Epistaxis differential diagnosis

Editor in Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amir Behzad Bagheri, M.D.

Many diseases can cause epistaxis. Based on patient history and physical examination we can diagnose the cause of epistaxis. The challenging part is differentiating anterior epistaxis from posterior epistaxis. Rhinoscopy is the best way to distinguish between anterior and posterior epistaxis. In selected cases, endoscopy may be required.

Epistaxis can be differentiated between anterior and posterior epistaxis.^{[1] [2]}

• Anterior epistaxis is more common than posterior epistaxis, but posterior epistaxis is harder to stop.
• Anterior and posterior epistaxis can be differentiated during clinical management, as anterior epistaxis is much more easily controlled. In case of refractory or profuse bleeding, suspect of posterior epistaxis.
• Causes of both anterior and posterior epistaxis are almost the same.
• Bleeding from nostrils usually refers to anterior epistaxis (it can occur in heavy posterior epistaxis too).
• Epistaxis in children is usually anterior but incidence of posterior epistaxis is more common in elderly patients.
• Rhinoscopy is the best way to distinguish between anterior and posterior epistaxis, in the case of not finding the source of bleeding with anterior rhinoscopy, treatment for posterior epistaxis must be started.
• Posterior epistaxis may cause cough and aspiration.

The more common and important causes of epistaxis are listed below:^[3]

• Nasal tumor
• DIC
• Hemophilia
• Rhinitis
• Foreign body in the nose
• Drug toxicity
• Von Willebrand disease

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