If epistaxis does not respond to anterior packing, which type of epistaxis should be suspected?

If epistaxis does not respond to anterior packing, which type of epistaxis should be suspected?

• A. Posterior epistaxis
• B. Anterior epistaxis
• C. Septal hematoma
• D. Nose fracture

Answer: (A)

Epistaxis that persists despite anterior packing points to a posterior source. Most nosebleeds come from the front of the nasal septum (Kiesselbach’s plexus) and respond well to anterior packing. When that fails, bleeding is often coming from higher in the nasal cavity—branches of the sphenopalatine artery—making it harder to control with anterior measures alone. Posterior epistaxis can flow down into the throat and be more brisk, frequently requiring longer or specialized posterior packing, and sometimes endoscopic ligation or arterial embolization for control. This scenario is more common in older patients or those with hypertension or vascular disease. Septal hematoma is a buildup of blood between the cartilage and nasal lining and causes nasal obstruction, requiring drainage, not ongoing epistaxis from a posterior source. A nose fracture is a traumatic injury that can bleed but isn’t a distinct category of epistaxis.

Epistaxis that persists despite anterior packing points to a posterior source. Most nosebleeds come from the front of the nasal septum (Kiesselbach’s plexus) and respond well to anterior packing. When that fails, bleeding is often coming from higher in the nasal cavity—branches of the sphenopalatine artery—making it harder to control with anterior measures alone. Posterior epistaxis can flow down into the throat and be more brisk, frequently requiring longer or specialized posterior packing, and sometimes endoscopic ligation or arterial embolization for control. This scenario is more common in older patients or those with hypertension or vascular disease.

Septal hematoma is a buildup of blood between the cartilage and nasal lining and causes nasal obstruction, requiring drainage, not ongoing epistaxis from a posterior source. A nose fracture is a traumatic injury that can bleed but isn’t a distinct category of epistaxis.