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 hyperaemia, such as allergy, viral rhinitis, bacterial rhinosinusitis, dust, or chemicals. Although rare, neoplasm may also cause nosebleed.
Topical anaesthesia 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.
History and exam
- dry weather and low humidity
- oxygen dependence
- septal deviation
- nasal and other facial fracture
- other nasal trauma
- nasal foreign body
- nasal polyp
- environmental irritants
- topical nasal drugs
- primary coagulopathy (e.g., haemophilia)
- acquired coagulopathy (e.g., use of aspirin, anticoagulant, non-steroidal anti-inflammatory drugs)
- familial hereditary haemorrhagic telangiectasia
- ulceration secondary to infection (e.g., herpes zoster, or bacterial infection)
- forceful coughing
- sinonasal neoplasm
- juvenile nasal angiofibroma
- chronic granulomatous disease
- coagulation studies (prothrombin time, activated partial thromboplastin time, platelet function tests)
- urea, 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
Consultant ENT Surgeon
Royal United Hospital Bath NHS Trust
DP declares that he has no competing interests.
Department of Internal Medicine
University of Colorado Health Sciences Center
EC declares that he has no competing interests.
UCLA School of Public Health and David Geffen School of Medicine
Health Disaster Management/Emergency Medical Services
Orange County Health Care Agency
SJS declares that he has no competing interests.
Professor of Otolaryngology - Head and Neck Surgery
Honorary Consultant Otolaryngologist
JW declares that she has no competing interests.
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