Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • blood at both sides of nose

Other diagnostic factors

  • bleeding starting at the nares
  • recurrent epistaxis
  • septal deviation
  • tachycardia
  • bleeding starting in the throat
  • hypotension
  • syncope
  • dizziness or lightheadedness
  • pallor
  • hypoesthesia and pain in the distribution of the second branch of the trigeminal nerve

Risk factors

  • dry weather and low humidity
  • oxygen dependence
  • septal deviation
  • nasal and other facial fracture
  • other nasal trauma
  • nasal foreign body
  • rhinitis
  • nasal polyp
  • environmental irritants
  • topical nasal drugs
  • primary coagulopathy (e.g., hemophilia)
  • acquired coagulopathy (e.g., use of aspirin, anticoagulant, NSAIDs)
  • familial hereditary hemorrhagic telangiectasia
  • barotrauma
  • ulceration secondary to infection (e.g., herpes zoster, or bacterial infection)
  • forceful coughing
  • sinonasal neoplasm
  • juvenile nasal angiofibroma
  • chronic granulomatous disease

Diagnostic investigations

Investigations to consider

  • CBC
  • coagulation studies (PT, activated partial thromboplastin time, platelet function tests)
  • BUN, serum creatinine
  • LFTs
  • 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
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant ENT Surgeon

Royal United Hospital Bath NHS Trust

Bath

UK

Disclosures

DP declares that he has no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Department of Internal Medicine

University of Colorado Health Sciences Center

Denver

CO

Disclosures

EC declares that he has no competing interests.

Professor

UCLA School of Public Health and David Geffen School of Medicine

Los Angeles

Medical Director

Health Disaster Management/Emergency Medical Services

Orange County Health Care Agency

Santa Ana

CA

Disclosures

SJS declares that he has no competing interests.

Professor of Otolaryngology - Head and Neck Surgery

Newcastle University

Honorary Consultant Otolaryngologist

Freeman Hospital

Newcastle-Upon-Tyne

UK

Disclosures

JW declares that she has no competing interests.

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