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Archive for February, 2013

Nosebleeds (Epistaxis)

Wednesday, February 13th, 2013

Nosebleeds are a fairly common occurrence and the vast majority represent just a minor nuisance. They tend to be frightening because they can be profuse and dramatic but only rarely are they life-threatening. They can occur at any age but are most common under age 10 and over age 50.

Nosebleeds can be divided into two types: anterior and posterior. Anterior epistaxis represents about 90% of nosebleeds and tend to be easier to manage. With an anterior nosebleed the blood will tend to come out the front of the nose. Bleeding that is more profuse and going down the back of the throat is more likely to be posterior.

The nasal mucous membranes warm and humidify air as it passes through the nose. To accomplish this, the nose has a very rich vascular supply. There is a collection of blood vessels on the anterior septum called Kiesselbach’s plexus where the vast majority of nosebleeds occur. Often, there is no obvious cause for the bleeding and it may seem very random. Some factors that may cause bleeding include dry air, trauma either from an injury or from picking the nose, chemical irritants, nasal septal deformities, allergies, upper respiratory infections, medications such as aspirin and other anti-coagulants, and medical illnesses such as hypertension and vascular disease.

Most nosebleeds can be managed at home. Humidifying the air and applying nasal saline sprays may help preventively. Avoid hard nose blowing and picking the nose. Avoid hot and spicy foods and hot showers and avoid aspirin and other anti-coagulants unless medically necessary. If bleeding occurs, sit down and lean forward and relax. Pinch the nose firmly on the soft part of the nose so that pressure is applied against the septum. Apply ice or cold cloths to the nose. Pinch the nose for 5 minutes watching the clock. If it is still bleeding then pinch the nose for another 10-15 minutes. If bleeding continues then medical attention may be necessary. Topical over-the-counter nasal sprays containing oxymetazoline or phenylephrine may help to decrease bleeding.

If bleeding persists or recurs or is severe then medical attention may be necessary. Anterior bleeding can sometimes be managed with chemical cauterization using silver nitrate. Occasionally, persistent bleeding will require nasal packing and, more rarely, surgical management or embolization

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How Much Caffeine is Present in Coffee? Decaff? Chocolate?

Wednesday, February 6th, 2013


There are quite a few ENT problems that can potentially be due to caffeine intake. Even death has been attributed to high caffeine intake in young adults who drink a lot of energy drinks like Red Bull.

In any case, caffeine can contribute to (some proven, some suspected, some debatable):

• Tinnitus
• Meniere’s Disease
• Migraine Headaches
• Headaches
• Dizziness
• Reflux
• Lump in Throat Sensation (Globus)
• Chronic throat clearing
• Dry throat
• Phlegmy throat

Alcohol and salt are other big as well as under-recognized items that may cause similar ENT issues.

As such, caffeine abstinence is one of the first things to be tried with some of these conditions. What many people may not realize is how prevalent caffeine is even in some food items not normally considered to contain caffeine. Such unrecognized items include decaffeinated coffee (it has been de-caffeinated, but not to the point of being caffeine free), tea, and chocolate.

Here is an infographic showing relative caffeine amounts in a variety of beverages taken from C&EN:

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