Older adults are more susceptible to nosebleeds due to the aging of the cardiovascular system, the aging and shrinkage of tissues, blood vessels, and adverse changes in biological processes related to hematopoiesis and coagulation.
Nosebleeds are a common emergency in the field of otolaryngology, which includes cases of bleeding from the front of the nose or bleeding that runs down the throat. Most cases of nosebleeds occur spontaneously, possibly accompanied by a clear local or systemic medical condition (or identifiable but very complex), known as spontaneous nosebleeds.
The majority of nosebleed cases are benign and self-limiting; however, some severe cases require emergency treatment as they can lead to death. Nosebleeds can be a secondary symptom of a specific medical condition but may also occur in isolation with no identifiable cause. For older adults, nosebleeds are more likely due to the aging of the cardiovascular system, tissues, and blood vessels.
In ancient Greece, around 2,500 years ago, there were approximately 130 artworks depicting nosebleeds. Around 600 BC, Assyrians, Hippocrates, and others began proposing methods to control nasal bleeding, while also researching various causes of nosebleeds such as the dilation and rupture of blood vessels and reduced internal hemostatic efficiency.
The nose is supplied by the internal carotid artery and the external carotid artery. These arteries have numerous branches that form a rich capillary network just beneath the delicate mucous membrane of the nose. Consequently, nosebleeds are very easy to occur; even dry weather can trigger bleeding.
Causes of nosebleeds can originate from within the nose (such as rhinosinusitis, foreign bodies causing ulceration, benign or malignant tumors, trauma) or from an acute systemic illness (such as measles, influenza, dengue fever, typhoid fever), blood disorders (such as bone marrow failure, leukemia, thrombocytopenia), cardiovascular diseases (such as hypertension), and acute and chronic glomerulonephritis.
Nosebleeds can occur at varying degrees of severity and will be managed based on the severity of the condition. In mild cases, bleeding is minimal, self-limiting, and does not affect the overall condition. Moderate bleeding is characterized by bright red blood flowing in streams, either from the front of the nose or down the throat, but the patient remains alert and responsive. Severe bleeding is classified when there is significant bright red blood loss, occurring repeatedly and severely affecting the overall condition—often due to rupture of major blood vessels.
If the bleeding is mild, the patient can simply pinch their nostrils together for 5 minutes. In more severe cases, a clean, long piece of fabric should be inserted firmly into the nose, and the patient should be taken immediately to an otolaryngology facility for hemostasis and thorough investigation of the cause. Currently, thanks to endoscopic tools, it is possible to locate the bleeding site deep within the nasal cavity and directly cauterize the bleeding point, achieving quick hemostasis. Doctors can also address ruptured points in very deep locations of the artery using a system that navigates through the femoral artery.
However, addressing the underlying cause is the most important factor in preventing recurrent nosebleeds.
ThS. PHAM BICH DAO, Health & Life
