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Epistaxis - Management
When should I refer a person with recurrent epistaxis?
- Refer the person to an ear, nose, and throat specialist if:
- Epistaxis episodes do not settle with the treatments available in primary care — further investigation and treatment in secondary care may be required.
- The person has recurrent episodes and is at high risk of having a serious underlying cause. Clinical judgement is required, for example consider referral for:
- 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.
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