If the patient rebleeds the packing is replaced and internal maxillary artery ligation is performed through the maxillary sinus, as well as anterior and posterior ethmoid artery ligations. If this fails embolization can be considered. As always these patients should be worked up for bleeding disorders and complications can occur. A patient with a severe nosebleed can develop hypovolemia, or significant anemia if fluid is being replaced. These conditions necessitate increased cardiac output which can lead to ischemia or infarction of the heart itself.
Infarctions can lead to a arrhythmias and arrhythmias can easily lead to death.
It should be therefore be noted that the most serious complication of a nosebleed is death. Malignant otitis externa is an old name for what should more appropriately be called necrotizing otitis externa. This is a severe infection of the external auditory canal usually caused by Pseudomonas . This infection spreads to the temporal bone and as such is really an osteomyelitis of the temporal bone. This can extend readily to the base of the skull if not adequately treated.