Aetiology
Most causes are simple trauma, resolve without much ado and are not sinister. Occasionally it indicates a more serious underlying disease. Often no cause is found.

• Trauma to the nose (commonest cause) - especially nose picking! Insertion of foreign bodies and excessive nose blowing may also be seen as trauma. The latter is likely to occur with a cold when the nasal mucosa is congested. Sinusitis causes nasal congestion.

• Disorders of platelet function. Thrombocytopenia and other causes of abnormal platelets including splenomegaly and leukaemia. Waldenström's macroglobulinaemia may present with nosebleeds. ITP can occur in children and young adults.

• Drugs - aspirin and anticoagulants.

• Disorders of platelets are more likely to be a problem than clotting factor deficiency.

• Abnormalities of blood vessels. In the elderly arteriosclerotic vessels prolong bleeding. Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome) causes recurrent epistaxis from nasal telangiectasiae.

• Malignancy of the nose may present with bleeding. Juvenile angiofibroma is a highly vascular benign tumour that typically presents in adolescent males.

• Cocaine Use - If the septum looks sloughed or atrophic ask about use of cocaine. The drug is usually taken by inhalation and it has a very strong vasoconstrictive effect that can lead to complete obliteration of the nasal septum.

• Other conditions - Wegener's granulomatosis and pyogenic granuloma can present as an epistaxis.

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