Epistaxis

Dr. Rod Schlosser, Associate Professor of Otolaryngology, recently published a review of epistaxis, (nosebleeds) in the prestigious New England Journal of Medicine (NEJM (360[8]:784-789), 2009.) Dr. Schlosser noted that nosebleeds are a common problem and are estimated to occur in 60% of individuals during their lifetime with the highest incidence in children and older adults.

Localized factors, such as digital trauma (nose picking) are common causes of epistaxis, particularly in the pediatric population. Mucosal trauma from topical nasal medications, such as nasal steroids or topical anti-histamines can often result in minor epistaxis. Systemic conditions with bleeding disorders often lead to epistaxis. Bleeding disorders can be genetic, such as hemophilia or acquired due to liver/renal disease, chronic alcohol use, or anti-coagulation medication. Alternative medications, such as garlic, gingko, green tea and ginseng may also contribute.

Most nose bleeds are self-limited and can be controlled by pinching the anterior aspect of the nose for 10-15 minutes. A common mistake is for patients to attempt to compress the area along the nasal bones. Care must be taken to ensure that pressure is closer to the tip of the nose and nostrils. In addition to pressure, application of topical oxymetazoline and ointments or gels is often useful. Cases that fail this approach usually require medical attention and respond to cautery or packing with a variety of absorbable hemostatic materials. Extreme cases may require posterior packing, surgical intervention or embolization. Recurrent episodes of epistaxis, particularly when localized to one side, warrant radiographic and endoscopic evaluation to rule out neoplastic processes.