The management of epistaxis

Abstract

Every specialty has its albatross; for otolaryngology, it must be epistaxis. However, unlike the orthopedist’s back pain and the neurologist’s headache, epistaxis is often an emergency. It is imperative that the treating physician has a plan of attack for all types of bleeds. The frequency of epistaxis, whether it be anterior or posterior epistaxis, has not been well documented. Weiss, using a selfadministered medical history, surveyed 6,672 subjects in order to evaluate the relationship of epistaxis to other illnesses and found 11% of patients reported a history of epistaxisl The severity and location of the epistaxis were not noted, but specifically found was an absence of an increased frequency or severity of epistaxis in the high-blood-pressure group. Similarly, Shaeen could find no relationship between epistaxis and hypertension, but suggested that the severity of epistaxis may be related to the blood pressure status of the patient.’ The association of posterior epistaxis to hypertension seems to be related only to the anxiety experienced by the patient suffering the bleeding. Once the bleeding is controlled and the anxiety diminished, the elevated blood pressure often returns to a normal level. Similarly, there is little information available regarding the pathology of epistaxis. We are not aware of any studies, or are any studies referenced, that show an altered state of the mucosa with epistaxis. One can hypothesize that the air flow may somehow locally traumatize the mucosa at one specific site, but this would be most difficult to prove with present techniques. Epistaxis seems to be more common during the colder seasons in northern climates because indoor humidity decreases to