THE ROLE OF RIGID NASAL ENDOSCOPE IN IDENTIFYING SITES AND CAUSES OF POSTERIOR EPISTAXIS

Background: Epistaxis is among the most frequent emergencies encountered in otorhinolaryngology practice. In many patients, the bleeding source remains unidentified because several regions of the nasal cavity cannot be adequately visualized with routine anterior or posterior rhinoscopy. This limitation highlights the value of rigid nasal endoscopy as a diagnostic tool for evaluating obscure epistaxis. Aim: To assess the role of rigid nasal endoscopy in detecting bleeding sites and underlying nasal pathologies in patients presenting with epistaxis when conventional nasal examination fails to determine the cause. Methods: A clinical descriptive study was conducted on 100 patients with epistaxis over a one-year period from December 1, 2013, to December 1, 2014, at Al-Yarmouk Teaching Hospital. Patients older than 13 years whose initial anterior and posterior rhinoscopic examinations were inconclusive underwent rigid nasal endoscopy under local anesthesia to localize the bleeding source and identify associated pathology. Results: Posterior epistaxis was more common in males (62%), particularly in middle-aged (33%) and elderly (30%) individuals. Systemic diseases—mainly hypertension (28%)—were frequently associated. Endoscopy identified the posterior septum as the most common bleeding site (43%), followed by the lateral nasal wall (35%), nasopharynx (5%), and floor of the nose (4%). Thirteen percent had no identifiable source. The most frequent endoscopic findings were bleeding points (48%), ulcerations (12%), crustations (11%), and granulation tissue (6%). Notably, 10% of patients had unsuspected benign or malignant nasal masses. Conclusion: Rigid nasal endoscopy significantly enhances diagnostic accuracy in epistaxis by precisely localizing bleeding sites and revealing hidden nasal pathologies often missed by routine examination.