Epistaxis
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Basics

Description

  • Hemorrhage from the nose involving either the anterior or posterior mucosal surfaces
  • Synonym(s): Nosebleed

Epidemiology


Incidence
  • In the US: Common
  • Estimated lifetime incidence ∼60%
  • Bimodal, with peaks in children up to 15 and in adults >50 years
  • Rare in children under age 2

Risk Factors

  • Local irritation from multiple causes (see “Etiology”)
  • Medications/Supplements, including aspirin and clopidogrel

General Prevention

  • Humidification at night
  • Cut fingernails to minimize picking.

Pathophysiology

  • Local vs. systemic disease. Most are due to local causes.
  • Anterior: 90–95% of all cases (Kiesselbach plexus)
  • Posterior: Usually branches of sphenopalatine arteries: May be asymptomatic or may present with other symptoms

Etiology

  • Idiopathic
  • Local inflammation/irritation:
    • Infection
    • Irritant inhalation
    • Topical steroid use
    • Septal deviation (more air movement on 1 side)
    • Low humidity
  • Trauma:
    • Epistaxis digitorum (nose picking)
    • Foreign bodies
    • Septal perforation
    • Sinus fracture

Commonly Associated Conditions

  • Vascular malformation/telangiectasia
  • Neoplasm (rare, but consider in persistent unilateral cases)
  • Systemic:
    • Coagulopathy: Primary or iatrogenic
    • Thrombocytopenia
    • Cirrhosis
    • Renal failure
    • Alcoholism
  • No proven association with hypertension (HTN), but may make control of bleeding more difficult.

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