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J Am Assoc Nurse Pract 2021 Jan 8. Epub 2021 Jan 8.

American Academy of Otolaryngology Head and Neck Surgery, Marco Island, Florida.

Abstract: Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Read More

Am J Rhinol Allergy 2018 Nov 1;32(6):539-545. Epub 2018 Oct 1.

1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.

Background: Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly.

Methods: The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. Read More

J Laryngol Otol 2017 Dec;131(12):1065-1092

Newcastle University,Newcastle upon Tyne,UK.

Background: The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.

Method: A systematic review of the literature was performed using standardised methodology. Read More

Otolaryngol Head Neck Surg 2016 Mar 24;154(3):547-52. Epub 2015 Nov 24.

Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Ireland

Objective: Sphenopalatine artery ligation is a commonly employed surgical intervention for control of posterior epistaxis unresponsive to nasal packing. The objective of the present study was to evaluate the outcome of sphenopalatine artery ligation for control of epistaxis at our institution and the impact of timing and other factors on outcome.

Study Design: Case series with chart review. Read More

Indian J Otolaryngol Head Neck Surg 2012 Dec 30;64(4):341-5. Epub 2011 Nov 30.

Department of Otolaryngology, R.G. Kar Medical College & Hospital, 3/1, Bose Para Lane, Baidyabati, Hooghly, 712222 Kolkata, West Bengal India.

Anterior nasal packing, which is a common procedure in otorhinolaryngology practice, has different complications. Pain during introduction and removal of pack, bleeding after removal due to mucosal damage and synechia formation are common among them. A continuous effort is going on worldwide to combat those by modifying the nature of pack material or inventing new materials for nasal packing. Read More

Eur Arch Otorhinolaryngol 2014 Mar 14;271(3):519-23. Epub 2013 Jun 14.

Royal Berkshire Hospital, Reading, Berkshire, UK,

There is little evidence to suggest that bilateral nasal packing increases intra-nasal pressures compared to a single pack (or is well tolerated) for uncontrolled unilateral epistaxis, but it is often performed and justified on those grounds. 15 volunteers were recruited according to strict criteria. Rapid Rhino(®) 5. Read More

Otolaryngol Head Neck Surg 2013 Sep 13;149(3):390-8. Epub 2013 Jun 13.

Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, USA.

Objective: This study explored the outcomes of epistaxis treatment modalities to optimize management and enable the development of a therapeutic algorithm.

Study Design: Case series with chart review.

Setting: Tertiary care hospital. Read More

Int Forum Allergy Rhinol 2013 Apr 25;3(4):334-7. Epub 2012 Oct 25.

Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA 02114, USA.

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder affecting multiple organ systems, with epistaxis being the most common manifestation. Multiple procedures have been used for the management of epistaxis in the setting of HHT, including closure of the anterior nares via a Young's procedure. While this procedure results in loss of smell and permanent nasal obstruction, proponents note significant improvement in patient symptomatology. Read More

B-ENT 2011 ;7(2):91-6

Department of ENT, Gian Sagar Medical College & Hospital, Ramnagar, Banur Distt. Patiala, Punjab.

Objective: To study and compare the effects of complete nasal packing and nasal packing with airways (uni/bilateral) on blood pressure, arterial oxygen saturation, middle ear pressure, and post-operative subjective complaints.

Methods: Ninety patients who underwent bilateral anterior nasal packing for epistaxis or following nasal surgery were divided into three equal groups by randomization. Group A received bilateral complete nasal packing, without an airway. Read More

Am J Rhinol Allergy 2011 Jan-Feb;25(1):61-3

Division of Rhinology, The Union Memorial Hospital, Baltimore, Maryland, USA.

Background: The purpose of this study was to evaluate the effectiveness and safety of endoscopically guided chitosan packing in controlling intractable epistaxis. A prospective case series was performed.

Methods: This is a prospective clinical study conducted in a tertiary rhinology fellowship training hospital between January 2009 and November 2009. Read More

Allergy Rhinol (Providence) 2011 Jan;2(1):12-5

Department of Ear, Nose, and Throat, Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, United Kingdom.

Fiberoptic nasoendoscopy (FNE) is a powerful investigative tool in ear, nose, and throat practice in which its use in the management of epistaxis is varied among clinicians. The practice of assessing the nasal cavity after removal of nasal packs is common but its usefulness has not been evaluated. Therefore, we assessed the benefits of routine FNE after removal of nasal packs in epistaxis patients. Read More

Emerg Med J 2011 May 17;28(5):450-1. Epub 2010 Jun 17.

St George's Hospital, London, Flat 2F2, 5 Gladstone Terrace, Edinburgh EH9 1LX, UK.

Ear Nose Throat J 2009 Jun;88(6):967-8

Department of Surgery, Lady Willingdon Hospital, Manali Kullu District, Himachal Pradesh 175 131 India.

In developing countries, when patients with traumatic epistaxis cannot be adequately treated at their local medical facility and require further treatment at a distant tertiary care center, it is important that bleeding be controlled before their transport. We describe a patient with a traumatic anterior ethmoidal artery bleed who needed to be taken to a tertiary care center 8 hours away for endoscopic ablation, which was not available at our hospital. The inflated balloon of an 18-Fr Foley catheter attached to the face guard of a cricket helmet was used as a posterior nasal pack. Read More

Acta Otolaryngol 2009 Feb;129(2):179-81

Department of Otolaryngology, Southmead Hospital, University of Bristol, Bristol, UK.

Conclusion: This pilot study did not show an advantage of the routine use of prophylactic antibiotics for spontaneous epistaxis treated by nasal packing.

Objective: The purpose of this study was to investigate the value of the use of prophylactic antibiotics in spontaneous epistaxis cases treated with anterior nasal packing.

Subjects And Methods: Over a period of 6 months, all cases of epistaxis managed with anterior nasal packing were studied prospectively. Read More

Curr Opin Otolaryngol Head Neck Surg 2007 Jun;15(3):180-3

Department of Surgery, University of Auckland, Auckland, New Zealand.

Purpose Of Review: The treatment of epistaxis has undergone significant changes in recent years. Gone are the days when patients had an uncomfortable posterior nasal pack inserted then spent several days on the ward only to bleed again on its removal. New packing devices, ingenious haemostatic agents and endoscopic surgical approaches have been developed to provide a variety of effective and well-tolerated treatment options. Read More

Rhinology 2005 Dec;43(4):305-8

Department of Otolaryngology, Royal Shrewsbury Hospital, Shrewsbury, United Kingdom.

Epistaxis is the commonest otolaryngological emergency, which is often managed by a nasal pack. A significant number of cases fail to respond to nasal packing and various surgical measures are available to control the nosebleed in these cases. However evidence is sparse regarding the best available surgical option for the management of persistent epistaxis. Read More

Clin Otolaryngol 2005 Aug;30(4):333-7

Department of Otolaryngology, Head and Neck Surgery, Blackburn Royal Infirmary, Lancashire, UK.

Objectives: A prospective non-blinded randomized controlled trial to compare the efficacy of Merocel and RapidRhino nasal packs in the treatment of anterior epistaxis.

Methods: Fifty-two consecutive participants admitted with anterior epistaxis refractory to digital pressure or nasal cautery were randomized to treatment using one or other of the nasal packs. Patients who required repacking because of continued bleeding, only the first packs were included in the analysis. Read More

Blood Coagul Fibrinolysis 2004 Jun;15(4):359-63

Department of Otolaryngology, Assaf Harofeh Medical Center, affiliated to the Sakler School of Medicine, Tel Aviv University, Israel and Israel National Hemophilia Center, Sheba Medical Center, Tel-Hashomer, Israel.

The purpose of the present study was to evaluate the haemostatic efficacy of fibrin sealant in patients with hereditary haemorrhagic telangiectasia (HHT) or Rendu-Osler-Weber disease suffering epistaxis. A retrospective observational study of patients with HHT who were admitted to an emergency room for anterior or posterior epistaxis during May 2000-March 2003. A total of 24 patients were evaluated, of whom 15 were managed with foam nasal packing during May 2000-March 2002 and another nine were treated during March 2002-March 2003 with 0. Read More

Rhinology 2003 Sep;41(3):182-3

Department of Otorhinolaryngology, Royal Liverpool University Hospital, Liverpool, United Kingdom.

Inadequate nasal packing in the treatment of posterior epistaxis can result in an increase in patient morbidity and mortality, and also hospital expenditure. The presence of a septal spur or septal deviation anterior to the bleeding may prevent sufficient local pressure over the bleeding point with a ribbon gauze pack. A modified Jobson-Horne probe can be used to ensure a tight ribbon gauze application over the bleeding point behind the septal spur or deviation. Read More

Arch Otolaryngol Head Neck Surg 2000 Sep;126(9):1130-4

Division of Otorhinolaryngology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong.

Objectives: To determine the action of the Foley catheter in the posterior nasal cavity in relation to balloon volume, and to deduce its implications in the treatment of posterior epistaxis.

Design: Human cadaveric study.

Materials: Twenty nasal fossae of 10 adult cadavers. Read More

Otolaryngol Head Neck Surg 1999 Oct;121(4):430-4

Centre for Research in Education, Department of Otolaryngology, Toronto Hospital, Ontario, Canada.

Epistaxis is a common problem faced by primary care physicians. Typically, first-hand experience with this problem is not obtained in medical school. A computer learning module was developed to address practical management of epistaxis. Read More

Otolaryngol Head Neck Surg 1999 Jun;120(6):865-8

Children's Hospital of Buffalo, Divisions of Otolaryngology, New York, USA.

A needs assessment was conducted to determine what family doctors need to know about otolaryngology. A survey was mailed to a group of community otolaryngologists and family doctors. They were asked to rate the importance of 46 otolaryngologic topics. Read More

Indian J Otolaryngol Head Neck Surg 1999 Jan;51(1):42-6

Dept. of E.N.T., Pravara Rural Medical College, Loni.

Bleeding per nose is one of the comnonest ailment encountered by each and every otolaryngologvst Since hemostasis is immediate concern, anterior nasal pressure pack is put and is usually allowed to remain for 24-72 hours. Blood soaked pack and raw mucosal surface are good media for bacterial multiplication resulting in infection including sinusitis and sometimes toxic shock syndromes.Present study is conducted to work out bacterial flora of anterior nasal pack and effect of svstemic antibiotics in controlling it. Read More

Laryngorhinootologie 1998 Feb;77(2):100-6

Klinik und Poliklinik für Otorhinolaryngologie, Hals- und Gesichtschirurgie, Universitätsspital Zürich.

Background: The purpose of this study was to analyze the therapy concept used in the management of severe epistaxis in order to optimize the quality of our treatment and to arrive at an optimal therapeutic concept.

Material And Methods: The study was performed as a retrospective analysis of the charts of all 335 patients treated as inpatients for epistaxis over a period of 6 years.

Results: An increased rate of complications was found in the following three situations: 1. Read More

Ann Emerg Med 1995 May;25(5):592-6

Department of Emergency Medicine, Akron City Hospital, Ohio, USA.

Study Objective: To describe the clinical features, evaluate the incidence of serious complications, and identify factors associated with rebleeding in adults with acute posterior epistaxis.

Design: Retrospective chart review.

Setting: University-affiliated community teaching hospital. Read More

Acta Otorrinolaringol Esp 1991 May-Jun;42(3):177-9

Clínica Universitaria de ORL, Hospital St. Elisabeth de Bochum.

Most cases of severe nasal bleeding are treated by anterior and posterior packing of the nose. The permanence of the packing makes necessary an antibiotic therapy and sedation of restless patients. Extraction of the packs may lead to new bleedings from original vessel, but also from granulation tissue which may grow onto the nasal pack. Read More

HNO 1986 May;34(5):208-15

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Read More

J Laryngol Otol 1983 Jul;97(7):599-604

Arterial blood samples were taken from adult healthy patients before and 24 hours after bilateral nasal packing. The blood samples were investigated for PO2, PCO2, HCO3, pH and Hb. It was found that there is (i) an increase of high significance of PCO2 and HCO3-, (ii)) a significant increase of percentage of Hb. Read More

Arch Otolaryngol 1977 Sep;103(9):521-3

Eustachian tube function was assessed by tympanometry in 47 patients (94 ears) with anterior nasal packing placed after nasal surgery and in 12 patients (24 ears) requiring anterior and posterior packing for epistaxis. Twenty-four of the 94 ears (25.5%) in patients with anterior packing exhibited reductions in middle ear pressure (greater than or equal to --100 mm H2O), whereas 12 of 13 ears (92. Read More