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Epistaxis is common, it is estimated to occur in 60% of persons worldwide during their lifetime, and affected persons usually do not seek medical attention, particularly if the bleeding is minor or self-limited, approximately 6% of those with nosebleeds seek medical treatment. The prevalence is increased for children less than 10 years of age. It appears to occur more often in males than in females.


Nose bleed can have an anterior or posterior source

Anterior epistaxis most often originates in the anterior nasal cavity, most cases of epistaxis occur in the anterior part of the nose, with the bleeding usually arising from the anterior nasal supply.

Posterior epistaxis generally arises from the posterior nasal cavity via branches of the sphenopalatine arteries. Such bleeding usually occurs at the posterior superior roof of the nasal cavity. It can be dangerous.


Self-induced trauma (nose picking) is common, particularly among children.

Environmental factors; humidity, temperature.

Local factors; anatomic abnormalities, inflammation, allergies, iatrogenic, tumors.

Systemic factors; hypertension, platelet and coagulation abnormalities, renal failure, alcohol abuse.

Medications affecting clotting of blood; anticoagulants, nonsteroidal anti-inflammatory drugs (NSAIDs)

The most serious cause of recurrent nosebleed is the intranasal tumor.


Nose bleeding usually responds to first-aid measures such as compression. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately.

Most anterior nosebleeds do not require medical treatment. They can be controlled by pinching the anterior part of the nose for 10 – 15 minutes. Relax and position the head either forward or backward to avoid swallowing or aspirating any blood that may be draining posteriorly into the pharynx. Anterior nasal packing is used for epistaxis that originates in Kiesselbach’s area, the packing products consist of nondegradable materials, such as gauze coated with petroleum jelly.

Posterior bleeding is less common than anterior bleeding and usually is treated by an otolaryngologist

Referral to an otolaryngologist is appropriate when complications are present or specialized treatment (balloon placement, arterial ligation, angiographic arterial embolization) is required.

Every attempt should be made to locate the source of bleeding that does not respond to simple compression and nasal plugging

Recurrent bleeding may indicate a systemic process such as hypertension, anticoagulation, or coagulopathy. In such cases, a hematologic evaluation should be performed.


  • Liberal application of petroleum jelly to each nostril to prevent mucosal drying is an efficacious and cost-effective way to prevent anterior epistaxis.
  • Antiseptic cream for recurrent epistaxis in children is effective.
  • A humidification unit, especially in dry climates and in centrally heated areas, should be used while sleeping, especially after having a nosebleed.
  • Fingernails should be trimmed to minimize trauma from nose picking.

When to call the Doctor:

  • Bleeding cannot be stopped or recurrent bleeding.
  • Bleeding is rapid (large amount of blood).
  • You feel weak or faint due to blood loss.
  • Bleeding begins by going down the back of the throat rather than the front of the nose.

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