Epistaxis Workup

  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 24, 2011
 

Approach Considerations

For the most part, laboratory studies are not needed or helpful for first-time nosebleeds or infrequent recurrences with a good history of nose picking or trauma to the nose. However, they are recommended if major bleeding is present or if a coagulopathy is suspected.

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Laboratory Tests

Laboratory tests to evaluate the patient’s condition and underlying medical problems may be ordered depending on the clinical picture at the time of presentation. If the bleeding is minor and not recurrent, then a laboratory evaluation may not be needed.

If a history of persistent heavy bleeding is present, obtain a hematocrit count and type and cross-match. If a history of recurrent epistaxis, a platelet disorder, or neoplasia is present, obtain a complete blood count (CBC) with differential. The bleeding time is an excellent screening test if suspicion of a bleeding disorder is present. Obtain the international normalized ratio (INR)/prothrombin time (PT) if the patient is taking warfarin or if liver disease is suspected. Obtain the activated partial thromboplastin time (aPTT) as necessary.

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Other Studies

Direct visualization with a good directed light source, a nasal speculum, and nasal suction should be sufficient in most patients. However, computed tomography (CT) scanning, magnetic resonance imaging (MRI) or both may be indicated to evaluate the surgical anatomy and to determine the presence and extent of rhinosinusitis, foreign bodies, and neoplasms. Nasopharyngoscopy may also be performed if a tumor is the suspected cause of bleeding.

Sinus films are rarely indicated for a nosebleed. Angiography is rarely indicated.

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Contributor Information and Disclosures
Author

Quoc A Nguyen, MD  Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Rhinological and Otological Society, American Rhinologic Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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  2. Abelson TI. Epistaxis. In: Schaefer SD. Rhinology and Sinus Disease 1st ed. New York: Mosby; 1998:43-50.

  3. Douglas R, Wormald PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg. Jun 2007;15(3):180-3. [Medline].

  4. Emanuel JM. Epistaxis. In: Cummings CW. Otolaryngology-Head and Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:852-865.

  5. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. May 2005;81(955):309-14. [Medline]. [Full Text].

  6. Cummings CW. Epistaxis. In: Cummings. Otolaryngology: Head and Neck Surgery. 4th ed. Philadelphia, Pa: Elsevier, Mosby; 2005:Chap 40.

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  8. Guarisco JL, Graham HD 3rd. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J. Jul 1989;68(7):522, 528-30, 532 passim. [Medline].

  9. Jarjour IT, Jarjour LK. Migraine and recurrent epistaxis in children. Pediatr Neurol. Aug 2005;33(2):94-7. [Medline].

  10. Knight YE, Goadsby PJ. The periaqueductal grey matter modulates trigeminovascular input: a role in migraine?. Neuroscience. 2001;106(4):793-800. [Medline].

  11. Gifford TO, Orlandi RR. Epistaxis. Otolaryngol Clin North Am. Jun 2008;41(3):525-36, viii. [Medline].

  12. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. Feb 19 2009;360(8):784-9. [Medline].

  13. Durr DG. Endoscopic electrosurgical management of posterior epistaxis: shifting paradigm. J Otolaryngol. Aug 2004;33(4):211-6. [Medline].

  14. García Callejo FJ, Muñoz Fernández N, Achiques Martínez MT, Frías Moya-Angeler S, Montoro Elena MJ, Algarra JM. [Nasal packing in posterior epistaxis. Comparison of two methods]. Acta Otorrinolaringol Esp. May-Jun 2010;61(3):196-201. [Medline].

  15. Abdelkader M, Leong SC, White PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol. Aug 2007;121(8):759-62. [Medline].

  16. Wormald PJ, Wee DT, van Hasselt CA. Endoscopic ligation of the sphenopalatine artery for refractory posterior epistaxis. Am J Rhinol. 2000;Jul-Aug;14(4):261-264.

  17. Strong EB, Bell DA, Johnson LP, Jacobs JM. Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis. Otolaryngol Head Neck Surg. Dec 1995;113(6):674-8. [Medline].

 
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Posterior epistaxis from the left sphenopalatine artery.
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
Nasal speculum.
Vaseline gauze packing.
Expandable (Merocel) packing (dry).
 
 
 
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