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J Am Assoc Nurse Pract 2021 01 8;33(11):1024-1029. 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

Anesth Prog 2019 ;66(4):211-217

Department of Dental Anesthesiology and Pain Management, Tohoku University Hospital, Sendai, Japan.

Epistaxis is one of the most common complications of nasotracheal intubation and can be life-threatening. However, there is little discussion in the current literature on the acute management of massive epistaxis after nasotracheal extubation. This is a report of 2 patients who experienced severe unanticipated nasal bleeding immediately after extubation, 1 after a surgical procedure for oral cancer and another after restorative dental treatment. 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

Wilderness Environ Med 2016 Sep 26;27(3):393-6. Epub 2016 Jul 26.

Department of Otolaryngology-Head & Neck Surgery, Columbus Regional Health, Columbus, IN.

Posterior epistaxis is a serious condition that can be difficult to treat in a wilderness setting. The initial standard of care involves packing the affected nostril with a 7 to 9 cm nasal pack to tamponade the bleed. These packs are often unavailable outside of the emergency or operating room. Read More

Pak J Med Sci 2015 Nov-Dec;31(6):1361-5

Shi-Ming Chen, Department of Otolaryngology Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.

Objective: To investigate the clinical features of epistaxis in the posterior fornix of the inferior nasal meatus and compare the treatment outcomes of endoscopic surgery and conventional nasal packing for this intractable form of epistaxis.

Methods: Between August 2011 and August 2014, the medical records of 53 adult patients with idiopathic epistaxis in the posterior fornix of the inferior nasal meatus diagnosed by nasal endoscopy were obtained from our department. Of these, 38 patients underwent endoscopic surgery (surgery group) and 15 received a nasal pack (packing group). 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

CJEM 2013 Jul;15(4):241-8

Objective: This study sought to establish the current state of procedural skills training in Canadian Royal College emergency medicine (EM) residencies.

Methods: A national Web-based survey was administered to residents and program directors of all 13 Canadian-accredited Royal College EM residency programs. Program directors rated the importance and experience required for competence of 45 EM procedural skills. 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

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

J Otolaryngol Head Neck Surg 2011 Jun;40(3):249-55

Department of Otolaryngology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON.

Objective: To describe current management of posterior epistaxis among Canadian otolaryngology-head and neck surgeons.

Methods: A cross-sectional Internet-based survey was distributed to all 550 members of the Canadian Society of Otolaryngology-Head and Neck Surgery with an electronic mail contact. The survey consisted of three sections: (1) demographic data, (2) opinions regarding management options for posterior epistaxis, and (3) opinions regarding management of complications after placement of a posterior nasal pack. Read More

Am J Rhinol Allergy 2011 May-Jun;25(3):188-92. Epub 2011 Jan 28.

Department of Otolaryngology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou PR China.

Background: This study was designed to investigate the role of endoscopic surgery for acquired choanal atresia after radiotherapy for nasopharyngeal carcinoma.

Methods: Twenty-two patients with bilateral or unilateral acquired choanal atresia received transnasal endoscopic surgery with the aid of a powered microdebrider to open atresia choana and received endoscopic sinus surgery simultaneously if they had sinusitis. Merocel epistaxis packing was used to pack the nasal airway for 3 days postoperatively. 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

Acta Otorrinolaringol Esp 2010 May-Jun;61(3):196-201. Epub 2010 Feb 6.

Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España.

Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis.

Patients And Methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). Read More

Ann R Coll Surg Engl 2009 Nov;91(8):713-4

Department of Otolaryngology, Derbyshire Royal Infirmary, Derby DE1 2NS, 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

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

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

J Laryngol Otol 1999 Jun;113(6):561-3

Department of ENT, Royal Hallamshire Hospital, Sheffield, UK.

A seven-year-old child sustained a fracture of her basisphenoid resulting in profuse, life-threatening haemorrhage which could not be controlled with a post-nasal pack. The fracture site was identified using rigid endoscopy and packed with oxidized cellulose, resulting in immediate control of the haemorrhage. The use of the nasal endoscope in the management of posterior epistaxis is discussed. 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

Laryngol Rhinol Otol (Stuttg) 1979 Apr;58(4):336-9

233 cases with posterior nasal pack are compared, two third being treated with Foley catheter technique. Using the Bellocq technique there are 47% of bleeding at intervals and 9% of bleeding while using the Foley catheter. Local and general complications are 3. Read More

Arch Otorhinolaryngol 1978 Nov;219(2):473-5

233 cases with posterior nasal pack are compared, two third being treated with Foley catheter technique. Using the Bellocq technique there are 47% of bleeding at intervals and 9% of bleeding while using the Foley catheter. Local and general complications are 3. 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

AMA Arch Otolaryngol 1951 Nov;54(5):558-9