Epistaxis, or nosebleed, is one of the most common ENT emergencies worldwide. It is estimated that 60% of the population will experience at least one episode of epistaxis in their lifetime, though only 6% will seek medical attention. While most nosebleeds are minor and self-limiting, some cases can be severe, recurrent, or indicative of underlying pathology, warranting further investigation and treatment.

What Causes Nosebleeds?

The nasal cavity contains a rich network of blood vessels, making it prone to bleeding from even minor trauma or environmental factors. Common causes of epistaxis include:
✅ Dry, cold weather causing mucosal dryness
✅ Digital trauma (nose picking)
✅ Allergic rhinitis
✅ Upper respiratory infections
✅ Use of blood-thinning medications
✅ Hypertension

In most cases, the bleeding originates from the anterior nasal septum (Little’s area), which is easily accessible and manageable. However, posterior epistaxis, though less common, tends to be more severe and may require more advanced interventions.

How Is Epistaxis Treated?

Initial management of epistaxis focuses on conservative measures:
– Applying direct nasal pressure for 10-15 minutes
– Topical vasoconstrictors (e.g., oxymetazoline)
– Chemical or electrical cauterization of visible bleeding sites
– Anterior nasal packing

A retrospective study of 3500 patients with epistaxis showed that over 85% were successfully treated with conservative methods, including medical therapy, cauterization, and nasal packing. Only a small fraction of patients required surgical intervention.

When Is Further Investigation Needed?

While most epistaxis cases resolve with basic measures, recurrent or persistent nosebleeds raise concerns for underlying structural or systemic causes. These may include:
🔍 Coagulopathies (clotting disorders)
🔍 Vascular malformations
🔍 Tumors of the nasal cavity or paranasal sinuses

In such cases, additional evaluation with nasal endoscopy and imaging (CT or MRI) may be necessary to identify hidden lesions or abnormal vascular sources.

The Risk of Tumors in Recurrent Epistaxis

Although rare, recurrent or unexplained epistaxis may be the first sign of a nasal or paranasal tumor. Benign vascular tumors like lobular capillary hemangioma (pyogenic granuloma) or more aggressive lesions such as hemangioendothelioma can present with persistent bleeding.

A clinical study identified cases where surgical biopsy revealed underlying tumors as the cause of uncontrollable epistaxis, emphasizing the importance of histopathological evaluation in suspicious cases.

When Is Surgery Required?

Surgical intervention is considered in patients where:
✔️ Conservative measures fail to control bleeding
✔️ The bleeding source is not accessible by anterior approaches
✔️ A tumor or vascular malformation is identified as the source

Surgical techniques may include:
– Endoscopic cauterization of posterior nasal vessels
– Endoscopic resection of vascular lesions
– Ligation of feeding arteries (e.g., sphenopalatine artery ligation)

In the aforementioned study, 1.5% of patients required surgical treatment. Among them, underlying pathologies such as hemangioendothelioma, lobular capillary hemangioma, and angiomatous polyps were identified. Complete surgical excision provided both a therapeutic and diagnostic benefit.

Conclusion: Don’t Ignore Recurrent Nosebleeds

Epistaxis is usually a benign and manageable condition, but recurrent, severe, or unexplained nosebleeds warrant careful evaluation to rule out serious causes like tumors or vascular anomalies. Early identification of underlying pathology can prevent complications and guide appropriate treatment.

If you experience frequent nosebleeds or persistent bleeding despite treatment, consult an ENT specialist for a thorough examination, possible nasal endoscopy, and tailored treatment plan—including surgical options if necessary.

👉 Contact our clinic today to schedule an evaluation with our experienced ENT team.