Archive for General ENT Conditions



Care and prevention

Most nose bleeds (or epistaxis) are mere nuisances; but some are quite frightening, and a few are even life threatening.  Doctors classify nose bleeds into two different types-

  1. Anterior Nose bleed: the nose bleed that comes from the front of the nose and begins with a flow of blood out of one or the other nostril if the patient is sitting up or standing
  2. Posterior Nose bleed: the nose bleed that comes from deep in the nose and flows down the back of the mouth and throat even if the patient is sitting up or standing

Obviously if the patient is lying down even the anterior nosebleeds seem to flow in both directions, especially if the patient is coughing of blowing his nose. Nevertheless, it is important to try to make the distinction since posterior nosebleeds are often quite severe and almost always require care from a doctor.  Posterior nose bleeds are more likely to occur in older people, persons with high blood pressure and in cases of injury to the nose or face.

Nosebleeds in children are almost always of the anterior type.  Anterior nose bleeds are common in dry climates and when the air is dry.  The dry air parches the nasal membranes so that they crust, crack and bleed.  This can be prevented if you will place a bit off lubricating cream or ointment (e.g. Vaseline, Bactroban ointment) about the size of a pea on the end of your fingertip and the rub it up the nose, especially on the middle portion (the septum).

Up to three applications a day may be needed, but usually every bedtime is enough.

Warfarin, Aspirin (or Aspirin containing products) and non-steroidal anti-inflammatories (e.g.Brufen, Voltaren) thin the blood and can cause bleeding, or cause the bleeding to persist.

If the nosebleeds persist you should see your doctor, who may recommend cautery to the blood vessel that is causing trouble.

To stop an anterior nosebleed 

If you or your child has an anterior nose bleed, you may be able to care for it yourself by taking the following steps:

  1. Pinch the soft (lower) parts of the nose together between your thumb and index finger.
  2. Hold it for 5 minutes (timed by the clock)
  3. Keep head higher than the level of the heart – sit up or lie with head elevated.
  4. Apply ice (crushed in a plastic bag or washcloth) to nose and cheeks
  5. Sucking ice is also useful

To prevent re-bleeding after bleeding has stopped:

  1. Do not pick or blow nose (sniffing is all right)
  2. Do not strain or bend down to lift anything heavy
  3. Keep head higher than the level of the heart

If re-bleeding occurs:

Clear nose of all blood clots by sniffing forcefully

  • Spray nose four times on both sides with decongestant nasal spray (such as Drixine or Otrivine)
  • Pinch the soft parts of the nose together between your thumb and two fingers for five minutes (to stop an anterior nose bleed)
  • Call your doctor if these measures fail.

When to call the doctor or go to the Accident and Emergency:

  • IF bleeding cannot be stopped or keeps reappearing within a short period of time
  • IF bleeding is rapid or if blood loss is large
  • IF you feel weak or faint, presumably from blood loss
  • IF bleeding begins by going down the back of the throat rather than the front of the nose


If your nose bleeds are severe and/or recurrent, please call 031 201 3118 for an appointment.

A complete history will be taken, and a thorough examination of the nasal passages will be performed (including nasal endoscopy). Further management will depend on the site and cause of the nose bleed, and will be in keeping with best ENT specialist practice guidelines.








At the lower end of the oesophagus (gullet) there is a one-way valve (lower oesophageal sphincter) which allows food and fluids to pass into the stomach and should prevent anything from flowing back from the stomach into the oesophagus.  In some people this one-way valve is faulty and irritating stomach acid may flow up from the stomach and into the oesophagus (gullet) and throat. This may cause indigestion and heartburn (a burning sensation behind the breastbone)

Occasionally people experience only the throat symptoms and do not experience indigestion or heartburn (this is sometimes referred to as “silent” reflux, or laryngopharyngeal reflux).

The reflux may cause throat symptoms such as irritation and burning in the throat, muscle spasm in the throat, and a feeling of a lump in the throat

Other symptoms include coughing,  hoarseness, excess mucus in the throat, and a bad taste in the throat.

The excess mucus in the throat may sometimes be mistaken for a postnasal drip.


  • Don’t smoke
  • Eat small meals regularly
  • Do not rush meals
  • Avoid those foods associated with your symptoms,  e.g. acidic fruit drinks, spicy meals, alcohol, coffee
  • Don’t take aspirin for headaches, colds and coughs- use Paracetamol instead
  • Avoid taking anti-inflammatory medications
  • Avoid becoming overweight- – if you are overweight, reducing your weight may be of great benefit
  • Posture- avoid bending from the waist or stooping just after meals. Try and bend from the knees. Take meals on an upright chair, rather than stooping in front of the TV
  • Avoid tight belts and underclothes as they increase pressure on the stomach
  • Eat your evening meal well before going to bed so that it has time to digest
  • Raise the head of the bed on blocks by 6 inches


  • Antacids are available from the chemist – they neutralise any acid in the gullet. Some preparations relieve symptoms by forming a layer on top of the stomach contents, e.g. Gaviscon.
  • Other drugs actually reduce the production of acid in the stomach (e.g. Losec).
  • Medication that enhances the normal movement of the gullet may be of help, eg Motilium


  • You suffer from heartburn regularly- every day or every week
  • Your heartburn or other symptoms persist for more than 2 weeks
  • Your symptoms do not respond to antacids


  • Over 45 years old
  • Have a family history of stomach problems
  • Drink or smoke heavily
  • Take aspirin or anti-arthritis pain killers



If you have symptoms suggestive of silent reflux, please call 031 201 3118 for an appointment.

A complete history will be taken, and a thorough examination conducted. This will include a flexible laryngopharyngoscopy.

Further management will depend on the clinical findings, but will be in keeping with best ENT specialist practice guidelines.