Causes of Epistaxis

They may be divided into:

A. Local, in the nose or nasopharynx.
B. General.
C. Idiopathic.
A. Local Causes

Nose

1. Trauma. Finger nail trauma, injuries of nose, intranasal surgery, fractures of middle third of face and base of skull, hard-blowing of nose, violent sneeze



2. Infections.

Acute: Viral rhinitis, nasal diphtheria, acute sinusitis. Chronic: All emst-forming diseases, e.g.atrophic rhinitis, rhinitis sicca, tuberculosis, syphilis septal perforation, granulomatous lesion of the nose, e.g. rhinosporodiosis.

3. Foreign bodies.
Non-living: Any neglected foreign body, rhinolith. Living: Maggots leeches.

4. Neoplasms of nose and paranasal sinuses.Benign: Haemangioma, papilloma.Malignant: Carcinoma or sarcoma.

5. Atmospheric changes. High altitudes, suddendecompression (Caisson's disease).

6. Deviated nasal septum.
Nasopharynx

1. Adenoiditis

2. Juvenile angiofibroma

3. Malignant tumours

B. General Causes

1. Cardiovascular system. Hypertension, arteriosclerosis,mitral stenosis, pregnancy (hypertension and hormonal).

2. Disorders of blood and blood vessels. Aplasticanaemia, leukaemia, thrombocytopenic and vascularpurpura, haemophilia, Christmas disease, scurvy, vitaminK deficiency, hereditary haemorrhagic telangectasia.

3. Liver disease. Hepatic cirrhosis (deficiency of factor!!,VII,IX&X).

4. Kidney disease. Chronic nephritis.

5. Drugs. Excessive use of salicylates and otheranalgesics (as for joint pains or headaches),anticoagulant therapy (for heart disease).
Mediastinal compression. Tumours of mediastinum

(raised venous pressure in the nose).




7. Acute general infection. Influenza, measles,chickenpox, whooping cough, rheumatic fever,infectious mononucleosis, typhoid, pneumonia, malaria,dengue fever.

8. Vicarious menstruation (epistaxis occurring at the timeof menstruation).

C. Idiopathic

Many times the cause of epistaxis is not clear.



Sites of epistaxis