A common condition with a bimodal age distribution, occurring more frequently in the young and the old.
90% arise at Little's area of the anterior septum, the location of the Kiesselbach plexus.
Precipitating factors include dry weather and other causes of nasal mucosal inflammation or hyperemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, dust, or chemicals. Although rare, neoplasm may also cause nosebleed.
Topical anesthesia and vasoconstriction are essential for initial treatment of active bleeding. If initial measures fail, almost all episodes may be controlled with anterior or anterior-posterior packing techniques.
Bleeding may be refractory in the presence of coagulopathy.
- blood at both sides of nose
- bleeding starting at the nares
- bleeding starting in the throat
- recurrent epistaxis
- septal deviation
- dizziness or lightheadedness
- hypoesthesia and pain in the distribution of the second branch of the trigeminal nerve
Other Tests to Consider
- coagulation studies (PT, activated partial thromboplastin time, platelet function tests)
- BUN, serum creatinine
- autoimmune screen/autoantibodies
- CT scan of paranasal sinuses
- MRI of head
- internal and external carotid angiography
- nasal endoscopy and nasopharyngoscopy
- plain nasal or sinus x-ray
active epistaxis: initial measures
- anterior septal pressure plus vasoconstrictor nasal spray
- resuscitation and supportive care
- treatment of underlying coagulopathy
active epistaxis: persistent bleeding despite initial measures
- topical anesthetic and vasoconstrictor
- treatment of underlying local cause
- anterior nasal packing or double-balloon catheter or traditional anterior-posterior pack
- antibiotics and analgesia
- intravenous sedation and antiemetic
- local anesthetic
- endoscopic management, or embolization by interventional radiologist
- open surgical ligation
quiescent but recurrent epistaxis
- treatment of underlying cause
- silver nitrate cautery