Post Nasal Discharge (PND)

Post-nasal discharge means to feel discharge is accumulated in the throat or to realize that discharge flows behind the nose.  PND may be observed because of exercise, problems related with throat muscles and swallowing.

Secretor glands that cover the nose and sinuses normally produce 250-500 ml secretion in one day.  There are small moving hairs on the surface of this mucosa which can be only seen by a microscope.  These enable the secretion to mode backwards. Then this secretion is swallowed unconsciously.  This secretion dampens and cleans the membranes, and fights against infections.  Production and cleaning of this secretion are dependent on the relation between the nerves, blood vessels, hormones and small hairs.

Nose Bleed
Nose bleed is the complaint that is most frequently encountered in ENT region.  Almost everyone has nose bleed at least for once in his/her life.  Even though reason of nose bleed is mostly simple and it can be stopped easily; sometimes the reason behind may be very serious and bleeding intensity may be life-threatening.

Why Does the Nose Bleed Frequently?
Nose contains intense and superficial vessels. Especially the front side of the chamber that divides the nose cavity into two is a section where vessels coming to the nose unite and where these vessels are superficial.  Especially in children, this section may bleed without any impact.  Flesh located on two side of the nasal cavity and named as concha is rich of vessels and it is the reason of some of the bleeds. 

What are the reasons of nose bleed?
Nose bleed develops both by the reasons arising from nose (local reasons) and problems outside of the nose (general reasons).

Local Reasons:

• Intranasal inflammations
• Sinusitis
• Impacts received by nose
• Nose-pick by children
• Foreign matters put into the nose
• Intranasal and sinus tumors
• Bone curvature in the nose
• Allergic rhinitis

General Reasons:

• Hypertension  
• Blood diseases (Bleeding-clotting disorders, leukemia, etc.)
• Enterozoa

Treatment:
Most of the nose bleeds stop by itself or when patient holds the tip of the nose and apply cold to it.  However, if bleeding does not stop in this way, medical treatment is required. 

Following treatments may be realized:

Cauterizing the vessels:
This technique is used for mild and frequent bleeding.  Chemicals are applied to the veining on the front side of the nose chamber.   When applied to both sides, or when chemicals are applied too much, there is risk for the nose chamber to be destroyed.

Placing tampon:
It is a treatment applied frequently.  It is used for bleeding that did not stop by holding the tip of the nose and applying cold.  Tampon placed to the nasal cavity makes pressure on the vessel and stops bleeding.  Gauze dressing to which crèmes with antibiotics are applied; and more advanced tampons that have a pipe in the middle from which patient shall breathe, may also be used as tampon.  In general, tampons stay in the nose for 48 hours.  If it stays more than this time period, it may cause infections.  Antibiotic should be given to the patient during tampon treatment.  Sometimes rear sections of the nose are the source of bleeding, and bleeding can not be stopped by the tampon placed to the front side.  In this case, tampon called posterior tampon, is inserted from mouth and placed to the rear section of the nose.

Inosculation:
This operation is a surgery, and it is used for bleeding that threatens life of the patient and can not be stopped with a tampon.  Vessel detected according to the place of bleeding is ligated from inside of sinus and sometimes by opening the neck.  It is very important to relieve the patient during these interventions.  With this purpose, diazem or other tranquilizers may be given especially to old patients and patients who have hypertension.

Sinus-Pain, Pressure, Discharge
Endoscopic Sinus Surgery (ESS) is one of the surgeries realized most as the first treatment option for the treatment of especially chronic sinus inflammations, sinus tumors, anterior skull base injuries, traumatic eye socket injuries and optic nerve compression.