Treatment of epistaxis without the use of nasal packing, a patient study

Abstract

We questioned how many patients with epistaxis can be treated by cautery without the use of nasal packing, as cautery is more effective and efficient. To investigate this, we performed a retrospective study of a cohort of 418 patients with epistaxis who presented to one ENT consultant at the ENT department of Medisch Centrum Leeuwarden (the Netherlands) between 1997 and 2007. Main outcomes were the treatment modality (cautery and/or nasal packing), recurrence of epistaxis and need for hospitalization. In 98% of all patients the bleeding site could be found and treated by cautery. The incidence of recurrent bleeding was 6%. Two percent of all patients had to be admitted to the hospital. This is considerably lower compared with recurrence rates and hospitalization after treatment by nasal packing known from the literature. Therefore we concluded that nearly all patients can be effectively treated by cautery with a low recurrence rate. In addition, this method of treatment is very cost effective. Because cautery requires skill and appropriate facilities, we recommend special attention for this in ENT training programs.

Comparison of topical treatment methods used in recurrent anterior epistaxis: a randomized clinical trial

“…Treatment in epistaxis is somewhat easier because bleeding originates from the anterior septum in most of the cases. 10 If there is no unusual condition such as coagulopathy, tumor, perforation, or hereditary hemorrhagic telangiectasia, bleeding usually originates from Kiesselbach's plexus. No special equipment is needed for diagnosis and treatment and most of the patients can be treated as outpatients unless profuse bleeding occurs.…”