Chapter 73 Epistaxis

Question 1

What is the definition of epistaxis?

Answer 1

Epistaxis is a common problem experienced by most individuals, occurring in 60% of the population

It is a common reason for emergency admission to otolaryngology services.

Question 2

What are the common causes of epistaxis?

Answer 2

• Nasal trauma
• Rhinitis
• Drying of nasal mucosa
• Nasal septum deviation
• Alcohol use
• Chemical irritants (e.g., cocaine)

Some individuals may have fragile mucous membranes that predispose them to nosebleeds.

Question 3

What is the incidence of epistaxis in different age groups?

Answer 3

• Highest in individuals younger than 10 years
• Highest in individuals over the age of 40

Most nosebleeds are idiopathic.

Question 4

Where do 90% to 95% of nosebleeds occur?

Answer 4

Within the Kiesselbach plexus on the anterior nasal septum

This plexus is particularly vulnerable and easily injured.

Question 5

What are the clinical presentations of anterior and posterior epistaxis?

Answer 5

• Anterior: Unilateral, continuous moderate bleeding
• Posterior: Bilateral, severe bleeding, difficult to treat

Bleeding into the pharynx indicates posterior epistaxis.

Question 6

What should be done first when managing a patient with epistaxis?

Answer 6

Check vital signs and ensure airway safety

The patient should be instructed to sit up straight and tilt the head forward.

Question 7

What is the recommended duration for applying pressure to the nose during epistaxis management?

Answer 7

15 minutes

This technique is often successful for anterior nosebleeds.

Question 8

What are the types of nasal packing used in epistaxis management?

Answer 8

• Merocel
• Rapid Rhino

Proper insertion is important to reduce bleeding.

Question 9

What is the role of vasoconstrictors in epistaxis management?

Answer 9

Short-acting topical nasal decongestants may help stop blood flow

OxyMetazoline is commonly used and has limited systemic absorption.

Question 10

What are the essential diagnostics for severe epistaxis?

Answer 10

• Complete blood count (CBC)
• Type and screen/crossmatch
• Prothrombin time and international normalized ratio

Additional studies may be needed if the patient is hemodynamically unstable.

Question 11

What are the priority differential diagnoses for epistaxis?

Answer 11

• Hypertension
• Anticoagulants (e.g., warfarin)
• Nasal steroids/allergic rhinitis
• Cocaine use
• Presence of a neoplasm

Other systemic factors should also be considered.

Question 12

What is the initial treatment for anterior epistaxis?

Answer 12

Application of direct pressure to the anterior portion of the nose for 15 minutes

The Kiesselbach plexus is the most common source of epistaxis.

Question 13

What are the complications associated with epistaxis treatment?

Answer 13

• Respiratory compromise
• Hypotension
• Anemia
• Necrosis
• Abscess formation
• Septal perforation
• Sinus infection

Toxic shock syndrome has been reported as a complication of nasal packing.

Question 14

What should patients avoid after an epistaxis episode?

Answer 14

• Vigorous exercise
• Aspirin-containing medications
• Tobacco
• Hot, spicy foods

These can cause vasodilation and increase the risk of bleeding.

Question 15

True or false: Antibiotics are routinely recommended for all patients with anterior nasal bleeds.

Answer 15

FALSE

Individualized care is key; some patients may benefit from antibiotics.

Question 16

What emerging treatment is being studied for epistaxis management?

Answer 16

Topical tranexamic acid, an antifibrinolytic agent

Research has shown promising results, but more studies are needed.