The rich vascular network of the nose makes it vulnerable to either spontaneous bleeds or bleeds secondary to trauma. In the majority of cases, epistaxis is mild and self-limiting. Epistaxis can result from local or systemic causes. Common etiologies of epistaxis include upper respiratory infection, sinusitis, local trauma, foreign bodies, irritants, and medications. Less common etiologies include vascular malformations, leukemia, thrombocytopenia, coagulopathies, or hepatic disease.

Anterior bleeds arise from the rich venous vascular network on the anterior nasal septum, the Kiesselbach plexus, and account for the majority of episodes. The thin and adherent nature of the anterior venous plexus makes it especially susceptible to trauma. The venous source of anterior bleeds results in a slow and oozing quality. In contrast, posterior bleeds occur less often and arise from branches of the sphenopalatine artery. The arterial source results in more profuse bleeds that may drain into the nasopharynx, thus carrying a higher risk of airway compromise.

Epistaxis generally requires minimal intervention. Those patients who are not actively bleeding should be given anticipatory guidance to avoid local trauma as well as to keep the mucosa moist. If a patient is actively bleeding, there are several management options that lie along a continuum ranging from conservative to invasive surgical interventions.