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Chronic Epistaxis: What Causes Chronic Nosebleeds?

Chronic Epistaxis: What Causes Chronic Nosebleeds?
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Chronic Epistaxis


Chronic epistaxis refers to frequent, recurring nosebleeds. While getting a nosebleed is seen as very normal, with at least 60% of the population having had at least one in their life, it is unusual to have recurring nosebleeds. If you have chronic nosebleeds, it is usually the result of an underlying condition.

What Causes Chronic Epistaxis?

  • Anatomical deformities
  • Blunt trauma
  • Foreign bodies in the nasal cavity
  • Chronic sinusitis
  • Intranasal tumors
  • Environmental irritants
  • Rhinitis
  • Respiratory infections
  • Cocaine use
  • Prolonged use of nasal sprays
  • Infectious diseases
  • Hypertension
  • Low humidity
  • Middle ear barotrauma
  • Surgery and/or damage to the nasal passages
  • Excessive alcohol consumption
  • Anemia
  • Blood dyscrasias
  • Connective tissue disorders
  • Liver disease
  • Hemophilia
  • Pregnancy
  • Vitamin C deficiency
  • Potassium deficiency
  • Heart failure
  • Idiopathic thrombocytopenic purpura
  • Hematological malignancy
  • Von Willebrand’s disease
  • Hemorrhagic telangiectasia
  • Vascular disorders
  • Thrombotic thrombocytopenic purpura

Types Of Chronic Epistaxis


This type of epistaxis is the most common. It is characterized by nosebleeds that originate in the front of the nose, known as the nasal septum.


This type of epistaxis is rare and considered more serious. It originates in the back of the nose, from the Woodruff’s plexus. These nosebleeds are harder to control and do not stop on their own.

Chronic Epistaxis Symptoms

  • Blood exiting one or more nostrils
  • Blood flowing to the back of the throat
  • Nausea
  • Vomiting
  • Coughing


Diagnosing Chronic Epistaxis

Your primary care physician can diagnose chronic epistaxis, but they will likely refer you to an ENT (ear, nose and throat specialist) to do a thorough examination of the nasal passages.

Treating Chronic Epistaxis

Most cases of epistaxis resolve on their own and do not require treatment. For chronic epistaxis that is severe, it may need to be addressed. Topical medications can stop the bleeding at the moment, but laser therapy surgery or embolization can block the blood vessels that frequently bleed, putting a permanent end to the epistaxis.

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