[Surgical versus non-surgical treatment of posterior epistaxis]

[Ligation of the sphenopalatine artery in posterior epistaxis. Retrospective study of 50 patients]

OBJECTIVES

The aim of this study was to evaluate the efficacy of endoscopic ligation of the sphenopalatine artery in the treatment of severe posterior epistaxis.

METHODS

We have carried out a retrospective study on 50 patients hospitalised with posterior recurrent epistaxis, in whom posterior nasal packing was not effective. All of them underwent surgical treatment, with endoscopic ligation of the sphenopalatine artery to control the epistaxis.

RESULTS

Only seven patients had a new epistaxis after surgery. One of them is being studied for some kind of coagulopathy, another patient was controlled by ligation of the anterior ethmoidal artery and it was necessary to ligate the contralateral sphenopalatine artery in a third patient. The other four patients were controlled with posterior nasal packing and discharged two days after surgery, without any complications.

CONCLUSIONS

We believe that endoscopic ligation of the sphenopalatine artery is a safe technique, with fewer complications than other methods such as posterior packing or embolisation.

[Nasal packing in posterior epistaxis. Comparison of two methods]

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). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects.

RESULTS

In patients with inflatable nasal packing its placement was significantly faster (36+/-19s vs. 228+/-102 s; p<0.001) and less painful (6.7+/-1.7 vs. 8.3+/-1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327+/-202 euro vs. 1648+/-318 euro; p<0.001) and it generated less short and long-term complications

CONCLUSIONS

The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing.

Clinical outcome of patients with epistaxis treated with nasal packing after hospital discharge

Epistaxis is a common clinical condition and in most public hospitals these patients received nasal packing and were admitted to the hospital as initial management strategies. However, little is known about the follow-up of these patients after they leave the hospital.

Aim

To identify the clinical outcome of patients treated for epistaxis following discharge.

Materials and Methods

We analyzed the results of questionnaires from patients hospitalized for non-traumatic epistaxis between March 2006 and March 2007.

Study design

Cohort longitudinal.

Results

Fifty-four of eighty-seven patients answered (62%). Epistaxis recurred in 37% of the patients. Of the patients who had recurrent bleeding, 70% were hypertensive, 35% were chronic users of acetylsalicylic acid, and 55% used tobacco. Forty per cent of the recurrences occurred in the first week after discharge, and fifty per cent needed to return to the emergency room. Seventy per cent of those who returned to the emergency room required a second treatment.

Conclusions

Recurrence after epistaxis treatment is common and may occur soon after the initial discharge. Although our sample was small, this data suggests the need for a reevaluation of the current treatment mode of patients with epistaxis in the emergency rooms of public hospitals.