From the Guidelines
Epistaxis, or nosebleed, is primarily caused by local factors such as trauma, mucosal irritation, and nasal septal deviation, as well as systemic factors including hypertension, blood disorders, and medications that affect blood clotting, as noted in the 2020 clinical practice guideline by the American Academy of Otolaryngology-Head and Neck Surgery 1.
Local Causes of Epistaxis
- Trauma (nose picking, facial injury)
- Mucosal irritation (dry air, chemical irritants)
- Foreign bodies
- Nasal septal deviation
- Inflammatory conditions like rhinitis or sinusitis
- Tumors, both benign and malignant
Systemic Causes of Epistaxis
- Hypertension
- Blood disorders (hemophilia, leukemia, thrombocytopenia)
- Liver disease
- Kidney disease
- Medications that affect blood clotting (aspirin, NSAIDs, warfarin, heparin, and novel oral anticoagulants)
Environmental and Demographic Factors
- Low humidity and high altitude can contribute by drying nasal mucosa
- Age is relevant, with children often experiencing anterior bleeds from digital trauma, while elderly patients may have more posterior bleeds due to atherosclerosis and medication use, as reported in a study using data from the Nationwide Emergency Department Sample (NEDS) from 2009 to 2011 1.
Management of Epistaxis
Understanding the various etiologies of epistaxis helps guide appropriate management, which may range from simple pressure application for minor bleeds to medical or surgical interventions for more severe or recurrent cases, with recent guidelines suggesting that a person experiencing epistaxis should sit with their head slightly forward with their nostrils pinched for 10 to 15 minutes, and seek medical attention if bleeding does not stop after 15 minutes of continuous manual pressure or if they become lightheaded from epistaxis 1.
From the Research
Epistaxis Etiology
- The exact cause of epistaxis is not specified in the provided study 2
- However, the study mentions that the "Clinical Practice Guideline: Nosebleed (Epistaxis)" from 2020 provides recommendations for the diagnosis, treatment, and prevention of nosebleeds, which may imply that the etiology is complex and multifactorial 2
- The guideline is based on research and aims to advise doctors and other health care providers on the management of nosebleeds, suggesting that there may be various underlying factors contributing to the development of epistaxis 2
- Further information on the specific etiology of epistaxis is not provided in the given study, and additional research may be necessary to fully understand the causes of nosebleeds 2