Primary Epistaxis Occurs Most Frequently During Overnight and Winter Months

by Linda Kossof •

CLINICAL QUESTION

What is the frequency of idiopathic epistaxis onset and its severity relative to the time of day?

BOTTOM LINE

Adult epistaxis occurred most frequently overnight, and this was associated with serious blood pressure between midnight and

6 a.m.

BACKGROUND: Epistaxis occurs in up to 60% of the population. Most patients develop primary epistaxis, which is mostly idiopathic and arises spontaneously. The causes and risk factors for secondary epistaxis are classified as local or systemic. Although the frequency and management of epistaxis have been extensively studied, data on epistaxis timing are lacking.

STUDY DESIGN: Retrospective study

SETTING: Department of Otolaryngology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China

SYNOPSIS: Researchers screened the medical records of all patients from a single institution whose medical records mentioned ear, nose, and throat emergency department outpatient visits for epistaxis. Timing of epistaxis onset was divided into morning (6:01–12:00), afternoon (12:01–18:00), evening (18:01–24:00), and overnight (00:01–6:00). Season of epistaxis onset was classified as spring (March-May), summer (June–August), fall (September–November), or winter (December–February). Risk factors included smoking, alcohol consumption, and the presence/absence of hypertension and diabetes. A total of 1,684 patients (1,032 men; median age 56 years) with primary epistaxis were included in the analysis. Findings showed that epistaxis incidence was highest in December (n=213), lowest in July (n=95), and highest in winter, followed by fall, spring, and summer. Epistaxis occurred most frequently overnight (n=823), followed by evening (n=410), morning (n=254), and afternoon (n=197). Odds ratios of the risk of epistaxis were 1.34, 1.47, and 3.52 in the evening, morning, and overnight, respectively. Epistaxis rates overnight were significantly strongest and positively proportional to blood pressure in the morning hours. Study limitations included its retrospective nature.

CITATION: Yu J, et al. Frequency and severity of idiopathic epistaxis relative to time of day. Sci Rep. 2024;14(1):29852. doi: 10.1038/s41598-024-81570-0.