This article describes a live leech inside the nasal cavity of a patient who presented with epistaxis. This case is reported in order to create awareness of this condition as well as to discuss the practical difficulties in removing these live foreign bodies from nasal cavities. A review of pulished material on this subject illustrated lack of scientific model pertaining to the best removal methodology to be followed. The methods described in literature bears testimony to the innovative skills of the surgeon rather than evidence based practice. It should also be stressed that ill advised removal methods could proove counterproductive.