Some Causes of Epistaxis
Cause* | Suggestive Findings | Diagnostic Approach† |
|---|---|---|
Common | ||
Drying of the mucosa (eg, in cold weather) | Usually visibly dry during examination | Clinical examination alone |
Local trauma (eg, nose blowing, picking, blunt impact) | Apparent by history | Clinical examination alone |
Less common | ||
Usually in older patients | Clinical examination alone | |
History of prior epistaxis or other bleeding sites, such as gingiva | CBC with platelet count, PT/PTT | |
Foreign bodies (mainly in children) | Often recurrent epistaxis with a malodorous discharge from one nostril | Clinical examination alone |
Local infections (eg, vestibulitis, rhinitis) | Crusting in the nasal vestibule, often with local pain and dry mucosa | Clinical examination alone |
Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber syndrome) | Telangiectasias on the face, lips, oral and nasal mucosa, and tips of the fingers and toes Positive family history | Clinical examination alone |
Visible during examination | Clinical examination alone | |
Systemic disorders (eg, AIDS, liver disease) | Presence of known disease Mucosal erosions and hypertrophy | Clinical examination alone |
Tumor (benign or malignant) of the nasopharynx or paranasal sinuses | Mass seen within the nose or nasopharynx Bulging of the lateral nasal wall | CT |
* Epistaxis of any cause is more common among patients with bleeding disorders (eg, thrombocytopenia, liver disease, coagulopathies) and with anticoagulant use. In such patients, bleeding is also often more severe and difficult to treat. | ||
† Clinical examination is always done but is mentioned in this column only when that can be the sole means of diagnosis. | ||
CBC = complete blood count; CT = computed tomography; PT/PTT = prothrombin time/partial thromboplastin time. | ||