Epistaxis Epistaxis, or a nose bleed, may be due to local or systematic causes. Some of the local causes include inflammation, trauma, septal deformity, foreign bodies, tumors, and aneurysms. Inflammation may result from colds or flu syndrome, chronic sinusitis, or allergies. Forceful nose blowing used to clear the nasal passages may result in blood-tinged mucous or frank bleeding. Also, there is increased vascularity and greater friability of the vessels inflamed membranes. Nose bleeds occur more frequently in winter months due to an increase in upper respiratory infections and decrease in the moisture of the air in overheated and underhumidified environments. Nose bleeds are unrelated to changes in barometric pressure; however, rapid decrease in pressure and ascents to high altitude commonly cause nose bleeds. Direct trauma to the nose, accidental or self-inflicted is probably the most common cause of nose bleeds. Irritation and ulceration of the mucosa of the front of the nose is produced by habitual rubbing and nose picking. Trauma to the outside of the nose may produce bleeding whether or not the bone is broken due to lacerations of the mucosa. Nose bleeds occur frequently in patients with a deviated septum. The deflection disturbs the normal flow of air currents producing eddy currents that dry the nasal mucosa. This leads to crusting and bleeding. Septal perforations, or holes in the septum, frequently bleed. Foreign bodies placed in the nose by children or disturbed people may result in bleeding. This should be suspected in children when there is a foul discharge from the side of the nose. Bleeding may be the first symptom of benign or malignant tumors of the nose or sinuses. The bleeding is usually one-sided and may be constant or intermittent. Aneurysms of the cavernous sinus portion of the internal carotid artery are an uncommon cause of bleeding. There is usually a history of head trauma and immediate onset. Systematic causes include a coagulation defect, Vitamin C or K deficiency, and arteriosclerosis. Hypertension does not seem to be a contributing factor. Management of Nose Bleed Our first responsibility is to stop the bleeding. Control of bleeding may involve cautery, anterior nasal packing (in front of the nose), or posterior packing (placement of a balloon in the back of the nose). A full history and physical exam is then done and, if necessary, blood tests and x-rays.