Nosebleeds, or epistaxis, are a common medical issue affecting approximately 60% of people in the United States at some point in their lives. Although most episodes are minor and self-limiting, around 6% of individuals experiencing nosebleeds will seek medical attention (Tunkel et al., 2020). In children, epistaxis is particularly prevalent, with 75% having at least one episode (Tunkel et al., 2020). There are two primary types of nosebleeds: anterior, which is more common, and posterior, which, although less frequent, often require medical intervention (Tabassom & Dahlstrom, 2024).

Epistaxis, despite often being seen as a mere nuisance, can occasionally pose life-threatening risks, particularly in resource-limited settings where adequate healthcare facilities are scarce. It is estimated that 60% of the global population will experience epistaxis, with about 6% requiring medical treatment due to the ineffectiveness of home remedies (Adoga et al., 2019).

Causes of Epistaxis

The most common cause of epistaxis are idiopathic (38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%) (Parajuli R, 2015)

Other Local causes are:

Anatomic deformities

Intranasal tumors

Low humidity

Vigorous nose blowing

Nose picking

In adults, medications such as non-steroidal anti-inflammatory drugs (NSAIDs) and anticoagulants like heparin and warfarin are common contributors. Hereditary bleeding disorders, including hemophilia A, hemophilia B, and von Willebrand disease, are also associated with epistaxis (Ameya et al., 2021).

Additionally, chronic vascular damage related to hypertension has been suggested as a potential mechanism linking high blood pressure to nosebleeds (Byun et al., 2021).

Management and Treatment of Epistaxis

Following steps can be used at Home. This method is also called Hippocratic method

1. Sit upright and lean slightly forward to prevent blood from running down your throat, which can cause nausea, vomiting, and diarrhea. Avoid lying flat or tilting your head back.
2. Breathe through your mouth.
3. Use a tissue or damp washcloth to catch the blood.
4. Pinch the soft part of your nose with your thumb and index finger, pressing it against the hard bony ridge that forms the bridge of your nose. Pinching above or on the bony part won’t effectively stop the bleeding.
5. Maintain pressure on your nose for at least five minutes before checking if the bleeding has stopped. If it persists, continue pinching for another 10 minutes.
6. Optionally, apply an ice pack to the bridge of your nose to help constrict blood vessels and provide comfort. This step is not essential but can be helpful (Cleveland Clinic).

Managing epistaxis requires a thorough examination and detailed patient history to identify the bleeding site and cause. Treatment methods vary depending on the location, severity, and etiology of the bleeding and can be broadly categorized into nonsurgical and surgical approaches. Simple measures include pinching the nose, while more severe cases might require ligation of vessels (Parajuli, 2015).

The majority of nosebleeds are acute, sporadic, and self-limited, typically responding to simple compression but sometimes requiring more aggressive measures like cautery (can be chemical or electric) or nasal packing. Conventional gauze pack and Merocel nasal pack are the common pack used in refractory anterior epistaxis (Shanmugam et.al, 2019)

Vasoconstrictors, such as oxymetazoline, xylometazoline can help locate the bleeding site. If simple measures fail, tranexamic acid, nasal cautery with silver nitrate, or nasal packing may be necessary. (Director, Paediatric Emergency Department, 2023). Endoscopic ligation of the sphenopalatine artery is done in case of persistent bleeding (Snyderman & Carrau, 1997).

If there is persistent bleeding then endoscopic ligation of the bleeding vessel is done.

• SPA ligation has been reported to be effective in 87-92% of cases (Kishimoto 2018, Wormald 2000).
• Bilateral SPA ligation has been shown to have lower rebleeding rates compared to unilateral ligation (Hervochon 2018).
• SPA ligation may reduce the risk of future severe epistaxis in anticoagulated patients.