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Epistaxis is one of the commonest presentations at the accident and emergency (A&E) department and is the most common ENT emergency (1). Most cases of nose bleeds are minor or self limiting but rarely can be a life threatening emergency due to massive bleeding (1,2).
An estimated 60 % of the general population has had at least one episode of epistaxis throughout their life time (2).
- out of these only 6% sought medical assistance for it
- 1.6 in 10,000 required hospitalisation (3)
- a bimodal distribution is seen in the poulation
- the incidence peaks at ages less than 10 years and above 50
- in the young, the blood comes from Little's area, a highly vascular area at the anterior border of the nasal septum. With age the site of bleeding moves posteriorly (2)
- rare in children under the age of 2 years and if present is often associated with injury or serious illness (4)
- seasonal variation can also be seen with an increase during the winter months (4)
- occurs frequently in males than in females (2)
Epistaxis may be due to local causes or general causes.
Epistaxis is usually classified into two types:
- anterior bleeding
- posterior bleeding (2)
Epistaxis summary (5)
- epistaxis is common
- an estimated lifetime prevalence in the United States of 60%
- approximately 6% of persons who have nosebleeds seek medical attention.
- management of epistaxis is straightforward in most cases but can be challenging in patients with cardiovascular disease, impaired coagulation, or platelet dysfunction.
- epistaxis is appropriately controlled in a systematic and escalating fashion
- initial management
- patients in the medical setting are advised to apply digital compression to the lower third of the nose for 15 to 20 minutes, which is followed by anterior rhinoscopy
- anterior bleeding can usually be controlled with topical vasoconstrictors, tranexamic acid, cautery, or anterior nasal packing.
- continued epistaxis despite these measures requires more aggressive treatment, with the involvement of specialists in otolaryngology and head and neck surgery and, generally, hospital admission
Last edited 03/2021 and last reviewed 03/2021