Etiology

In most cases, the exact cause of epistaxis remains unknown (idiopathic epistaxis). While a single episode of epistaxis usually does not require any investigation, recurrent epistaxis must be investigated for an underlying cause (e.g., a bleeding disorder).

• Nose picking (most common cause)

• Foreign intranasal body

• Dry nose (rhinitis sicca)

• CPAP therapy

• Excessive nose blowing

• Intranasal drug use (e.g., cocaine, topical corticosteroids)

• Hereditary hemorrhagic telangiectasia (HHT)

• Nasal hemangioma

• Allergic rhinitis

• Bacterial sinusitis

• Rhinosporidiosis

• Blunt trauma (e.g., a fist punch to the nose)

• Nasal and septal fractures

• Zygomatic, maxillary, or frontal bone fracture

• Basal skull fractures

• Deviated nasal septum

• Septal spurs

• Septal perforation

• Juvenile nasopharyngeal angiofibroma

• Squamous cell carcinoma

• Bleeding disorders

  • Von Willebrand disease

  • Severe thrombocytopenia (e.g., ITP, leukemia, dengue)

  • Hemophilia

  • Anticoagulant and/or aspirin therapy

• Vascular causes

  • Hypertension

  • Granulomatosis with polyangiitis

  • Carotid artery aneurysm