Objective: A prospective study of various risk factors for recurrent epistaxis and comparison of different initial treatment methods for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented. Methods: The data of 160 patients with idiopathic epistaxis treated during oct 2016? sep 2017 were analyzed. Treatment data for 53 cases of posterior bleeding were analyzed. Results: Recurrent epistaxis occurred in 16 cases (10 %). In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (4% vs. 39.3%), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (36.85% vs. 15.7 %) Conclusion: In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point .Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies and appropriate analyses of factors related to hospitalization, surgery, and embolization