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Epistaxis - Management
When should I refer a person with acute epistaxis?

  • Admit the person to hospital if:
    • Epistaxis continues despite efforts to stop the bleeding.
    • Bleeding from the posterior area of the nose is suspected.
    • A nasal pack has been inserted in primary care.
  • Consider admission to hospital if the person is elderly or has a comorbid condition (such as coronary artery disease, severe hypertension, clotting disorder, or significant anaemia).
  • Consider referral to an ear, nose, and throat specialist if the person has recurrent episodes and is at high risk of having a serious underlying cause. Use clinical judgement and consider referral in the following groups:
    • Males 12–20 years of age — angiofibroma is possible (but rare).
    • Middle-aged people of Chinese origin — due to the high incidence of nasopharyngeal cancer.
    • People older than 50 years of age — as nasal, sinus, and nasopharyngeal cancers are more common (although they usually present with associated symptoms).
    • People with any symptoms suggestive of cancer — such as nasal obstruction, facial pain, hearing loss, eye symptoms (proptosis or double vision), or palpable neck glands.
    • People with a family history of hereditary haemorrhagic telangiectasia and suggestive features upon examination — telangiectasia on the lips, mucous membranes, and fingers.
    • People with occupational exposure to wood dust or chemicals.
  • Consider referral to a paediatrician for children younger than 2 years of age who present with epistaxis.

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