Epistaxis overview

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Epistaxis Microchapters

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Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Epistaxis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

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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., Liudvikas Jagminas, M.D., FACEP [2]

Overview

Epistaxis is the relatively common occurrence of hemorrhage (bleeding) from the nose, usually noticed when it drains out through the nostrils. There are two types: anterior (the most common), and posterior (less common, and more severe). Sometimes in more severe cases, the blood can come up the nasolacrimal duct and out from the eye. Fresh blood and clotted blood can also flow down into the stomach and cause nausea and vomiting.

Historical Perspective

In past centuries, people thought epistaxis happened due to internal diseases. As the medical knowledge advanced, people found out that nasal compression can stop bleeding. Hippocrates was the first one who used some instruments to stop nasal bleeding. The term epistaxis was originally derived from the Greek word epistazein (epi – above, over; stazein – to drip).

Classification

Epistaxis may be classified according to the anatomical origin of the bleeding into 2 groups: anterior and posterior. It can also be further classified into primary (if idiopathic) or secondary (if there is a known cause) and acute or chronic.

Pathophysiology

All nosebleeds are due to tears in the mucosal lining and the many small blood vessels it contains. Fragility or injury may cause tears, while inflammation, coagulation problems, and other disorders may make the injury harder to repair. In some patients rapture of nasal blood vessels is spontaneous.

Causes

The causes of epistaxis can be divided into idiopathic and non-idiopathic ones. There are many diseases can cause epistaxis, it can start spontaneous either. Usually epistaxis is not dangerous but in some cases it can become life threatening. Trauma is the most common cause of epistaxis. besides it, medications and idiopathic epistaxis are other common causes of epistaxis.

Differentiating Epistaxis from other Diseases

Many diseases can cause epistaxis. Based on patient history and physical examination we can diagnose cause of epistaxis. The challenging part is differentiate anterior epistaxis from posterior epistaxis. Rhinoscopy is the best way to distinguish between anterior and posterior epistaxis. In selected cases, endoscopy may be required.

Epidemiology and demographics

Epistaxis is a prevalent symptom in general populations worldwide. About 60 percent of people experience epistaxis at least once, and about 6 percent of these people looking for medical action at least once. It is more common in children and elderly patients

Risk Factors

The most common risk factor of epistaxis in trauma. Other risk factors include coagulopathies, infections and vascular abnormalities. It can occur spontaneous either. Childhood and senility are unchangeable risk factors.

Screening

No screening is indicated for epistaxis in asymptomatic patients.

Natural History, Complications, and Prognosis

Although epistaxis often stops easily, it can become challenging to stop specially in posterior epistaxis which can cause aspiration. Most of the time bleeding stops without any action .Prognosis is generally good, and mortality is very rare.

Diagnostic study of choice

The diagnostic study of choice to find the source of epistaxis is rhinoscopy. In patients which rhinoscopy is not efficient to find the source vessel of bleeding, internal carotid artery (ICA) angiography is the most efficient action to find the bleeding site.

History and Symptoms

History of trauma, especially nose picking for anterior epistaxis, previous epistaxis and coagulopathies are in top list. Dizziness and fainting can be symptoms of epistaxis in case of heavy bleeding.

Physical Examination

Patients with epistaxis are usually well-appearing. Physical examination of patients with epistaxis is usually remarkable for bleeding from nostrils and posterior nose bleeding.

Laboratory Findings

Laboratory findings is usually normal among patients with epistaxis, but when bleeding is heavy or physician is suspicious to coagulopathy, The following tests should be performed: CBC, PT, PTT, BT.

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Echocardiography and Ultrasound

CT Scan

Other Imaging Findings

Other Diagnostic Studies

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-effectiveness of Therapy

Future or Investigational Therapies

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