Version June 2024
| Local | |
| Trauma | Nose-picking* Foreign body Blunt or penetrating facial trauma Child abuse Postoperative Nasotracheal intubation Nasogastric tube placement High flow oxygen by nasal cannula |
| Mucosal irritation | Dry air* Inhaled irritants/drugs (tobacco (cigarette smoke), inhaled corticosteroids, cocaine, heroin, volatile inhalants of abuse) Upper respiratory infection or systemic infection with nasal congestion Localized skin or soft tissue infection Colonization with pathologic bacteria (eg, Staphylococcus aureus) |
| Anatomic | Septal deviation or unilateral choanal atresia causing asymmetric airflow |
| Tumors | Hemangioma Juvenile nasopharyngeal angiofibroma (particularly in adolescent males) Pyogenic granuloma Rhabdomyosarcoma Nasopharyngeal carcinoma Inverting papilloma |
| Other | Increased nasal venous pressure secondary to paroxysmal coughing |
| Systemic | |
| Bleeding disorders | Inherited or acquired coagulation disorders, platelet disorders, systemic lupus erythematosus (lupus anticoagulant hypoprothrombinemia syndrome), blood vessel disorders (eg, hereditary hemorrhagic telangiectasia) |
| Medications | Aspirin and anticoagulants (including rodenticides) |
| Granulomatous disorders | Granulomatosis with polyangiitis (Wegener's), sarcoidosis, tuberculosis |
| Hypertension | Primary hypertension, secondary hypertension (renal disease, corticosteroids), increased venous pressure (exertion, superior vena cava syndrome) |
| Recurrent | |
Usually related to recurrent/chronic nasal trauma (eg, nose picking) or irritation, but may be the presenting symptom of:
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