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Management of intractable epistaxis: endoscopy or nasal packing?

Published online by Cambridge University Press:  01 March 2012

Y Liu ,
C Zheng ,
W Wei  and
Q Liu
Y Liu
Affiliation:
Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
C Zheng*
Affiliation:
Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
W Wei
Affiliation:
Department of Otolaryngology, Huadong Hospital, Fudan University, Shanghai, China
Q Liu
Affiliation:
Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China
*
Address for correspondence: Dr Chunquan Zheng, Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, 83 Fen Yang Road, Shanghai 200031, China Fax: +86 21 64377151, E-mail: zhengdoctor96@yahoo.com.cn
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Abstract

Objectives:

To investigate common origins of intractable epistaxis, and the efficacy of endoscopic management.

Methods:

Retrospective study of 265 patients with uncontrolled idiopathic epistaxis presenting between July 2008 and July 2009. Patients underwent endoscopic examination and subsequent radiofrequency electrocautery, selective packing or observation.

Results:

Nasal endoscopy indicated that the commonest bleeding sources were the superior nasal septum at the olfactory cleft (39.2 per cent), the inferior meatus (27.5 per cent), the sphenoethmoid recess (6.0 per cent), the middle meatus (5.3 per cent) and other locations (3.4 per cent). Bleeding was successfully controlled with nasal endoscopy plus radiofrequency electrocautery or selective packing. In 49 (18.5 per cent) patients, no abnormality was identified; these patients received observation only, and no further bleeding occurred. None of the patients had serious complications or recurrent epistaxis during the three-month follow-up period.

Conclusion:

Thorough endoscopic examination combined with radiofrequency electrocautery should be used as first-line therapy for intractable epistaxis.

Keywords

EpistaxisEndoscopic Surgical ProceduresAnatomyPathology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 5 , May 2012 , pp. 482 - 486
Copyright
Copyright © JLO (1984) Limited 2012

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References

1Moñux, A, Tomás, M, Kaiser, C, Gavilán, J. Conservative management of epistaxis. J Laryngol Otol 1990;104:868–70CrossRefGoogle ScholarPubMed
2Sengupta, A, Maity, K, Ghosh, D, Basak, B, Das, SK, Basu, D. A study on role of nasal endoscopy for diagnosis and management of epistaxis. J Indian Med Assoc 2010;108:597–8, 600–1Google Scholar
3McGarry, GW. Nasal endoscope in posterior epistaxis: a preliminary evaluation. J Laryngol Otol 1991;105:428–31CrossRefGoogle ScholarPubMed
4Thornton, MA, Mahesh, BN, Lang, J. Posterior epistaxis: identification of common bleeding sites. Laryngoscope 2005;115:588–90CrossRefGoogle ScholarPubMed
5Chiu, TW, Shaw Dunn, J. Pressure injection demonstrates points of weakness in the posterior nasal arteries. J Laryngol Otol 2010;124:750–2CrossRefGoogle ScholarPubMed
6Hara, MJ. Severe epistaxis. Arch Otolaryngol 1962;75:258–69CrossRefGoogle ScholarPubMed
7Yang, DZ, Cheng, JN, Han, J, Shu, P, Zhang, H. Management of intractable epistaxis and bleeding points localization. Chin J Otorhinolaryngol Head Neck Surg 2005;40:360–2Google ScholarPubMed
8Rotenberg, B, Tam, S. Respiratory complications from nasal packing: systematic review. J Otolaryngol Head Neck Surg 2010;39:606–14Google ScholarPubMed
9Floreani, SR, Nair, SB, Switajewski, MC, Wormald, PJ. Endoscopic anterior ethmoidal artery ligation: a cadaver study. Laryngoscope 2006;116:1263–7CrossRefGoogle ScholarPubMed
10Douglas, R, Wormald, PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg 2007;15:180–3CrossRefGoogle ScholarPubMed
11Fukutsuji, K, Nishiike, S, Aihara, T, Uno, M, Harada, T, Gyoten, M et al. Superselective angiographic embolization for intractable epistaxis. Acta Otolaryngol 2008;128:556–60CrossRefGoogle ScholarPubMed
12Christensen, NP, Smith, DS, Barnwell, SL, Wax, MK. Arterial embolization in the management of posterior epistaxis. Otol Head Neck Surg 2005;133:748–53CrossRefGoogle ScholarPubMed
13Nouraei, SA, Maani, T, Hajioff, D, Saleh, HA, Mackay, IS. Outcome of endoscopic sphenopalatine artery occlusion for intractable epistaxis: a 10-year experience. Laryngoscope 2007;117:1452–6CrossRefGoogle Scholar