Epistaxis (Nosebleeds)

Nosebleeds are usually minor and self-limiting, but in certain circumstances, they can become recurrent or life-threatening.

Epistaxis, commonly known as nosebleeds, occurs when the blood vessels in the nose rupture, often due to a variety of causes.

These can include trauma, nasal surgery, structural issues like a deviated septum, nasal dryness, use of intranasal drugs (such as steroid sprays or cocaine), nasal tumours, use of blood thinners, and bleeding disorders like hereditary hemorrhagic telangiectasia (HHT). Most nosebleeds originate from the front of the nasal septum, where a network of blood vessels known as Kiesselbach's Plexus is located.

Stages of Epistaxis (Nosebleeds)

Epistaxis (nosebleeds) can be understood in the following stages:

These stages include:

In the early stage, nosebleeds may result from temporary irritation or trauma to the delicate blood vessels in the nose, such as dry air, nose picking, or mild trauma. These nosebleeds are usually infrequent or short-lived, and are easily managed local pressure (i.e. pinching of the soft part of your nose).

As nosebleeds become more frequent, underlying causes such as nasal dryness, anatomical issues (like a deviated septum), blood thinners, or frequent use of intranasal drugs (e.g., steroid sprays, cocaine) may contribute. These recurrent episodes indicate persistent irritation or injury to the blood vessels, often requiring more attention. These nosebleeds may prevent with frequent use nasal moisturizers or saline sprays, as well as a bedside humidifier. Also consider avoiding blowing nose forcefully and/or picking your nose.

In the chronic phase, nosebleeds occur regularly and may be more severe. Conditions such as bleeding disorders, prolonged use of blood thinners, or the presence of nasal tumours may complicate the situation. This phase often leads to significant disruption in daily life, and treatment is necessary to control the bleeding and address the underlying cause.

When conservative treatments fail or the epistaxis becomes frequent and severe, surgical intervention may be considered. Procedures such as cauterization, septoplasty (to correct a deviated septum), or nasal tumour removal might be recommended to prevent further bleeding and resolve the underlying condition. In extreme cases, ligation of blood vessels or septodermoplasty may be necessary.

Factors, Symptoms, Diagnosing, and Beyond:

What are the common symptoms of epistaxis?

Nosebleeds can affect one or both sides of the nose and may be anterior (from the front) or posterior (from the back, possibly through the mouth). Depending on the cause, they may also be accompanied by symptoms like ear pain, reduced sense of smell, thick nasal discharge, congestion, facial pain or numbness, vision problems, and fever.

How are epistaxis diagnosed by an ENT specialist?

An ENT specialist diagnoses epistaxis by first taking a detailed medical history and performing a complete head and neck exam, which may include using a nasal endoscope to examine the nasal passages for the source of bleeding. Additional tests, such as bloodwork and imaging (CT or MRI) may be conducted to assess underlying causes, such as structural abnormalities, tumours, or bleeding disorders. The goal is to identify the source and cause of the nosebleed to guide appropriate treatment.

What are the best treatment options for epistaxis?

The best treatment options for epistaxis (nosebleeds) include prevention by minimizing contributing factors (ex. nasal dryness), using humidifiers, nasal saline sprays, or lubricant gels to keep the nasal lining moist. It is also important to avoid trauma to the nose. During an acute bleed, conservative options involve applying direct pressure for 15 minutes, using nasal decongestants, and applying a cold compress. If these methods fail, surgical options such as cauterization, septoplasty, septodermoplasty or endoscopic sphenopalatine artery ligation may be necessary for more persistent cases.