Clinical Scorecard: Imaging Guidelines for Nasal Obstruction and Epistaxis: Recommendations from the European Society of Head and Neck Radiology

At a Glance

Key Highlights

• Initial clinical assessment and nasal endoscopy guide imaging necessity.
• Non-contrast CT is preferred for structural evaluation before surgery in nasal obstruction.
• Imaging in epistaxis is reserved for severe, recurrent, or posterior bleeding to localize bleeding source and exclude pathology.

Guideline-Based Recommendations

Diagnosis

• Perform initial clinical history and nasal endoscopy to assess nasal obstruction or epistaxis (Level 2a, Class I).
• Use non-contrast CT to evaluate structural abnormalities in nasal obstruction prior to surgery (Level 1b, Class I).
• Reserve imaging for epistaxis patients with severe, recurrent, or posterior bleeding to identify vascular sources and underlying pathology (Level 2b, Class IIa).

Management

• Conservative management or nasal packing for anterior epistaxis from Kiesselbach’s plexus.
• Surgical or endovascular intervention planned based on imaging findings in complicated cases.
• Radical surgery indicated for inverted papilloma due to malignant potential.

Monitoring & Follow-up

• Monitor patients with recurrent or severe epistaxis for underlying systemic factors such as hypertension, anticoagulant use, or coagulation disorders.

Risks

• Consider risk factors for sinonasal malignancies including smoking, chemical exposure, and HPV infection.
• Recognize potential complications from neoplasms invading adjacent structures.
• Be aware of iatrogenic causes of epistaxis including surgical complications and nasal packing.

Patient & Prescribing Data

Patients presenting with nasal obstruction or epistaxis across all age groups

Imaging guides surgical planning and intervention; conservative treatment effective for most anterior epistaxis; imaging reserved for complicated or severe cases.

Clinical Best Practices

• Use clinical history and nasal endoscopy as first-line assessment tools.
• Apply non-contrast CT imaging selectively to evaluate structural causes before surgery.
• Limit imaging in epistaxis to cases with severe, recurrent, or posterior bleeding.
• Consider systemic comorbidities contributing to epistaxis in hospitalized patients.
• Recognize imaging features of juvenile nasopharyngeal angiofibroma and sinonasal tumors for appropriate management.

References

• Epidemiology of nasal obstruction
• Structural causes of nasal obstruction
• Sinonasal neoplasms statistics
• Risk factors for sinonasal malignancies
• Management of inverted papilloma
• Imaging features of juvenile nasopharyngeal angiofibroma
• Trauma as cause of epistaxis
• Iatrogenic causes of epistaxis
• Anterior epistaxis management
• Posterior epistaxis characteristics
• Systemic factors in epistaxis