Understanding Refractory Chronic Cough: What You Need to Know Have you ever faced a cough that simply refuses to subside? While most coughs resolve independently, some persist for an unacceptable length of time—weeks, months, or even years. This condition is known as refractory chronic cough (RCC), and it is a significant issue that demands attention in the medical community, especially among specialists in ear, nose, and throat (ENT) care. In this blog post, we will clearly outline what RCC is, why it occurs, and the most promising treatments available to those suffering from relentless coughing. What is Refractory Chronic Cough? A chronic cough is defined as one that lasts longer than eight weeks in adults. For many individuals, it is associated with conditions such as asthma, allergies, acid reflux, or certain medications. However, there are instances where the cough continues even after these underlying causes have been effectively ad...
What is nose bleed or epistaxis?
Inside of the nose is lined by mucosa which is very rich in blood vessels. One of the main functions of the nose is to humidify the air we breathe in and out. Humidication is naturally achieved by mucous cells lining the nose. Blood vessels can become weak due to dryness, high pressure behind the vessels or hormonal changes.
What are different kinds of nose bleeds?
In simple terms, one can have an anterior nose bleed or posterior nose bleed. Anterior nose bleed is when most of the blood comes out through the nostril and some you spit out. Posterior nose bleed is when you spit most of the blood and little comes out through nostril.
Why do children have nose bleeds?
It is very common for children between 2 to 10 to have nose bleeds.
Dry weather during summers and dry air indoors during winters due to heating tends to dry nasal mucosa. Dry nasal mucosa, in turns, makes it itchy for children to rub their nose and lead to nose bleeds. It is also common for children with allergies to have nose bleeds. In some cases, children can get a nose bleed due to trauma.
What to do when children get a nose bleed?
The first thing to do is "keep calm." Make the child sit on a chair and slightly lean forward. Ask them to breathe through the mouth and then gently pinch the soft part of the nose for 10 mins. You can use some ice on the forehead. You should see your GP if your child has frequent nose bleeds. The child may need to be seen by an ENT specialist for examination and management.
What happens when an ENT specialist sees children for the nose bleeds?
Typically ENT specialist will take a full detailed history and use a special camera to examine the nose to look for the site of nose bleed. He may recommend simple measures like managing allergy, using an antibiotic cream or emollient, using saline drops or spray. If this does not work, then he may recommend nasal cauterization.
Nasal cauterization is a procedure performed on nasal mucosa using a chemical stick or electrical cautery to stop the bleeding.
If performed under local anaesthetic, the surgeon will spray the inside of the nose with decongestant and anaesthetic medication.
Medication will numb the nose in a couple of minutes. After this, with a special chemical stick, the surgeon will apply the chemical on the bleeding point. The whole procedure takes 15-20 minutes and can be done in the clinic on the same day of consultation.
In some cases, the surgeon may recommend the procedure to be done in theatre under general anaesthetics.
After the nasal cautery, the child can still have some spotting. You will be advised to continue with nasal cream and saline drops for two weeks. In case the child gets nose bleeds from both nostrils, the surgeon may decide to do the worse side first and manage the other side after a few weeks.
Why do teenager boys get nose bleeds?
All teenager boys, if they get one-sided nose bleed need to be seen by ENT surgeon for camera examination of the back of the nose.
Endoscopy is done to rule out vascular swelling at the back of the nose.
Why is a nose bleed common during pregnancy?
During pregnancy, the body tends to retain more water and have hormonal changes. Hormonal changes can have an impact on the lining of the nose, making it more prone to nose bleed.
Why do adults get a nose bleed?
Like children, adults can also get nose bled due to dry nose, allergy and sinusitis. In some cases, high blood pressure or nasal tumour (cancerous or non-cancerous) can cause a nose bleed.
If you are taking blood thinners, it is good to have a discussion with your GP for alternative blood thinners.
If you get a one-sided nose bleed, with/ without facial pain, with/without nasal obstruction, with/ without eye pain, you need to be seen by ENT specialist for urgent nasal endoscopy and scanning of the nose to rule out a nasal tumour.
Mr Gaurav Kumar
Consultant Ear Nose Throat Surgeon
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Disclaimer: For general information, always seek medical advice from your treating consultant
