Epistaxis, commonly referred to as nosebleeds, is one of the most frequent ENT presentations across all age groups. It occurs due to rupture of fragile blood vessels within the nasal cavity, which is richly supplied with blood to warm and humidify inhaled air. While many nosebleeds are mild and self-limiting, epistaxis can sometimes be severe, recurrent, or life-threatening, particularly in older adults or individuals with underlying medical conditions.

Nosebleeds are broadly classified into anterior and posterior epistaxis. Anterior epistaxis originates from the front part of the nasal septum, specifically a vascular network known as Kiesselbach’s plexus. This type is most common in children and young adults and is usually triggered by nasal dryness, minor trauma such as nose picking, upper respiratory infections, or allergic inflammation. Posterior epistaxis arises from deeper blood vessels and is more common in elderly patients, often associated with hypertension, atherosclerosis, or blood-thinning medications. Posterior nosebleeds tend to be heavier, more difficult to control, and frequently require medical intervention.

Multiple local and systemic factors contribute to epistaxis. Local causes include nasal trauma, deviated nasal septum, chronic sinusitis, nasal polyps, infections, excessive nasal spray use, and environmental dryness. Systemic causes include uncontrolled high blood pressure, bleeding disorders, liver disease, chronic kidney disease, and use of anticoagulant or antiplatelet medications. In rare cases, recurrent epistaxis may be a sign of nasal tumors or vascular malformations, particularly when bleeding is unilateral and persistent.

Clinical presentation varies from occasional blood-streaked nasal discharge to profuse bleeding from one or both nostrils. Some patients may experience blood flowing into the throat, causing coughing, nausea, or vomiting. Recurrent episodes can lead to anxiety, sleep disturbance, iron deficiency anemia, and reduced quality of life.

Diagnosis begins with a detailed medical history and thorough ENT examination. Identifying the bleeding site is critical and may require nasal endoscopy, especially in recurrent or posterior epistaxis. Blood tests may be ordered to evaluate clotting function, hemoglobin levels, or systemic contributors when indicated.

Management depends on severity and underlying cause. Initial measures include nasal compression, topical vasoconstrictors, and nasal moisturization. Identified bleeding points may be treated with chemical or electrical cauterization. More severe cases may require nasal packing, balloon devices, or surgical ligation of bleeding vessels. Addressing contributing factors such as blood pressure control and medication adjustment is essential for long-term prevention.