Management of idiopathic epistaxis in adults: what’s new?

Meccariello, Giuseppe; Georgalas, Christos; Montevecchi, Filippo; Cammaroto, Giovanni; Gobbi, Riccardo Gomes; Firinu, Elisabetta; Vito, Andrea De; Vicini, Claudio

doi:10.14639/0392-100x-2155

Cited by 22 publications

(19 citation statements)

References 30 publications

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“… 10 Cauterization as a treatment option is more viable if the source of bleeding can be identified, and provides economic advantages compared to the cost of nasal packing. 2 , 10 , 11 Cauterization should be used if the location of the bleed can be identified in cases of anterior epistaxis. 12 If the bleeding site is not identified or cauterization is not available, nasal packing is required, which leads to them being closely related in the clinical care pathway.…”

Section: Resultsmentioning

confidence: 99%

“… 10 Absorbable packing can be used in both anterior and posterior epistaxis, though it is more typically involved in anterior epistaxis. 2 …”

Section: Resultsmentioning

confidence: 99%

“… 1 Bleeding from the Kiesselbach’s plexus (anterior epistaxis) accounts for around 80% of all cases. 2 Causes of epistaxis include nose picking (trauma), temperature change, allergic rhinitis, specific medications such as (anticoagulation), and idiopathic sources. 3 …”

Section: Introductionmentioning

confidence: 99%

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Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Tran¹,

Barnett²,

O’Connell³

et al. 2021

OAEM

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We performed a narrative review of epistaxis management in the emergency department. First, we examined the pathophysiology, the current types of treatment that are available to emergency clinicians. When nasal packing is indicated, we examined the efficacy of nasal packing in addition to other topical treatment such as tranexamic acid and the evidence of prophylactic antibiotics. We detailed current studies involving tranexamic acid and prophylactic antibiotics for nasal packing. Finally, we introduced an epistaxis clinical care pathway, based on current evidence, to aid emergency clinicians with their clinical decision-making processes.

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Section: Resultsmentioning

confidence: 99%

“… 10 Absorbable packing can be used in both anterior and posterior epistaxis, though it is more typically involved in anterior epistaxis. 2 …”

Section: Resultsmentioning

confidence: 99%

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Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Tran¹,

Barnett²,

O’Connell³

et al. 2021

OAEM

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“…This forms an eschar that obstructs and scleroses blood vessels [ 9 ]. Prior studies have shown that failure rates of silver nitrate can be quite high, ranging from 16% to 26% [ 10 , 11 ]. No serious adverse effects have been associated with nasal silver nitrate cautery, but pain is often reported [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Topical Silver Nitrate for Control of Post-tonsillectomy Hemorrhage

Rohe¹,

Gresham²,

Rohde³

et al. 2022

Cureus

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Management of patients with post-tonsillectomy hemorrhage (PTH) is not well defined but may include observation, topical bedside treatments, or return to the operating room. Data on the use and efficacy of silver nitrate as a topical bedside agent for the management of PTH remain unexplored. Our primary objective was to assess the efficacy of silver nitrate in reducing the need for operative control of PTH. MethodsSingle-institution retrospective chart review included patients aged 5-18 years who presented with tonsillar bleeding within 30 days of tonsillectomy. Patients undergoing observation or bedside silver nitrate cautery were compared based on clinical characteristics and experience of the physician performing the procedure. The outcome of interest was rebleeding requiring operative control. Sample characteristics according to treatment modality were described using Fisher's exact tests and ANOVA. ResultsOf the patients eligible for inclusion, 29 (20%) were observed and 70 (48.3%) were treated with topical silver nitrate. Age was the only statistically significant clinical difference among treatment groups. The silver nitrate group had more patients who underwent operative control of PTH compared to the observation group (p = 0.004). When comparing the need for operative control between the observation group and patients who had initial success with silver nitrate, there was no difference (p = 0.29). No differences were found in the rate of bleeding requiring operative control when comparing experience of the physician performing the procedure (p = 0.20). ConclusionMore patients who underwent silver nitrate cautery required PTH control in the operating room compared to the observation group. This may be due to patient selection as our results also suggest that there is no statistical difference in rates of operative control of PTH when comparing initial successful treatment with topical silver nitrate to observation. Age is likely a factor that was used by physicians in this study to decide the initial management of PTH. Provider experience does not appear to affect rebleeding rates. Future studies are necessary to evaluate the clinical impact of silver nitrate in the context of PTH and will benefit from more robust sample sizes and enhanced diversity in the sample group.

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“…However, there are some cases of recurrent epistaxis where the bleeding site is deep and difficult to manage (12,13) . In line with recent uprising in endoscopic nasality sinus surgery, endoscopic cauterization of the sphenopalatine artery is now used for posterior epistaxis (14) . Therefore, the current study aimed to evaluate the efficacy of this surgical procedure for a group of patients suffering from idiopathic refractory posterior epistaxis.…”

Section: Introductionmentioning

confidence: 99%

Competence of Cauterization of Sphenopalatine Artery for Idiopathic Refractory Posterior Epistaxis

Faiq

Ghareeb²

2022

The Egyptian Journal of Hospital Medicine

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Background: Refractory posterior epistaxis requires cautery of sphenopalatine artery.Objective: This study aimed to estimate the efficiency of cautery the sphenoid artery and to observe postoperative complications. Patients and methods: This prospective study was conducted on 200 adult patients with posterior epistaxis at a private hospital and clinic in Kirkuk, northern Iraq, from the period from February 2019 to September 2021.The nasal cavity of each participant was carefully examined endoscopically to find out the location of the bleeding, and then determine the necessity of surgical intervention. Results: A total of 200 cases of epistaxis were included, posterior epistaxis accounted for 12 (6%) of all epistaxis cases, and required cauterization of the sphenoid artery. According to the results, the success rate of all surgical cases was complete, as no serious complications were observed intra and post endoscopic cauterization, except for one case of numbness of the palate, which gradually disappeared during the first three months after the operation. Conclusions: Good success can be achieved by cautery of the sphenopalatine artery and it can be considered as the first-line for idiopathic posterior epistaxis.

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Management of idiopathic epistaxis in adults: what’s new?

Cited by 22 publications

References 30 publications

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Nasal Packing in the Emergency Department: A Practical Review for Emergency Providers

Efficacy of Topical Silver Nitrate for Control of Post-tonsillectomy Hemorrhage

Competence of Cauterization of Sphenopalatine Artery for Idiopathic Refractory Posterior Epistaxis

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