Skip to main content Accessibility help

The distribution of bleeding sites in idiopathic hidden arterial epistaxis

  • Z-C Lou (a1) and Z-H Lou (a2)

To determine the frequency distribution of bleeding sites in idiopathic hidden arterial epistaxis.


In this retrospective cohort study, 107 patients with hidden arterial epistaxis were endoscopically examined for sites of bleeding.


All sites of hidden arterial epistaxis were identified by endoscopic examination. Bleeding sites were identified at initial surgery in 103 patients and during the second surgery in 4. The bleeding sites included: the olfactory cleft region in 47 patients, the inferior meatus region in 29, the middle meatus region in 11, multiple bleeding sites (olfactory cleft and anterior septum) in 3, the anterior roof of the nasal cavity in 4, the nasal floor in 11 and the nasopharynx in 2. The bleeding points showed a white or red volcano-like bump in 75 patients, isolated prominent telangiectasia in 21 and mucosal ulceration in 11.


Common sites of hidden arterial epistaxis include the olfactory cleft, inferior meatus and middle meatus. However, there should be awareness of some uncommon bleeding sites (including the anterior roof of the nasal cavity, the nasal floor and the nasopharynx) and of multiple bleeding sites.

Corresponding author
Author for correspondence: Dr Zhen-Cai Lou, Department of Otorhinolaryngology, Affiliated Yiwu Hospital of Wenzhou Medical University, 699 Jiangdong Road, Yiwu, Zhejiang 322000, China E-mail: Fax: +86 0579 5209 678
Hide All

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

Hide All
1Melia, L, McGarry, GW. Epistaxis: update on management. Curr Opin Otolaryngol Head Neck Surg 2011;19:30–5
2Douglas, R, Wormald, PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007;15:180–3
3de Bonnecaze, G, Gallois, Y, Chaynes, P, Bonneville, F, Dupret-Bories, A, Chantalat, E et al. Intractable epistaxis: which arteries are responsible? An angiographic study. Surg Radiol Anat 2017;39:1203–7
4Christensen, NP, Smith, DS, Barnwell, SL, Wax, MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 2005;133:748–53
5Dutta, M, Haldar, D. Optimizing the outcome of transnasal endoscopic sphenopalatine artery ligation in managing refractory posterior epistaxis: a case-control analysis. Auris Nasus Larynx 2017;44:554–60
6Pádua, FG, Voegels, RL. Severe posterior epistaxis–endoscopic surgical anatomy. Laryngoscope 2008;118:156–61
7Simmen, DB, Raghavan, U, Briner, HR, Manestar, M, Groscurth, P, Jones, NS. The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol 2006;20:502–5
8Gandomi, B, Arzaghi, MH, Khademi, B, Rafatbakhsh, M. Endoscopic cauterization of the sphenopalatine artery to control severe and recurrent posterior epistaxis. Iran J Otorhinolaryngol 2013;25:147–54
9Shrestha, 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
10Wiorowski, M, Schultz, P, Perrot, JB, Gentine, A, Debry, C. Indications and results of cauterization by endoscopic approach of the sphenopalatine artery in severe posterior epistaxis. Auris Nasus Larynx 2004;31:131–3
11Ando, Y, Iimura, J, Arai, S, Arai, C, Komori, M, Tsuyumu, M et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx 2014;41:41–5
12Iimura, 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
13Liu, J, Sun, X, Guo, L, Wang, D. Posterior epistaxis: common bleeding sites and prophylactic electrocoagulation. Ear Nose Throat J 2016;95:E1822
14Thornton, MA, Mahesh, BN, Lang, J. Posterior epistaxis: identification of common bleeding sites. Laryngoscope 2005;115:588–90
15Paul, J, Kanotra, SP, Kanotra, S. Endoscopic management of posterior epistaxis. Indian J Otolaryngol Head Neck Surg 2011;63:141–4
16Bhatnagar, RK, Berry, S. Selective surgical packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4
17Chiu, TW, McGarry, GW. Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis. Otolaryngol Head Neck Surg 2007;137:390–3
18Turri-Zanoni, M, Arosio, AD, Stamm, AC, Battaglia, P, Salzano, G, Romano, A et al. Septal branches of the anterior ethmoidal artery: anatomical considerations and clinical implications in the management of refractory epistaxis. Eur Arch Otorhinolaryngol 2018;275:1449–56
19Segal, RA, Kepler, GM, Kimbell, JS. Effects of differences in nasal anatomy on airflow distribution: a comparison of four individuals at rest. Ann Biomed Eng 2008;36:1870–82
20Zhao, K, Jiang, J. What is normal nasal airflow? A computational study of 22 healthy adults. Int Forum Allergy Rhinol 2014;4:435–46
21Leong, SC, Chen, XB, Lee, HP, Wang, DY. A review of the implications of computational fluid dynamic studies on nasal airflow and physiology. Rhinology 2010;48:139–45
22Hong, SC, Leopold, DA, Oliverio, PJ, Benson, ML, Mellits, D, Quaskey, SA et al. Relation between CT scan findings and human sense of smell. Otolaryngol Head Neck Surg 1998;11:183–6
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed