Aetiological profile of non-traumatic epistaxis: a two-year retrospective analysis in a tertiary care hospital


  • Najmudheen Manappattu Department of ENT, MES Medical College, Perinthalmanna, Malappuram, Kerala,
  • N. K. Bashir Department of ENT, MES Medical College, Perinthalmanna, Malappuram, Kerala,
  • Girish Raj Department of ENT, MES Medical College, Perinthalmanna, Malappuram, Kerala,



Epistaxis, Rhinosporidiosis, Etiology, Trauma, Idiopathic


Background: Epistaxis is one of the commonest rhinological emergencies. Studies from different parts of the world show wide variation in aetiological profile. Idiopathic epistaxis is the most common form in most western studies while in many developing countries trauma is the predominant factor. Rhinosporidiosis is an important cause for epistaxis in certain parts of Malappuram district of Kerala. Hence this study was designed to analyze the non-traumatic causes for epistaxis in study location with a special emphasis on age and sex distribution and the role of rhinosporidium in epistaxis.

Methods: Retrospective analysis of case records of epistaxis patients was done in a tertiary care teaching hospital in Malappuram district of Kerala, India. Patients with epistaxis reported through OP, IP and referrals from other departments were included as the study population. Age and sex distribution of idiopathic epistaxis and systemic and local cause of epistaxis with its age and sex distribution were analysed.  

Results: Total of 110 patients were studied, 74 males and 36 females, between the ages of 4 and 80. Predominant age group was 11-20 years followed by 21-30, with male dominance in almost all age ranges. Right side predominance was noted in unilateral cases. Thirty-six patients had primary epistaxis. Among the systemic causes, 15 had hypertension, four platelet dysfunction and three altered coagulation. Local causes were found in 51 cases; rhinosporidiosis being the commonest followed by infection.

Conclusions: Non-traumatic epistaxis is more common among young males. Nasal rhinosporidiosis and infection are the two prominent local causes for epistaxis.

Author Biographies

N. K. Bashir, Department of ENT, MES Medical College, Perinthalmanna, Malappuram, Kerala,

HOD & Professor of ENT

Girish Raj, Department of ENT, MES Medical College, Perinthalmanna, Malappuram, Kerala,



Laflamme L, Monárrez-Espino J, Johnell K, Elling B, Möller J. Type, number or both? A population-based matched case-control study on the risk of fall injuries among older people and number of medications beyond fall-inducing drugs. PLoS One. 2015;10(3):123390.

Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907-16.

Chauhan JP, Singh AB, Kumar A. A Prospective Analysis of Etiology and Efficacy of Various Treatment Modalities Used in Epistaxis at a Tertiary Care Teaching Hospital. Ind J Basic Applied Med Res. 2016;5:750-5.

Parajuli R. Evaluation of etiology and treatment methods for epistaxis: a review at a tertiary care hospital in central Nepal. Int J Otolaryngol. 2015;2015.

Shah WA, Amin P, Nazir F. Epistaxis-etiological profile and treatment outcome at a tertiary care centre. J Evolution Med Dental Sci. 2015;4(3):5204-10.

Singh V, Singhal RK. Etiology and Treatment Outcome of Epistaxis at Medical College in Western UP-A Prospective Review of 52 Patients. Int J Contemporary Surg. 2014;2(1):35.

Byrne JV. Embolisation for Epistaxis. In: Tutorials in Endovascular Neurosurgery and Interventional Neuroradiology. Springer, Cham; 2017.

Walker TWM, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions, 1995-2004. Clin Otolaryngol. 2007;32:361-5.

Razdan U, Rai Zada RM, Chaturvedi VN. Epistaxis: Study of aetiology, site and side of bleeding. Indian J Med Sci. 1999;53:545-52.

Eziyi JAE, Amusa YB, Eziyi, AK. Epistaxis in Nigerians. East and Central J Surg. 2009;14(2):93-4.

Pallin DJ, Chng Y, McKay MP, Emond JA, Pelletier AJ, Camargo CA: Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46:77-81.

Padgham N. Epistaxis anatomical and clinical correlates. J Laryngd Otol. 1990;104:308-11.

Gilyoma JM, Chalya PL. Etiological profile and treatment outcome of epistaxis at a tertiary care hospital in Northwestern Tanzania: a prospective review of 104 cases. BMC Ear Nose Throat Disor. 2011;11:8.

Varshney S, Saxena RK. Epistaxis: a retrospective clinical study. Ind J Otolaryngol Head Neck Surg. 2005;57:125-9.

Stell PM. Epistaxis. Clin Otolaryngol.1977;2:263-73.

Charles R, Corrigan E. Epistaxis and Hypertension. Postgrad Med J. 1977;53:260-1.

Iseh KR, Muhammad Z. Pattern of epistaxis in Sokoto, Nigeria: A review of 72 cases. Ann Afr Med. 2008;7:107-11

Lubianca-Neto JF, Bredemeir M, Carvahal EF, Arruda CA, Estrella E, Pletsch A, et al. A study of the assocaiation between epistaxis and the severity of hypertension. Am J Rhinol. 1998;12:269-72.

Cummings CW, Haughey BH, Thomas JR, Harker LA, Robbins KT, Schuller DE, et al. Cummings Otolaryngology Head and Neck Surgery. 4th ed. Philadelphia, PA: Elsevier Mosby; 2005: 942-945.

Malik MK, Bhatia BPR. Epistaxis a study of 600 patients. Indian Medical Gazette. 1978;112:56-9.

Livessy JR, Watson MG, Kelly PJ, Kesteven PJ. Do patients with epistaxis have drug induced platelet dysfunction? Clin otolaryngol. 1995;20:407.

Arseculeratne SN. Recent advances in rhinosporidiosis and rhinosporidium seeberi. Indian J Med Microbiol. 2002;20:119-31.

Ahmed NA, Mohammed S, Raj G. Rhinosporidiosis: an epidemiological study. J Evolution Med Dental Sci. 2013;2(38):7227-33.

Watkinson JC. Scott-Brown’s Otolaryngology. 6th ed. Volume 4. 2018: 1-6.

Petruson B. Epistaxis in Childhood Rhinology. Rhinology. 1979;17:83-90.

Juselius H. Epistaxis: A Clinical study of 1724 patients. J Laryngol Otol. 1974;88:317-7.






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