Epistaxis natural history, complications and prognosis

Although epistaxis often ceases easily, it can become challenging to stop especially in posterior epistaxis which can cause aspiration. Most of the time bleeding stops without any intervention. Prognosis is generally good, and mortality is very rare.

There are two types of epistaxis:^[1][2][3]

• Anterior epistaxis is more common, and the source of this bleeding is usually Kiesselbach’s plexus. The most common cause is nasal picking and trauma, and it is usually self-limiting being easily controlled pressing the nose or with nasal packing.
• Posterior epistaxis is harder to control, and the source of this bleeding is usually Woodruff’s plexus. It is more commonly associated with coagulopathies, use of anticoagulants and other causes. It usually demands nasal packing and bleeding can be profuse and life-threatening, due to airway compromise.

• Although epistaxis often stops easily it can become challenging to control, especially in posterior epistaxis which can cause aspiration.
• Heavy epistaxis may cause hypovolemia.

• Aspiration^[4]
• Sinusitis
• Hypovolemia in heavy bleeding
• Cerebral abscess is very uncommon^[5]

• Prognosis is generally good, and mortality is very low.

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