Epistaxis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.
Overview
Although epistaxis often ceases easily, it can become challenging to stop especially in posterior epistaxis which can cause aspiration. Most of the time bleeding stops without any intervention. Prognosis is generally good, and mortality is very rare.
Natural History, Complications, and Prognosis
Natural History
There are two types of epistaxis:[1][2][3]
- Anterior epistaxis is more common, and the source of this bleeding is usually Kiesselbach's plexus. The most common cause is nasal picking and trauma, and it is usually self-limiting being easily controlled pressing the nose or with nasal packing.
- Posterior epistaxis is harder to control, and the source of this bleeding is usually Woodruff's plexus. It is more commonly associated with coagulopathies, use of anticoagulants and other causes. It usually demands nasal packing and bleeding can be profuse and life-threatening, due to airway compromise.
- Although epistaxis often stops easily it can become challenging to control, especially in posterior epistaxis which can cause aspiration.
- Heavy epistaxis may cause hypovolemia.
Complications
- Aspiration[4]
- Sinusitis
- Hypovolemia in heavy bleeding
- Cerebral abscess is very uncommon[5]
Prognosis
References
- ↑ Pallin, Daniel J.; Chng, Yi-Mei; McKay, Mary Patricia; Emond, Jennifer A.; Pelletier, Andrea J.; Camargo, Carlos A. (2005). "Epidemiology of Epistaxis in US Emergency Departments, 1992 to 2001". Annals of Emergency Medicine. 46 (1): 77–81. doi:10.1016/j.annemergmed.2004.12.014. ISSN 0196-0644.
- ↑ Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
- ↑ Tunkel, David E.; Anne, Samantha; Payne, Spencer C.; Ishman, Stacey L.; Rosenfeld, Richard M.; Abramson, Peter J.; Alikhaani, Jacqueline D.; Benoit, Margo McKenna; Bercovitz, Rachel S.; Brown, Michael D.; Chernobilsky, Boris; Feldstein, David A.; Hackell, Jesse M.; Holbrook, Eric H.; Holdsworth, Sarah M.; Lin, Kenneth W.; Lind, Meredith Merz; Poetker, David M.; Riley, Charles A.; Schneider, John S.; Seidman, Michael D.; Vadlamudi, Venu; Valdez, Tulio A.; Nnacheta, Lorraine C.; Monjur, Taskin M. (2020). "Clinical Practice Guideline: Nosebleed (Epistaxis)". Otolaryngology–Head and Neck Surgery. 162 (1_suppl): S1–S38. doi:10.1177/0194599819890327. ISSN 0194-5998.
- ↑ Ryu, Taeha; Kim, Dong Hyuck; Byun, Sung Hye (2018). "Fiberoptic bronchoscopic treatment of blood aspiration and use of sugammadex in a patient with epistaxis". Medicine. 97 (15): e0428. doi:10.1097/MD.0000000000010428. ISSN 0025-7974.
- ↑ Murer, Karin; Holzmann, David; Burkhardt, Jan-Karl; Soyka, Michael Benjamin (2015). "An unusual complication of epistaxis: cerebral abscess formation after anterior ethmoidal artery ligation". BMJ Case Reports: bcr2015213389. doi:10.1136/bcr-2015-213389. ISSN 1757-790X.