Epistaxis (Nosebleeds) Treatment in Singapore

Anterior epistaxis is the most common type of nosebleed and originates from Kiesselbach’s plexus, a network of small, fragile blood vessels located near the front of the nasal septum. This type of nosebleed is typically mild, easy to manage with first-aid measures such as pinching the nose and applying a cold compress, and rarely results in severe complications.

Posterior epistaxis arises from larger blood vessels, such as the sphenopalatine artery, situated deeper within the nasal cavity. This type of nosebleed is less common but more serious, often requiring medical intervention. Due to the risk of significant blood loss and difficulty in accessing the bleeding site, posterior epistaxis frequently necessitates specialist care, such as nasal packing or surgical treatment.

• First Aid Measures: The patient should sit upright and lean forward to prevent blood from entering the throat. The soft part of the nose should be pinched firmly for 10–15 minutes to apply pressure to the bleeding vessels. A cold compress can be applied to the bridge of the nose to constrict blood vessels and reduce bleeding.
• Topical Vasoconstrictors: Nasal sprays containing vasoconstrictive agents, such as oxymetazoline, help control mild to moderate anterior nosebleeds by shrinking blood vessels. These sprays should be used sparingly, typically for no more than three days, to avoid rebound congestion.
• Cauterisation: Recurrent anterior nosebleeds may be treated with cauterisation. This involves sealing the bleeding vessels using silver nitrate (chemical cauterisation) or an electrical device. The procedure is performed under local anaesthesia and is effective in preventing further episodes.
• Nasal Packing: Persistent or severe bleeding, particularly from posterior sources, often requires nasal packing. Materials such as sponges, gauze, or inflatable balloons are inserted into the nasal cavity to apply pressure. These are usually left in place for 24–72 hours to ensure bleeding stops.
• Treating Underlying Causes: Systemic issues contributing to epistaxis, such as hypertension or clotting disorders, must be addressed. This may involve adjusting medications, managing chronic conditions, or consulting ENT specialists for further treatment.

• Artery Ligation: Severe cases that do not respond to non-surgical methods may require artery ligation. This involves tying off the affected arteries, such as the sphenopalatine or ethmoidal artery, to stop the bleeding. It is typically used as a last resort.
• Endoscopic Surgery: Endoscopic techniques are used to address structural issues, such as tumours or nasal polyps that contribute to recurrent or severe epistaxis. This approach is minimally invasive and targets the underlying cause.
• Septoplasty or Turbinate Reduction: Structural abnormalities, such as a deviated septum or enlarged turbinates, can be corrected surgically. Septoplasty realigns the septum, while turbinate reduction reduces its size, improving airflow and reducing irritation that may lead to nosebleeds.