Changing Pattern of Epistaxis During the Past 45 Years

Nothing new under the sun: the management of epistaxis

“…In the early part of this century epistaxis was largely managed at home with only the most severe cases referred for admission. The typical scene which greeted the attending doctor was described by Stewart (1957): 'the patient slumped in his bed with a blood-stained bath towel draped round his neck and shoulders, or with his head dependent over the side coughing and spluttering blood into some homely receptacle. The room was probably packed with anxious members of his family .…”

Historical use of silver nitrate for the management of epistaxis – evidence-based practice?

“…Similar to this, there are reports of cold metal being placed over the cervical sympathetic ganglion. 18…”

“…17 A study by Stewart, which covered epistaxis management from 1912 to 1957, described the use of silver nitrate sticks in the cauterisation of active epistaxis at the Royal Infirmary Edinburgh; it was not utilised as a mainstay of treatment however. 18 The paper describes using a hot or cold saline douche, applied with a syringe, alongside ribbon gauze for packing, which was soaked in hydrogen peroxide for haemostasis, and the use of a 'Rose-Cooper' inflatable bag to exert pressure upon the bleeding point. 18 Stewart also makes reference to an epistaxis treatment, used in 1769, which involved immersing the genitalia into cold water, perhaps to promote vasoconstriction?…”

“…18 The paper describes using a hot or cold saline douche, applied with a syringe, alongside ribbon gauze for packing, which was soaked in hydrogen peroxide for haemostasis, and the use of a 'Rose-Cooper' inflatable bag to exert pressure upon the bleeding point. 18 Stewart also makes reference to an epistaxis treatment, used in 1769, which involved immersing the genitalia into cold water, perhaps to promote vasoconstriction? Similar to this, there are reports of cold metal being placed over the cervical sympathetic ganglion.…”

“…Similar to this, there are reports of cold metal being placed over the cervical sympathetic ganglion. 18 By 1974, silver nitrate cautery had established itself as a key part of epistaxis management. It was the fifth most used epistaxis treatment in a study of 1724 patients, behind anterior packing, posterior packing, blood transfusion and the Stevens balloon.…”