Epistaxis causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Marcelo R. Zacarkim, M.D. [2] Kiran Singh, M.D. [3] Amir Behzad Bagheri, M.D. José Eduardo Riceto Loyola Junior, M.D.[4]

Overview

The causes of epistaxis can be divided into idiopathic and non-idiopathic ones. There are many diseases and medications that can cause epistaxis but it also may be spontaneous. Usually epistaxis is not dangerous but in some cases it can become life threatening. Trauma is the most common cause of epistaxis.

Causes

Life Threatening Causes

Common Causes

Less Common Causes

Neoplasia
- Sinonasal squamous cell carcinoma
- Papillomas
- Juvenile nasopharyngeal angiofibroma
- Esthesioneuroblastoma
- Paraganglioma
Vascular malformations
- Capillary hemangioma
- Hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)
Intracranial aneurysms^[2]

There is not enough evidence that hypertension is a risk factor for epistaxis.The role of lowering blood pressure to control and prevent epistaxis remains controversial.

In the table below different causes of epistaxis are classified based on organ system.

Causes by Organ System

Cardiovascular	Aneurysm of the carotid artery, atherosclerosis, blood vessel disorders, cardiopulmonary resuscitation, coarctation of the aorta, congestive heart failure, hypertension, malignant hypertension, rheumatic fever, secondary hypertension, superior vena cava syndrome, vascular disorders
Chemical / poisoning	Aerosol abuse, ammonia, angiofibroma, biphenyl, borates rodenticide poisoning, brodifacoum rodenticide poisoning, bromadiolone rodenticide poisoning, brown snake rodenticide poisoning, calcium sulfate, chemical irritants, chlorophacinone rodenticide poisoning, chromates rodenticide poisoning, coumachlor rodenticide poisoning, coumafuryl rodenticide poisoning, coumatetralyl rodenticide poisoning, difenacoum rodenticide poisoning, difethialone rodenticide poisoning, diphacinone rodenticide poisoning, formaldehyde, indandione rodenticide poisoning, inhalant abuse, inhaled irritants, matikus rodenticide poisoning, metaldehyde, mouser rodenticide poisoning, mucormycosis, phosphorous, pindone rodenticide poisoning, ratak plus rodenticide poisoning, rodend rodenticide poisoning, rodenticides, solvent abuse, sulphuric acid, talon rodenticide poisoning, tetrachloroethylene, tetryl, vanadium, volak rodenticide poisoning, volid rodenticide poisoning, tobacco smoke
Dental	Dental extraction
Dermatologic	Benign mucosal pemphigoid, defibrination syndrome, leprosy, localized skin infection, melanoma, mucormycosis, nasal excoriation, Osler-weber-rendu disease, purpura, septal granulomas, staphylococcal furuncles, systemic lupus erythematosus, thrombocyopenic purpura
Drug Side Effect	Allegra, anticoagulants, antiplatelet drug, aspirin, bicalutamide, budesonide, butorphanol, cefpodoxime, ciclesonide,clemastine fumarate, clopidogrel, caspofungin acetate, clove (herbal agent), desmopressin, diquat dibromide, febuxostat, fexofenadine, flurbiprofen, fluticasone nasal spray, heroin, histrelin, Ibuprofen, corticosteroids, ipratropium bromide, isotretinoin leflunomide, lenvatinib, loratadine, meropenem, metipranolol, miltefosine, narcotics, nasal steroids, olopatadine, oxcarbazepine, palbociclib, pennyroyal oil (herbal agent), pramipexole, prasugrel, ramucirumab, retapamulin, rifaximin, riociguat,romiplostim, sertraline, sulindac, telfast, tiagabine, thalidomide, tobramycin, topiramate, triamcinolone acetonide, trimethadione, valproic acid, warfarin
Ear Nose Throat	Abnormal nasal anatomy , acute sinusitis, allergic rhinitis, antrochoanal polyps, antrostomy, barotrauma, benign nose tumors, broken nose, chronic irritation of the nasal mucosa, chronic rhinitis , chronic sinusitis common cold, deviated septum, dry nasal mucosa, epstein's syndrome, esthesioneuroblastoma, ethmoidal polyps, hereditary haemorrhagic telangiectasia, increased nasal venous pressure, intranasal rhabdomyosarcoma, inverted papilloma, juvenile nasopharyngeal angiofibroma, maxillary sinus carcinoma, maxillofacial injury, middle ear barotrauma, nasal cancer, nasal cannula, nasal colonization with staphylococcus aureus , nasal congestion, nasal diphtheria, nasal excoriation, nasal foreign body, nasal fracture, nasal infection, nasal obstruction, nasal polyp, nasal septum deviation, nasal sprays, nasal tuberculosis, nasopharyngeal angiofibroma, nasopharyngeal carcinoma, nasal ulceration, non-allergic rhinitis, nose picking, rhinitis, rhinoplasty rhinoscleroma septal deviation, septal perforation, sinonasal undifferentiated carcinoma, sinus tumor, sinusitis, superior vena cava syndrome, trauma to littlee's area, unilateral choanal atresia, viral rhinitis
Endocrine	Acthar, cystic fibrosis, corticotropin
Environmental	Cold air, dry air, environmental irritants, humidity
Gastroenterologic	Cirrhosis, hepatitis, mucormycosis, progressive familial intrahepatic cholestasis, Banti's syndrome, rhinocerebral mucormycosis, rhinocerebral zygomycosis, Von Gierke Disease, Zygomycosis
Genetic	ADP platelet receptor P2Y12 deficiency, autoimmune lymphoproliferative syndrome, Banti's syndrome, christmas disease, coarctation of the aorta, congenital afibrinogenemia, congenital hypoplastic anemia, congenital syphilis, Congential fibrinogen deficiency, connective tissue disease, cystic fibrosis, familial platelet syndrome, Fanconi's anemia, Hemoglobin Lepore syndrome, hemophilia, Hermansky-Pudlak syndrome, inherited coagulation disorders, leukocyte adhesion deficiency, May-Hegglin anomaly, Osler-Weber-Rendu Disease, Owren parahemophilia, progressive familial intrahepatic cholestasis, prothrombin deficiency, sickle cell anemia, Von Gierke disease, Von Willebrand disease, X-linked dyserythropoietic anemia and thrombocytopenia
Hematologic	Acquired coagulation disorders, acquired factor XIII deficiency, acute erythroleukemia, acute leukemia, acute lymphocytic leukemia, acute promyelocytic leukemia, anemia, aplastic anemia, autoimmune lymphoproliferative syndrome, autoimmune thrombocytopenia, Bernard-Soulier syndrome, Bing-Neel syndrome, bleeding diathesis, bleeding disorders, bleeding tendency, blood dyscrasias, christmas disease, chronic leukemia, coagulation disorders, congenital afibrinogenemia, congenital hypoplastic anemia, congential fibrinogen deficiency, defibrination syndrome, Epstein's syndrome, factor V deficiency, factor VII deficiency, factor X deficiency, familial blood dyscrasias, familial platelet syndrome, Fanconi's anemia, hematological malignancy, Hemoglobin Lepore syndrome, hemoglobin SC, hemophilia, Hermansky-Pudlak syndrome, idiopathic thrombocytopenic purpura, Inability of the blood to clot, leukaemia, lymphomatoid granulomatosis, May-Hegglin anomaly, myelodysplastic syndromes, myeloproliferative diseases, Owren parahemophilia, pancytopenia, people with blood group O, platelet disorders, polycythemia vera, purpura, sickle cell anemia, stuart factor deficiency, superior vena cava syndrome, thrombasthenia, thrombocytopenic purpura, thrombocytopathy, thrombocytopenia, Von Willebrand disease, Waldenstrom macroglobulinemia, X-linked dyserythropoietic anemia and thrombocytopenia
Iatrogenic	Adenoidectomy, antrostomy, dental extraction, endoscopic sinus procedures, facial surgery, nasal cannula, nasal surgery, nasogastric tube placement, nasotracheal intubation, Orbital decompression, postoperative, rhinoplasty, septoplasty, sinus surgery, turbinectomy
Infectious Disease	Argentinean hemorrhagic fever, Bolivian hemorrhagic fever, congenital syphilis, dengue hemorrhagic fever, Hantavirosis, hepatitis, idiopathic fibrosing mediastinitis, infectious diseases, inflammatory disorders, leprosy, localized skin infection, Machupo virus, mucocutaneous leishmaniasis, mucormycosis, nasal diphtheria, nasal infection, Omsk hemorrhagic fever, nasal tuberculosis, pertussis, relapsing fever, respiratory tract infection, rhinocerebral mucormycosis, rhinocerebral zygomycosis, rheumatic fever, rhinoscleroma, rhinosporidiosis, scleroma, sinusitis, Stachybotrys chartarum, Soft tissue infection, Staphylococcal furuncles, Streptococcus pyogenes infection, systemic infection with nasal congestion, tuberculosis, typhoid fever, viral rhinitis, viral upper respiratory infections, Weil syndrome, whooping cough, zygomycosis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Acute cholinergic dysautonomia, Bing-Neel syndrome, head injury, Osler-Weber-Rendu syndrome
Nutritional / Metabolic	ADP platelet receptor p2y12 deficiency, clove (herbal agent), cystic fibrosis, excessive dieting, ginseng, glycogen storage disease, malnutrition, rapid weight loss, vitamin C deficiency, vitamin K deficiency, Von Gierke disease
Obstetric/Gynecologic	Menopause, pregnancy
Oncologic	Acute erythroleukemia, acute leukemia, acute lymphocytic leukemia, acute promyelocytic leukemia, adenoid cystic carcinoma, angiofibroma, chronic leukemia, esthesioneuroblastoma, hemangioma, hematological malignancy, Intranasal rhabdomyosarcoma, inverted papilloma, juvenile nasopharyngeal angiofibroma, leukaemia, maxillary sinus carcinoma, melanoma, myelodysplastic syndromes, myeloproliferative diseases, nasal cancer, nasal type natural killer/t-cell lymphoma, nasopharyngeal angiofibroma, nasopharyngeal cancers, nasopharyngeal carcinoma, neoplasm, pindborg tumor, polycythemia vera, rhabdomyosarcoma, Sinonasal undifferentiated carcinoma, squamous cell carcinoma, Waldenstrom macroglobulinemia
Opthalmologic	Orbital decompression
Overdose / Toxicity	Alcohol abuse, chronic usage of nasal sprays, chronic vitamin A toxicity, cocaine, heroin, narcotics
Psychiatric	Aerosol abuse, alcohol abuse, child abuse, inhalant abuse, solvent abuse, volatile inhalants
Pulmonary	Asphyxiation, barotrauma, common cold, cystic fibrosis, idiopathic fibrosing mediastinitis, pertussis, respiratory tract infection, sarcoidosis, Wegener's granulomatosis, Whooping cough
Renal / Electrolyte	Chronic kidney disease, Epstein's syndrome, renal artery stenosis, renal dialysis, renal disease, systemic lupus erythematosus, Wegener's granulomatosis
Rheum / Immune / Allergy	Allergic rhinitis, allergies, autoimmune lymphoproliferative syndrome, autoimmune thrombocytopenia\|autoimmune thrombocytopenia, benign mucosal pemphigoid, immune thrombocytopenic purpura, leukocyte adhesion deficiency, polychondritis, rheumatic fever, rhinitis, sarcoidosis, systemic lupus erythematosus, Wegener's granulomatosis
Sexual	No underlying causes
Trauma	Barotrauma, blunt trauma, broken nose, facial trauma, head injury, maxillofacial injury, nasal fracture, post-traumatic pseudoaneurysm, Skull fracture, sphenoidal fracture, trauma to littlee's area
Urologic	Inverted papilloma
Miscellaneous	Foreign bodies, pennyroyal oil

Causes in Alphabetical Order

References

↑ Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.
↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1016/j.otc.2008.01.003 Check |pmid= value (help).

Template:WikiDoc Sources

[KrulewitzFix2019-1] Krulewitz, Neil Alexander; Fix, Megan Leigh (2019). "Epistaxis". Emergency Medicine Clinics of North America. 37 (1): 29–39. doi:10.1016/j.emc.2018.09.005. ISSN 0733-8627.

[pmiddoi:10.1016/j.otc.2008.01.003-2] Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID doi:10.1016/j.otc.2008.01.003 Check |pmid= value (help).

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