Nose Bleeding: Symptom of Deviated Septum
Nose bleeding could be a disturbing or life threatening condition especially if it occurs much more frequently than usual. The author did experience frequent nose bleeding since the early part of December 2011 and had to be confined in the hospital for more than three weeks. While he had experienced nose bleeding before, this time it became more frequent and occurred without warning. Bleeding was profuse.
The usual approach to persistent nose bleeding is for the doctor to place nose packing (in this case Merocel) inside the nose to keep the blood from flowing into the nasal cavity and the throat. But this proved to be ineffective because nose bleeding kept on despite the nose packing. It could be something else as the source of the blood streaming is apparently from deep inside the right sinus.
Better facilities are required to address the problem so the author had to be airlifted to a much better hospital in Manila as he is living in Palawan, a much more rural area. Diagnostic procedures consisted of blood composition or clotting evaluation, chest x-ray, electrocardiogram (ECG), and computerized tomography or CT scan. The CT scan revealed that the author had a deviated septum. All the other tests are normal. These are standard operating procedures before a patient undergoes surgery.
The author was put under general anesthesia, general endotracheal anesthesia to be exact. He was unconscious when operated on. He underwent operation to correct a deviated septum.
What is a deviated septum?
A deviated septum is a misalignment of the wall of the cartilage and bone that divides the left and right nostrils. Although most people have septum that is not centered, the author's septum is deviated quite far enough, which may be the reason for the frequent nose bleeding. The septum deviates to the right making the right nasal airway narrower.
Fig. 1. The author's deviated septum veering towards the right revealed by the CT scan.
What causes a deviated septum?
A deviated septum can be due to birth or congenital. It could also be due to a previous injury in the nose sustained from a forceful blow or accident. The author could not remember that he suffered a facial injury in the past so it could be a congenital one.
How is a deviated septum corrected?
There is no other way to correct a deviated septum but surgery. No medical solution is in sight so the author underwent a major operation where three procedures were performed namely functional endoscopic sinus surgery or FESS, Caldwell Luc, and septoplasty.
FESS is surgery aimed towards restoring the natural clearing function of the sinuses. Fiberoptic telescopes and small cameras that display images on a television screen guide the doctors in enlarging the drainage pathways of the sinuses. While this can be performed on an outpatient basis, it was used to remove the blocking polyps and dead mucosa inside the author's nose. There was infection inside the nose. This could be the reason why two weeks before the episodes of bleeding, the author had difficulty clearing his nose of persistent mucus.
Caldwell Luc is a surgical procedure used to treat sinusitis. It is used to clear a blocked or infected maxillary sinus and involves making an incision into the front, canine tooth to the region above the first or second molar teeth. The maxillary sinus is then cleared of polyps, diseased tissue or tumor in some cases.
Septoplasty is a surgical procedure aimed primarily to restore normal breathing by removing blockage in the nasal airways. If the nasal airways are blocked, sleep apnea or inability to breath during sleep results. Indeed, the author had experienced sleep apnea several times during the past months. He suddenly wakes up catching his breath as if drowning. He had also insomnia during some nights.
A Word of Caution
So if you have a long-term cold, persistent nose bleeding and sleep apnea, these should be a cause of concern. Consult an otolaryngologist right away. It could be a matter of life and death.