Epistaxis Management: From First Aid to Surgical Intervention

Background Epistaxis, commonly referred to as a nosebleed, is among the most frequent otolaryngological emergencies encountered in clinical practice. It affects approximately 60% of the general population during their lifetime, with nearly 10% seeking medical attention and a smaller proportion requiring hospitalization or surgical intervention. Although the majority of episodes are self-limiting and originate from the anterior nasal septum, severe cases may result in significant blood loss, airway compromise, hemodynamic instability, and substantial healthcare utilization. The management of epistaxis has evolved considerably over recent decades, with advances in endoscopic techniques and interventional radiology providing highly effective alternatives to traditional approaches. Objective This review aims to provide a comprehensive overview of epistaxis management, beginning with initial first-aid measures and progressing through medical treatment, nasal cauterization, nasal packing, endoscopic surgical procedures, and endovascular interventions. The review also highlights current evidence-based practices and proposes a structured approach to clinical decision-making. Methods A narrative review of contemporary literature, clinical practice guidelines, and standard otolaryngology references was conducted. Relevant studies addressing the epidemiology, pathophysiology, classification, assessment, and management of epistaxis were reviewed and synthesized to provide a practical framework for healthcare professionals involved in the care of patients presenting with nasal bleeding. Results Successful management of epistaxis depends on prompt patient assessment, identification of the bleeding source, and implementation of a stepwise treatment strategy. Initial management should prioritize airway protection, hemodynamic stabilization, and application of first-aid measures, including direct nasal compression and topical vasoconstrictors. Persistent anterior epistaxis may be effectively treated with chemical or electrical cauterization, while refractory cases often require anterior nasal packing. Posterior epistaxis presents greater management challenges and frequently necessitates hospitalization, posterior packing, endoscopic sphenopalatine artery ligation, or endovascular embolization. Recent evidence supports endoscopic sphenopalatine artery ligation as the preferred surgical option due to its high success rate, reduced morbidity, and lower recurrence rates compared with prolonged nasal packing. Conclusion Epistaxis remains a common yet potentially serious clinical condition requiring a systematic and evidence-based approach. While most cases respond to conservative measures, a subset of patients requires advanced interventions. Early recognition of high-risk presentations, appropriate escalation of care, and multidisciplinary collaboration are essential to optimizing patient outcomes and minimizing complications.