Epistaxis: Current Approaches in Diagnosis And Management Of An Old Problem

Epistaxis, commonly known as nosebleed, is one of the most frequent emergencies encountered in otolaryngology. Despite its prevalence, the true incidence is uncertain due to underreporting, with estimates suggesting that up to 60% of the general population experience at least one episode in their lifetime. Most cases originate from the anterior nasal cavity, while a minority arise posteriorly, potentially posing life-threatening complications. The rich vascular network of the nasal cavity, including the Kiesselbach plexus anteriorly and Woodruff plexus posteriorly, underlies the pathophysiology of epistaxis. Etiological factors can be broadly categorized into local and systemic causes, ranging from digital trauma and nasal anatomical variations to coagulopathies and cardiovascular diseases. Clinical management requires a structured, stepwise approach, starting with basic first-aid measures, followed by anterior or posterior tamponade, chemical or electrocauterization, arterial ligation, and, in refractory cases, endovascular embolization. A thorough understanding of nasal anatomy, combined with careful evaluation of underlying systemic conditions, is essential for effective management and prevention of recurrence. This review aims to provide a comprehensive overview of epistaxis, summarizing current evidence on its anatomy, etiology, pathophysiology, diagnostic work-up, and contemporary management strategies.