Aetiology

Risk factors for epistaxis include: (1)

• a hot, dry indoor climate
  • this causes the delicate nasal skin to crack
  • occurs more often during changes of seasons before the tissues are still not accustomed to the changes in humidity.
• deviated nasal septum
  • this alters airflow pattern and causes the skin on one side of the nasal septum to become dry
• colds and allergies
  • upper respiratory tract infections and allergies increase the risk of bleeding due to inflammation
• irritant chemical exposure
  • cigarette smoke, sulfuric acid, ammonia, gasoline
• medical causes
  • kidney failure, thrombocytopenia, hypertension, hereditary bleeding disorders (e.g. haemophilia)
• alcohol
• drugs
  • anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin and ibuprofen
• homeopathic medications
• dietary supplements

Causes of epistaxis

• a detailed history and examination readily identifies most causes of nasal bleeding (2)
• these can be considered locally and systemically.

Reference:

1. Mulla O, Prowse S, Sanders T, et al; Epistaxis. BMJ. 2012 Feb 23;344
2. Tunkel DE, Anne S, Payne SC, et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020 Jan;162(suppl 1):S1-38.