Epistaxis in Elderly | 5 sinister causes to suspect (part 3 of 3)

Epistaxis or nosebleeds become common as the age increases. Multiple reasons are responsible for the increased incidence of epistaxis in the elderly.

1. Hypertension

Uncontrolled high blood pressure is responsible for the majority of nosebleeds presenting to the emergency room. “Woodruff’s plexus” is plexus of veins present at the back of the nose. It is the culprit in most cases with hypertension. Bleeding can be brought under control by reducing blood pressure. These kinds of epistaxis become a recurrent issue if not medically intervened.

2. Blood thinners

Blood thinners such as aspirin, clopidogrel, warfarin and heparin are responsible for another chunk of epistaxis presenting to ER. Most of the time it may be a combination of high blood pressure and blood thinners. Blood-thinners are prescribed for heart disease, thrombosis and stroke. As the name suggests, this group of drugs prevent blood from clotting and dissolve any pre-existing clots. Hence, any minor trauma tends to bleed profusely.

3. Tumours

With increasing age the incidence of malignancy increases. This is the case for sino-nasal tumours too. Tumours of the nose and paranasal sinuses are aggressive and present with nose block and bleeding. Surgery, radiation and chemotherapy are the three treatment modalities. Selected as per the stage & type of malignancy.

4. Trauma

The elderly population is prone to both accidental trauma (falls) and physical violence. Trauma affects the nose. The trauma victim will present to emergency room with a clear history and findings of the same. Treatment revolves around stopping the bleed and identifying the cause to avoid a repeat.

5. Ageing tissue

With age the collagen in our tissues breaks down, resulting in thinning of the skin, mucosa, walls of blood vessels etc. Even minor trauma such as nose-picking (injury to Kiesselbach’s plexus) or blowing the nose can result in profuse bleeds. Atherosclerosis is the hardening of the walls of the blood vessels. These blood vessels are rigid, prone to rupture with increased pressure and do not constrict adequately to stop the bleeding. Therefore, bleeding in the elderly is profuse and recurrent.

In conclusion, nosebleeds in the elderly are mostly multifactorial. A detailed history and examination aid in making a correct diagnosis and treatment plan, which reduces the severity and chances of recurrence.

This article was written by Dr Akanksha Saxena, Consultant ENT, Head & Neck Surgeon, ENT360. She is a practising ENT Specialist in Gurgaon with over 10 years of experience. Read more of her blogs here.