Endoscopic picture of the nasopharynx taken with a zero degree telescope. This elderly patient presented with severe epistaxis and clots in the oropharynx. The bleeding arteriole was discovered in the vault of the nasopharynx and cauterized with a suction Bovie. Incidentally, the picture shows the slightly elevated posterior lip of the orifice of the right Eustachian tube, the torus tubarius. Above the Eustachian tube orifice is a lateral extension of the nasopharynx, called pharyngeal recess or fossa of Rosenmuller.
Most nosebleeds resolve spontaneously and do not need medical attention. Profuse or prolonged nosebleeds, however, could be life-threatening in the elderly or debilitated.
Anterior epistaxis is the most common type, accounting for about 90 % of nosebleeds. Bleeding is usually visible on inspection and typically occurs in Little's Area in the anterior half of the nasal septum. This area contains numerous vessels called Kiesselbach's plexus. In the majority of cases, anterior epistaxis can be controlled by compressing (pinching) the cartilaginous part of the nose.
Posterior epistaxis accounts for 10% of nosebleeds. Bleeding is profuse because of the larger vessels in that location (usually, the sphenopalatine artery). In general, posterior epistaxis occurs in older patients, who have fragile vessels because of hypertension, atherosclerosis, coagulopathies, or weakened tissue. Posterior epistaxis requires aggressive treatment and hospitalization.