What Are the Different Treatments for an Infected Nose Piercing?

Allergic rhinitis is one of the common clinical symptoms, commonly known as epistaxis. It can be caused by nasal diseases or by systemic diseases. Nosebleeds are mostly unilateral, and bilateral nosebleeds can occur in rare cases; the amount of bleeding varies, with light in the nasal discharge only, and severe cases can cause hemorrhagic shock, and repeated nosebleeds can lead to anemia.

Basic Information

nickname: Nosebleed
English name: epistaxis
Visiting department: ENT

Multiple groups: Patients with blood diseases
Common causes: Caused by nasal disease or systemic disease
Common symptoms: Unilateral or bilateral nostril bleeding

Causes of rhinitis

There are many causes of epistaxis, which can be caused by diseases of the nasal cavity itself, or induced by perinasal cavity or systemic diseases.

Local cause

(1) Nasal injuries Mechanical traumas such as car accidents, falls, boxing injuries, and nose digging are common causes of nosebleeds. Barometric injuries During high-altitude flight and diving, if the air pressure difference between the inside and outside of the sinuses suddenly changes too much, the mucosal blood vessels in the nasal cavity and the sinuses will rupture and rupture. Radiotherapy injury During and after radiotherapy of the head and neck, congestion and edema of the nasal mucosa, or epithelial shedding may occur, and nosebleeds may also occur.

(2) Deflection of the nasal septum occurs mostly near the epiphysis or spine (rectangular process) or the convex surface of the deviated nasal septum, where the mucosa is thinner, and the air flow direction changes here, so the mucosa becomes dry Blood vessels rupture. Patients with perforation of the nasal septum can cause repeated nosebleeds due to dryness, erosion and detachment of the mucosa at the edge of the perforation.

(3) Inflammation of the nose Non-specific inflammation of the nose Acute rhinosinusitis, dry rhinitis, atrophic rhinitis, etc. are prone to cause nosebleeds, and the amount of bleeding is generally small. nose-specific infections Specific infections such as tuberculosis, lupus, syphilis, leprosy, and diphtheria can cause nosebleeds due to mucosal erosions, ulcers, granulations, and perforation of the nasal septum.

(4) Tumors of the nasal cavity, sinuses, and nasopharynx Among the patients who are most prone to nosebleeds are nasal septum hemangioma, nasopharyngeal fibrohemangioma, hemorrhagic nasal polyps, and nasal sinus malignant tumors. A small amount of nosebleeds or blood in the nose is one of the main early symptoms of malignant tumors.

(5) Nasal foreign bodies are common in children, mostly unilateral nosebleeds, because nasal foreign bodies remain in the nasal cavity for a long time, which can cause nasal mucosal erosion and bleeding. Animal nasal foreign bodies, such as Leeches, can cause repeated massive nosebleeds.

2. Systemic causes

(1) Hemorrhagic diseases and hematological diseases Diseases of the structure and function of blood vessel walls, such as hereditary hemorrhagic telangiectasia, vitamin C deficiency, allergic purpura, drug-induced vascular purpura, infectious vascular purpura, blood vessels Sexual hemophilia and so on. Platelet count or dysfunction diseases such as primary thrombocytopenic purpura, secondary thrombocytopenia caused by various reasons, etc. clotting factor disorders, such as hemophilia, vitamin K deficiency and so on. The blood's own anticoagulant effect is too strong, such as improper use of anticoagulants, antifibrinogen and other anticoagulant substances in the blood circulation, or excessive or accelerated fibrin dissolution, such as diffuse intravascular coagulation.

(2) Acute febrile infectious diseases such as flu, flu, hemorrhagic fever, scarlet fever, malaria, measles and typhoid. Mostly due to high fever, toxic vascular damage, nasal congestion, swelling and dryness, resulting in capillary rupture and bleeding. Under normal circumstances, the amount of bleeding is small, mostly occurs in the fever period, and the bleeding site is mostly located in the front of the nasal cavity.

(3) Cardiovascular diseases Hypertension and arteriosclerosis Hypertension and arteriosclerosis are important causes of nasal bleeding in the elderly, and vascular sclerosis is the pathological basis. Increased blood pressure, especially during constipation, excessive force or emotional excitement, can cause nasal blood vessels to rupture, causing nosebleeds. In addition, sneezing, coughing hard, nasal breathing or nasal massage are also factors that cause repeated and difficult to control nosebleeds. Increased venous pressure Emphysema, pulmonary heart disease, mitral valve stenosis, neck or mediastinal space occupying diseases, etc., can cause superior vena cava hypertension. The nasal cavity and nasopharyngeal veins of these patients often have venous congestion, When the patient has a severe cough or other inducement, the blood vessels can rupture and bleed, and the bleeding site is mostly located in the nasopharyngeal vein at the posterior nostril from the distribution area.

(4) Other systemic diseases Pregnancy, premenopause, and menopause can cause nosebleeds, which may be related to increased capillary fragility. Patients with severe liver disease can cause nosebleeds due to liver coagulation factor disorders. Uremic disease can also cause nosebleeds. Nosebleeds can be one of the early manifestations of rheumatic fever.

Clinical manifestations of epistaxis

Nosebleeds have different performances due to different reasons. Most nosebleeds are unilateral or bilateral; they can be intermittently repeated, and they can also be persistent. The amount of bleeding varies, with light blood, a few drops or a few milliliters in the milder snot, which can reach tens of milliliters or even hundreds of milliliters or more, leading to hemorrhagic shock. Repeated bleeding can cause anemia. A small amount of bleeding can stop on its own or after self-compression.

Most of the bleeding sites occur in the easy-bleeding area before and after the nasal septum, and sometimes jet or pulsatile arterial bleeding is seen. Nasal bleeding in children and young people occurs in this area. Nasal bleeding in middle-aged and elderly people is often related to hypertension and arteriosclerosis. The bleeding site is more common in the back of the nasal cavity, Wu's nasal-nasopharyngeal vein plexus near the back of the inferior turbinate, and arteries in the back of the nasal septum. Bleeding in this area is generally fierce, and it is not easy to stop bleeding. The bleeding often flows quickly into the pharynx and is spit out of the mouth. Nasal bleeding caused by local diseases mostly occurs on one side of the nasal cavity, while those caused by systemic diseases may have alternate or simultaneous bleeding on both sides of the nasal cavity.

Rhinoplasty diagnosis

1. Inquire about the history and bleeding in detail, confirm that the bleeding originates from the nasal cavity or adjacent tissues, and exclude hemoptysis and vomiting.

2. Determine the bleeding site, determine the location of the site by combining anterior nose, endoscope, and / or CT and MRI.

3. Routine blood tests are essential for patients with large bleeding and suspected hematological diseases. For patients using anticoagulants and suspected coagulation disorders, coagulation needs to be checked.

4. Estimate the amount of bleeding, assess the patient's current circulatory system status, and whether there is hemorrhagic shock. Necessary fashion must consult with relevant departments. Comprehensively determine the amount of bleeding according to each bleeding situation and number of episodes, the patient's blood pressure, pulse, general conditions and laboratory tests. When the blood loss reaches 500ml, dizziness, thirst, fatigue, paleness and other symptoms may appear; when the blood loss reaches 500ml ~ 1000ml, sweating, blood pressure drop, and pulse speed may occur; if the systolic blood pressure is lower than 80mmHg, it indicates blood Capacity has been lost by about 1/4.

5. Troubleshoot systemic disorders.

Differential diagnosis of epistaxis

Hemoptysis

After bleeding from the throat, trachea, bronchi, and lungs, the blood leaks out through the mouth. It is common in tuberculosis, bronchiectasis, lung cancer, lung abscess, and pulmonary congestion caused by heart disease. Can be identified based on the patient's previous medical history, signs and auxiliary examination.

2. Hematemesis

Hematemesis is one of the main manifestations of upper gastrointestinal bleeding. When a large amount of hematemesis occurs, blood can flow out of the mouth and nasal cavity, often accompanied by other symptoms of gastrointestinal diseases. A general physical examination may have positive signs and can be identified.

Rhinitis treatment

Nosebleed is an emergency, and you should first maintain vital signs, stop bleeding as quickly as possible, and treat the cause.

General processing

First, comfort the nervous and feared patients and their relatives to calm them down, so as to prevent the patients from increasing their blood pressure due to mental factors and exacerbating the bleeding. The blood pressure and pulse should be measured in time, and fluid should be replenished if necessary to keep the vital signs stable. If the patient is in shock, first aid should be given to the shock. When inquiring about the medical history, ask the following: which side of the nasal cavity or which side of the nasal cavity first bleeds, the rate and amount of bleeding, whether there have been repeated nosebleeds in the past, whether the bleeding was induced, and whether there were other accompanying symptoms.

2. Find the bleeding point

Depending on the situation, local and systemic nasal examinations are performed. When examining the nasal cavity, clear the clot in the nasal cavity, apply 1% ephedrine and dicaine to fully contract and anesthetize the nasal mucosa, find the bleeding site as much as possible in order to stop bleeding accurately. If possible, it is best to find the bleeding point under the nasal endoscope and implement hemostatic treatment.

3. Hemostasis of nasal cavity

According to the severity of the bleeding, the bleeding site, the amount of bleeding and the etiology, choose different hemostatic methods.

(1) Shiatsu method Patients can pinch the bilateral wing with their fingers or press the bleeding wing to the nasal septum for 10 to 15 minutes. They can also press the upper lip with their fingers and apply a cold compress to the forehead and neck. This method is suitable for patients with a small amount of bleeding and bleeding in the front of the nasal cavity. Patients with nose bleeding at home can take this method.

(2) Local hemostatic drugs are suitable for lighter anterior nasal bleeding. This method is simple and easy, and the patient has less pain. For bleeding areas, cotton pads can be dipped in 1% ephedrine, 1 adrenaline, 3% hydrogen peroxide solution, or thrombin, and the nasal cavity can be tightly closed for several minutes to several hours to achieve the purpose of hemostasis.

(3) Cauterization method Commonly used are chemical and physical cauterization (including electric cauterization, laser cauterization, and microwave cauterization). The bleeding located before and after the nasal septum is clearly visible after fully contracting and anesthetizing the nasal mucosa. You can use a cotton swab dipped in 30% -50% silver nitrate or 30% trichloroacetic acid to burn the bleeding point and press it for a moment. Until a white film is formed locally.

(4) Anterior nostril packing may be applied when severe nasal active bleeding or bleeding is not clear before surgery.

Vaseline oil gauze anterior nostril tamponade is a traditional method of hemostasis. Most patients with nosebleeds can stop bleeding after tamponade. A few patients need repeated tamponade or further posterior nostril tamponade. Vaseline oil gauze strips can be folded from the top of the nasal cavity from top to bottom and packed tightly, or they can be stuffed from the bottom of the nose to the top of the nasal cavity. There must be a certain depth and strength when stuffing. Do not stack the gauze strips at the front nostril. After stuffing, check if there is still blood flowing into the pharynx from the nostril. The time for removing the nasal stuffing should be determined according to the situation. For patients with severe bleeding or hematological diseases, the packing time should be appropriately extended. During the stuffing process, patients should be given antibiotics to prevent nasal cavity and sinus infection.

Vaseline oil gauze anterior nostril tamponade is currently widely used in the treatment of nosebleeds, but patients have greater pain and are prone to recurrence. There are currently many improved methods, such as: Hemostatic tamponade puts finger covers coated with oil or ointment Enter the nasal cavity, and then use the gauze to do stuffing in the sleeve. This method is less painful when filling and removing the gauze. Compression hemostasis with airbag or water sac The hemostatic airbag with various shapes is made of rubber film, placed on the nasal bleeding site, and inflated or filled with water to compress the hemostasis. Others Other filling hemostatic materials can be selected, such as swelling sponges, calcium alginate fibers, etc., which are suitable for diffuse nasal mucosa and small amount of bleeding, and have the advantages of good hemostatic effect and less pain.

(5) Posterior nostril tamponade. After anterior nostril tamponade, the bleeding still does not stop. It flows backward into the pharynx or flows out from the contralateral nasal cavity. The classic posterior nostril stuffing method puts a thin urinary catheter from the bleeding side of the nasal floor into the pharynx and pulls out the mouth. The silk of the posterior nasal embolization ball is tied at the tip of the catheter, and the posterior nasal embolization ball is delivered with one hand. At the entrance cavity, gradually pull the urethral catheter with the other hand to make the posterior nasal embolization ball enter the posterior nostril, and then perform anterior nasal stuffing with oil gauze strips, and then tie the silk thread to a gauze roll and fix it to the patient's anterior nostril. The operation of posterior nostril stuffing is more complicated, and the patient is more painful. Generally, the patient needs to be hospitalized for observation and given sufficient antibiotics to prevent infection. The soft palate and the anterior nostril should be checked daily for redness and swelling, and the patient's breathing and eating conditions should be observed. Can be stuffed for 3 to 7 days. Packing method of airbag or sac The use of airbag (Foley tube) with trachea for posterior nostril filling can not only significantly reduce the pain of patients, but also greatly reduce the occurrence of complications. Most scholars believe that the application of Foley tube makes posterior nostril embolization simple and feasible, and has obvious advantages in emergency treatment. The patient can take any position, the operation is simple, the hemostasis is rapid, the patient's physical damage is small, the treatment effect is good, the size of the balloon pressure can be controlled by the injected liquid, can be adjusted at will, the nasal mucosa is stimulated, the damage is light, and it is easy to master the application.

(6) Transnasal endoscopic hemostasis method With the advancement of ENT equipment, in recent years, the method of detecting the blood site and performing electrocoagulation to stop bleeding under nasal endoscope has achieved remarkable results and has been widely used, and its effective rate can reach 90. % Or more, the advantage is that the hemostasis of all parts of the nasal cavity, especially the upper, posterior and nasopharyngeal areas, which are not easy to observe in the front nose, is clearly and reliably stopped, which is accurate and reliable. Compared with petroleum jelly packing, it greatly reduces With the damage to the nasal mucosa, the patient suffered less. No special care is needed after hemostasis, no hospitalization is required, and fewer complications. The disadvantage is the higher cost.

(7) Arterial embolization The rapid development of imaging technology has helped the diagnosis and treatment of severe nosebleeds. Through digital silhouette angiography (DSA) technology, the bleeding site can be located and the blood vessels in this area can be embolized. The method is to insert a catheter through a femoral artery puncture, selectively place it on the arterial trunk, perform an angiogram and observe the external carotid artery branch. After determining the bleeding vessel branch, inject an embolizer from the catheter to stop bleeding. Arterial embolism can be applied to: difficult to control primary nosebleeds, traumatic nosebleeds, internal carotid artery-cavernous sinus fistula, internal carotid artery rupture, and nasopharyngeal fibrohemangioma bleeding. The method can directly display the bleeding site and cause, and the hemostatic effect is rapid and quick, and the treatment time is shortened. In the critical situation of heavy bleeding, digital silhouette angiography embolization is an effective rescue measure. However, arterial embolization requires certain equipment and conditions for the treatment of epistaxis. The technical requirements are high and the cost of the patient is also large. Allergies, severe atherosclerosis, and liver and kidney dysfunction are contraindicated, so the indications must be strictly controlled.

(8) Vascular ligation is currently less commonly used, mostly for those with severe nosebleeds who are still unable to stop bleeding through the above-mentioned various treatment methods. Before ligating, you should try to determine the source of the bleeding as accurately as possible before deciding which artery to ligate. Generally, anterior ethmoid artery ligation can be used for bleeding in the upper nasal cavity; patients with hemorrhage in the lower part of the nasal cavity should undergo maxillary or external carotid artery ligation.

(9) Nasal Septum Surgery Nasal septum mucosal scratches are suitable for repeated nosebleeds caused by dilated small blood vessels before and after the nasal septum. Under local anesthesia, the mucosa of the nasal septum is scratched to destroy the expanded small blood vessel network, and the effect of preventing repeated nosebleeds is achieved. Laser, radio frequency and other methods can also be used to destroy the expanded small blood vessel network. Nasal bleeding caused by deviated nasal septum, nasal septum correction is feasible.

(10) Other operations For nasal bleeding caused by tumors in the nasal cavity or sinuses, hemostasis should be stopped first, or the tumor should be removed surgically, or radiotherapy, or ligature of the neck vessels should be used to stop the bleeding, depending on the specific conditions and the nature of the tumor.

4. Systemic treatment

There are many causes of nosebleeds and the degree of bleeding varies. The treatment and management of nosebleeds cannot be just hemostasis in the nasal cavity. Necessary systemic and special treatments must be taken according to the condition, that is, the primary disease should be actively treated during hemostasis.

(1) Find the cause of bleeding and treat it.

(2) The amount of bleeding should be evaluated in patients with nosebleeds, especially for patients who are still bleeding at the time of consultation.

(3) For elderly patients or patients with more bleeding, pay attention to the situation such as hemorrhagic anemia, shock, and heart damage, and deal with it in a timely manner. Patients with a large amount of bleeding should also detect blood type and prepare blood at the same time, according to the amount of blood loss to rehydration, blood transfusion treatment. Those with high blood pressure should be actively treated with antihypertensive therapy, and the blood pressure of elderly patients should not be reduced too quickly to avoid thrombosis.

(4) Nasal packing and posterior nostril packing can cause lower blood oxygen partial pressure and elevated carbon dioxide partial pressure. Therefore, elderly patients should pay attention to cardiopulmonary and cerebral functions, give oxygen inhalation if necessary, pay attention to the nutrition of patients, and give them high-temperature and easy digestion. diet.

(5) Appropriate application of systemic hemostatic drugs, such as thrombin, aminocaproic acid, phenothelamine, etc.

(6) For patients with emotional stress, sedative drugs can be appropriately applied. Psychological treatment can also reduce the patient's nervousness, anxiety, and prevent re-bleeding.

Rhinitis prevention

Usually pay attention to prevent the occurrence of nosebleeds, measures include:

1. Keep the room quiet and clean, and the temperature should be appropriate. Keep the air fresh in the room. Open the windows and ventilate properly. The temperature should be kept at 18 20 . Too dry air can induce nasal bleeding, so the air humidity should be 60%.

2. The elderly should move slowly during weekday activities. Don't blow your nose hard.

3. Eat some digestible soft foods in your diet, eat more fruits and vegetables, avoid spicy food to stimulate the diet, and keep the stool smooth, constipation can be given laxatives.

4. Elderly patients with epistaxis are often accompanied by hypertension, coronary heart disease, bronchitis, etc. The primary disease should be regularly prevented and treated accordingly, especially for patients with hypertension, and blood pressure must be controlled to normal or as soon as possible. Close to normal level, observe the change of condition, and go to the hospital for treatment in time.

5. For children with nosebleeds, the bad habits such as digging the nose, rubbing the nose, and placing foreign objects with curiosity may be corrected. ^[1-3]