Four Bloody Noses: Current Concepts in Epistaxis

Gordon H. Sun, MD, MS


November 20, 2017

Intermittent Minor Nosebleeds

A 28-year-old postdoctoral student presented to an urgent care center with mild bleeding from both nostrils intermittently over the past 2 weeks.

Image from iStock

She denied antecedent head trauma or upper respiratory illness. She had not experienced nasal congestion, rhinorrhea, dental problems, or nasofacial pain and pressure, nor any bleeding down the back of her throat. She denied easy bruising or menorrhagia. In addition, she denied visual or otologic deficits.

The patient's medical and family history were negative for bleeding disorders. She reported no medication use or drug allergies, and was a nonsmoker and nondrinker. She denied recent travel and has lived in the same house for many years.

The patient was cooperative, alert, and in no apparent distress on examination. Vital signs were within normal limits. Ocular and otoscopic exams were unremarkable. No facial pain, swelling, or weakness was evident. Anterior rhinoscopy demonstrated fresh abrasions on the anterior nasal septum bilaterally, but no active bleeding or clots. Intraoral examination demonstrated good dentition, no pharyngeal inflammation or edema, and no posterior pharyngeal drainage or bleeding. Her neck was flat and supple, with full range of motion and no palpable masses.


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