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Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?

  • Z-C Lou (a1)



To review the origins of epistaxis in patients with unknown bleeding sites.


This consecutive case series included 26 patients with unknown bleeding sites previously considered to have posterior epistaxis. All patients had previously been examined endoscopically at least once, and were again examined with 30°, 45° and 70° endoscopes.


The bleeding site was at the: anterior end of the lateral wall of the inferior meatus in one patient (3.8 per cent); anterosuperior lateral wall of the nasal cavity in five patients (19.2 per cent); anterior nasal cavity roof in seven patients (26.9 per cent); anterosuperior part of the cartilaginous septum in nine patients (34.6 per cent); ostium pharyngeum tubae in two patients (7.7 per cent); and anterior nasal base in two patients (7.7 per cent). The morphology of the bleeding point showed: nasal mucosa ulceration in 1 patient, isolated primary telangiectasia in 3 patients, prominent vessels in 5 patients and capillary angioma in 17 patients.


Epistaxis originating from the anterosuperior nasal cavity and nasopharynx can be easily misdiagnosed as posterior epistaxis or unknown bleeding sites. Areas that should be considered as possible origins of epistaxis in cases with unknown bleeding sites were identified.


Corresponding author

Author for correspondence: Dr Zheng-Cai Lou, Department of Otorhinolaryngology, Yiwu central Hospital, 699 Jiangdong Road, Yiwu City 322000, China E-mail:


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Dr Z-C Lou takes responsibility for the integrity of the content of the paper



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1Chiu, TW, McGarry, GW. Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis. Otolaryngol Head Neck Surg 2007;137:390–3
2Thornton, MA, Mahesh, BN, Lang, J. Posterior epistaxis: identification of common bleeding sites. Laryngoscope 2005;115:588–90
3Iimura, J, Hatano, A, Ando, Y, Arai, C, Arai, S, Shigeta, Y et al. Study of hemostasis procedures for posterior epistaxis. Auris Nasus Larynx 2016;43:298303
4Bhatnagar, RK, Berry, S. Selective Surgicel packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4
5Almeida, GS, Diógenes, CA, Pinheiro, SD. Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution. Braz J Otorhinolaryngol 2005;71:146–8
6Liu, J, Sun, X, Guo, L, Wang, D. Posterior epistaxis: common bleeding sites and prophylactic electrocoagulation. Ear Nose Throat J 2016;95:E1822
7Paul, J, Kanotra, SP, Kanotra, S. Endoscopic management of posterior epistaxis. Indian J Otolaryngol Head Neck Surg 2011;63:141–4
8Shrestha, BL. Endoscopic sphenopalatine artery cauterization in recurrent posterior epistaxis: an experience at Dhulikhel Hospital, Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ) 2014;12:85–6
9Hey, SY, Koo Ng, NKF, McGarry, GW. Endoscopic sphenopalatine artery ligation: general applicability in a teaching unit. Ear Nose Throat J 2019;98:85–8
10Yukitatsu, Y, Tsuzuki, K, Takebayashi, H, Sakagami, M. Clinical study of 1,515 patients presenting with epistaxis over the last 6 years. ORL J Otorhinolaryngol Relat Spec 2016;78:232–40
11Wei, W, Lai, Y, Zang, C, Luo, J, Zhu, B, Liu, Q et al. A blind area of origins of epistaxis: technical or cognitive? Eur Arch Otorhinolaryngol 2018;275:1501–5
12Zou, Y, Deng, YQ, Xiao, CW, Kong, YG, Xu, Y, Tao, ZZ et al. Comparison of outcomes between endoscopic surgery and conventional nasal packing for epistaxis in the posterior fornix of the inferior nasal meatus. Pak J Med Sci 2015;31:1361–5
13Stoddard, T, Loehrl, TA, Hunt, BC, Poetker, DM. Intractable epistaxis due to isolated primary telangiectasias. JAMA Otolaryngol Head Neck Surg 2014;140:160–3


Does epistaxis with an unknown bleeding site originate from the posterior part of the nasal cavity?

  • Z-C Lou (a1)


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