Endoscopic Management of Posterior Epistaxis

Abstract

The traditional method of management of posterior epistaxis has been with anteroposterior nasal packing. Apart from the high failure rate of 26-50% reported in various series, nasal packing is associated with marked discomfort and several complications. In order to avoid nasal packing, we started doing endoscopic cauterization in cases of posterior epistaxis. A total of 23 patients with posterior epistaxis were subjected to nasal endoscopy with the intent to stop bleeding by cauterization of the bleeding vessel. Of these, in four cases unsuspected diagnosis was made. Of the remaining 19, in three patients, the bleeding point could not be localized accurately and these patients were managed by anteroposterior packing. The rest of the 16 patients were managed by endoscopic cauterization. In four patients, there was recurrence of bleeding within 24 h. In one of these, cauterization controlled the bleeding while in the rest nasal packing had to be resorted to. Thus, of the 23 patients of posterior epistaxis subjected to nasal endoscopy, we could avoid nasal packing in 17 (74%). To conclude, endoscopic nasal cauterization is recommended as the first line to treatment in all cases of posterior epistaxis. This will not only prevent the uncomfortable and potentially dangerous nasal packing but also help in finding the underlying pathology.

Endoscopic evaluation of bleeding points in epistaxis: a cross sectional study

“…[5][6][7][8] But there are previous studies showing lateral wall of nasal cavity as common areas of epistaxis. [9][10][11] Lateral wall of nasal cavity have been identified as a bleeding location only in 19.6% of the study population in the present study. Identified bleeding points in lateral wall were over middle turbinate, uncinate process, inferior turbinate and in inferior meatus.…”

Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016

“…Si bien nuestro estudio muestra una eficacia similar entre el manejo médico y quirúrgico en el control de la epistaxis, han sido descritas en numerosos estudios las ventajas de esta última intervención [4][5][6][7] .…”

Nasogastric tube induced refractory epistaxis during liver transplantation

“…Gauze, a Foley catheter, a nasal balloon catheter, or a nasal sponge/tampon can be used as a posterior pack. However, these balloons are easy to insert, but are not very effective in controlling posterior epistaxis (11).…”