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Approach to the adult with epistaxis

Harrison Alter, MD, MS, FACEP
Section Editors
Allan B Wolfson, MD
Daniel G Deschler, MD, FACS
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Epistaxis is a common problem, occurring in up to 60 percent of the general population [1]. While most episodes are uncomplicated, epistaxis can occasionally be difficult to control. Knowledge of the basic anatomy of the nasopharynx and a few hemostatic strategies are reassuring in the face of acute hemorrhage.

This topic addresses epistaxis in adults. Epistaxis in children is discussed separately. (See "Evaluation of epistaxis in children" and "Management of epistaxis in children".)


Survey data suggest that although 60 percent of adults experience an epistaxis episode, only 10 percent or fewer seek medical attention [2,3]. Epistaxis is a common otolaryngologic cause for hospital admission, although surgical intervention is rarely needed [4].

Epistaxis appears to have a bimodal age distribution, with most cases occurring before age 10 or between 45 and 65 years of age [1,5]. Hospital admission for epistaxis increases progressively with age, but these data often do not control for aspirin or anticoagulant use [6]. Among hospitalized patients, there is male predominance prior to age 49, after which the sex distribution equalizes. This phenomenon has been attributed to a protective effect of estrogen in women, whether in fostering a healthy nasal mucosa or in preventing vascular disease more generally [6-8].

Seasonal variation, with predominance in winter months, has been found in most [9-13] but not all [14], studies. Seasonal factors affecting epistaxis include the incidence of upper respiratory infections, allergic rhinitis, and mucosal changes associated with fluctuations in temperature and humidity.

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Literature review current through: Nov 2017. | This topic last updated: Jul 26, 2017.
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