Epistaxis: anatomical and clinical correlates.

One hundred and seven consecutive patients with acute and chronic epistaxis were examined to identify the site and nature of the source. Aetiological factors in the history, nasal anatomy or pathology were noted, along with the blood pressure and laboratory results. In most presentations an anterior bleeding point was isolated. Cautery usually sufficed in both anterior and posterior sources. No source was hidden behind a septal spur or deflection. Hypertension was associated with bleeding from the middle meatus, but not with the severity of bleeding. Patients on antihypertensive medication were more likely to be admitted. Point sources of bleeding were from prominent vessels or haemorrhagic nodules; the latter are not well recognized and are easily overlooked. Routine blood tests did not reveal unsuspected abnormalities or change management; neither did sinus X-rays. Initial examination of the nose in the acute phase by experienced personnel is suggested, to reduce admissions and avoid nasal packing.