Aim: To compare the precision and efficacy of endoscopic control versus nasal packing in epistaxis presenting to the emergency room.Design: Open labelled randomized controlled trial for comparison of precision and efficacy of emergency blind nasal packing with primary endoscopic control of epistaxis.Subjects: A total of 160 consecutive patients of epistaxis in the age group of 40 to 70 years were randomized in two groups (A and B) of 80 patients each. Group A was subjected to blind nasal packing and group B to endoscopic procedure. About 48 (30%) patients were alcoholic, 64 (40%) were hypertensive and 48 (30%) patients did not have any overt predisposing factor. Bleeding time, clotting time, prothrombin time, partial thromboplastin time and international normalized ratio (INR) were done in all patients to rule out coagulation diseases. Results:The nasal pack of patients in group A was removed after 48 hours. The nose was endoscopically examined on 3rd day, 7th day and then 1 month after the epistaxis. A total of 44 (55%) patients of group A had nasal mucosal abrasions (p < 0.05), two (2.5%) patients had secretory otitis media (p > 0.05) and 10 (12.5%) had synechiae formation (p > 0.05). A total of 28 (35%) patients from group A had one episode of rebleed after nasal pack removal. Group B had no complications.Conclusion: Epistaxis presenting to the emergency room can be precisely and effectively controlled endoscopically. Clumsy nasal packing, complications and subsequent hospitalization costs are thereby reduced.