CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.
Epistaxis - Management
How should I identify an underlying cause for recurrent epistaxis?
- Determine whether an underlying cause is likely, by asking about:
- Symptoms suggestive of a tumour (benign or malignant) — including nasal obstruction, rhinorrhoea, facial pain, or evidence of cranial neuropathy (for example facial numbness or double vision).
- Current medications (for example aspirin and warfarin, nasally-administered drugs).
- If the person is taking warfarin, check the INR (international normalized ratio).
- Conditions predisposing to bleeding (such as haemophilia or leukaemia).
- Family history of bleeding disorders.
- Environmental factors (such as humidity and allergens).
- Have a low threshold for referral in children younger than 2 years of age (underlying cause likely).
© NHS Institute for Innovation and Improvement