<p>Epistaxis is one of the most prevalent otolaryngological emergencies, particularly challenging in resource-limited settings. While various management approaches exist, evidence-based comparisons of their effectiveness and safety remain limited. This study aimed to analyze the etiological spectrum and assess treatment outcomes and complications associated with different modalities used in managing epistaxis. This prospective observational study enrolled 100 patients presenting with epistaxis at a tertiary care center over one year. Patients were managed through different interventions including nasal packing, submucosal cauterization, and endoscopic sphenopalatine artery ligation (ESPAL). Demographic data, clinical features, comorbidities, bleeding site and duration, and treatment compliance were documented. Follow-up assessments were conducted at 1-, 2-, and 4-weeks post-intervention. Epistaxis was more common in males (66%), and predominantly occurred in patients aged 41–60 years. Posterior bleeds slightly outnumbered anterior ones (53% vs. 47%). Hypertension was the most prevalent comorbidity (61%). The combination of nasal packing (NP) with ESPAL was the most used modality (38%). Crusting was most frequent in cauterization groups, while synechiae formation was higher in NP/ESPAL cases. Rebleeding rates were significantly higher in nasal packing-only groups. Compliance was notably higher in cauterization patients (86.3%) compared to nasal packing (15.2%). As compared to nasal packing, submucosal cauterization produced superior compliance and fewer complications. It was found that combined treatment modalities like NP/ESPAL were effective in controlling bleeding but had a higher incidence of late complications. Tailored treatment selection is essential for enhancing patient outcomes.</p>