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Posterior epistaxis is bleeding which comes from the back of the nose. It is much less common than anterior epistaxis, which is bleeding from the front of the nose. Only around ten percent of cases of epistaxis, or nosebleed, are posterior. In posterior epistaxis, the amount of bleeding can be quite large and treatment in the hospital may be necessary.
When bleeding comes from the back of the nose, it generally originates from branches of what are called the sphenopalatine arteries in the posterior nasal cavity. Posterior epistaxis causes may arise from the nose itself and may include conditions such as infections, allergies and injuries. Alternatively, a disease affecting the whole body could result in nasal bleeding. Such conditions could include blood clotting disorders, such as hemophilia, or disorders such as liver disease and leukemia.
One of the most obvious signs of posterior epistaxis is a doctor failing to find any source of bleeding at the front of the nose. It may also become apparent when bleeding continues even after a pack has been applied to the front of the nose. If there is blood coming from both nostrils, this can be an indication of posterior epistaxis, although bleeding can occur from only one nostril at first. Sometimes, because bleeding is coming from the rear of the nose, blood is seen running down the back of the throat. In some cases, there may be no symptoms of posterior epistaxis, but in others, anemia, coughing or vomiting blood, or blood in the stools may occur.
Posterior epistaxis treatments usually involve the use of a nasal pack, which is set in place by an ear, nose and throat specialist. A nasal pack consists of a wad of gauze, and this is maneuvered into place using a flexible tube called a catheter. The catheter is inserted into a nostril before being pushed to the back of the nasal cavity, round and down into the throat and out through the mouth. A pack of gauze is fixed to the mouth end of the catheter and this is then moved into place by pulling on the nostril end of the catheter until the gauze pack is lodged in the back of the nasal passage. As it seals the opening at the rear of the nose and presses on the source of the bleeding, the pack can help stop the hemorrhage.
An alternative treatment for posterior epistaxis involves using what is called a double-balloon device, which is inserted into a nostril. The device is then passed to the back of the nose and a posterior balloon is inflated. This sits at the rear of the nasal cavity, stemming the flow of blood. An anterior balloon is inflated at the front of the nose to anchor the posterior balloon and prevent it from moving down and interfering with breathing.
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