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Nosebleed (Epistaxis): New Clinical Practice Guideline to Promote Consistent Care across Clinical Settings

Nosebleed (Epistaxis): New Clinical Practice Guideline to Promote Consistent Care across Clinical Settings

ALEXANDRIA, VA — The American Academy of Otolaryngology‒Head and Neck Surgery Foundation published the Clinical Practice Guideline: Nosebleed (Epistaxis) today in Otolaryngology–Head and Neck Surgery. A nosebleed is a common medical condition that occurs at some point in at least 60 percent of people in the United States.

Although it is common, methods of diagnosis and treatment for nosebleed have not been uniformly used across clinicians and settings. To address that and to help reduce variations in care, this guideline provides evidence-based recommendations to improve quality of care.

David E. Tunkel, MD (Chair of the guideline development group)

A nosebleed is bleeding from the nostril, nasal cavity (inside of the nose), or nasopharynx (the part connecting the nose and throat). Nosebleed often happens without an obvious cause and occurs more often in children and the elderly, with three out of four children having a nosebleed at least once. A recent study based on data from the Nationwide Emergency Department Sample from 2009 to 2011 identified 1.2 million emergency department encounters for nosebleed.

Care for nosebleed ranges from self-treatment and home remedies to more intensive, procedural intervention in medical offices, emergency departments, hospitals, and operating rooms. This clinical practice guideline is designed for patients who cannot manage their nosebleeds through self-treatment and instead have bleeding that is severe enough to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that affects a person’s quality of life.

“This is the first multidisciplinary, evidence-based guideline on nosebleed developed in the United States,” said Dr. Tunkel. “It informs clinicians about the current level of evidence and includes areas of improvement of practice – such as providing patient instructions for nasal packing care – that were developed by the guideline panel after a review of all the literature.”

The guideline delineates clear and actionable recommendations to implement quality improvement opportunities in clinical practice. The GDG used evidence-based research from five clinical practice guidelines, 17 systematic reviews, 16 randomized controlled trials, and 203 related studies to inform the Key Action Statements (KASs) for patient care.

The target patient for the guideline is any individual who is three years old or older with a nosebleed or history of nosebleed who needs medical treatment or who seeks medical care. The target audience for the guideline includes all clinicians who evaluate and treat patients with nosebleed.

Members of the media who wish to obtain a copy of the guideline or request an interview should contact Adrianne Wyatt at 703-535-3761 or [email protected]. Upon release, the guideline and other supplemental materials can be found at


  1. What is a nosebleed?
    A nosebleed is defined as bleeding from the nostril, nasal cavity (inside of the nose), or nasopharynx (the part connecting the nose and the throat).
  2. Why is this guideline important?
    This multidisciplinary, evidence-based guideline identifies quality improvement opportunities in the management of nosebleed and creates clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleed, improve health outcomes, and minimize the potential harms of nosebleed or interventions to treat nosebleed.
  3. What is the incidence of nosebleed?
    • Nosebleed occurs at some point in at least 60 percent of people in the United States.
    • About six percent of people who experience nosebleed will seek medical attention.
    • It is estimated that nosebleed accounts for 0.5 percent of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters.
  4. Who is at risk for a nosebleed?
    Children and the elderly are more at risk for nosebleeds than the general population. In addition, patients with a family history of bleeding disorders (like Von Willebrand disease or hemophilia) or genetic bleeding diseases (like hereditary hemorrhagic telangiectasia [HHT] syndrome), those who take anticoagulant medications, or those who take medications and drugs through the nose may also be at higher risk of experiencing nosebleed.
  5. When should someone seek medical care?
    Someone who is experiencing a nosebleed should see a healthcare provider if the nosebleed flow is heavy, won’t stop, is long-lasting, keeps coming back, makes them feel weak or dizzy, and/or the bleeding keeps them from normal activities.

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About the AAO-HNS/F
The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) represents approximately 12,000 specialists worldwide who treat the ear, nose, throat, and related structures of the head and neck. The AAO-HNS Foundation works to advance the art, science, and ethical practice of otolaryngology–head and neck surgery through education, research, and lifelong learning.
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