impending surgery.