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Background: The best initial strategy for managing epistaxis is unclear. We performed a systematic review and network meta‐analysis (NMA) to compare the effectiveness of various noninvasive treatments for patients with epistaxis. Methods: We searched PubMed, Embase, and the Cochrane Library from inception to September 2022 without language restrictions. Randomized controlled trials (RCTs) assessing immediate hemostasis, 2‐day and 7‐day rebleeding outcomes, as well as the use of noninvasive interventions for the treatment of epistaxis were selected. Frequentist NMA was performed. Results: The systematic review included 20 RCTs (2994 participants) involving 12 different interventions. The NMA demonstrated that topical treatment with tranexamic acid (TXA) significantly reduced the odds of 2‐day rebleeding compared with the control conservative treatment (odds ratio [OR] 0.36, 95% confidence interval [CI] 0.21–0.61) and traditional anterior nasal packing (OR 0.45, 95% CI 0.26–0.76). The sensitivity analysis yielded robust results, and the overall evidence was high. Topical TXA significantly reduced the odds of 7‐day rebleeding compared with traditional nasal packing (OR 0.33, 95% CI 0.15–0.70), with moderate evidence owing to the heterogeneous results. Despite the significant effects of topical TXA on achieving immediate hemostasis and Rapid Rhino nasal packing on preventing 2‐day rebleeding compared to the control and traditional nasal packing, the evidence is low to very low due to heterogeneity, inconsistency, and within‐study bias. Conclusions: In the treatment of epistaxis, topical TXA may be superior to conservative treatment or traditional nasal packing, particularly in preventing 2‐day rebleeding. [ABSTRACT FROM AUTHOR]

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Hemolacria is a rare complication of epistaxis treated with nasal compression or tamponade. We report the case of a man, aged 81 years, with end-stage renal disease who developed hemolacria after insertion of a "Rhino Rocket" nasal tamponade device to treat persistent epistaxis. The hemolacria resolved after treatment with intranasal oxymetazoline. In the setting of epistaxis with nasal tamponade, hemolacria is thought to be caused by retrograde flow from the inferior nasal turbinates via an anatomic connection with the lacrimal system, with passage through the valves of Hasner and Rosenmüller to the lacrimal ducts. Hemolacria is very rare even in severe cases of epistaxis; we postulate that only patients with either congenital absence or acquired incompetence of the lacrimal valves are predisposed to hemolacria after treatment of epistaxis with a tamponade device. Physicians should be aware that hemolacria in the setting of epistaxis is usually a self-limited condition that can be treated with conservative measures to control nasal hemorrhage. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We evaluated the efficacy of topical application of the injectable form of tranexamic acid (TXA) compared with anterior nasal packing (ANP) for the treatment of epistaxis in patients taking antiplatelet drugs (aspirin, clopidogrel, or both) who presented to the emergency department (ED). Methods: A randomized, parallel‐group clinical trial was conducted at two EDs. A total of 124 participants were randomized to receive topical TXA (500 mg in 5 mL) or ANP, 62 patients per group. The primary outcome was the proportion of patients in each group whose bleeding had stopped at 10 minutes. Secondary outcomes were the rebleeding rate at 24 hours and 1 week, ED length of stay (LOS), and patient satisfaction. Results: Within 10 minutes of treatment, bleeding was stopped in 73% of the patients in the TXA group, compared with 29% in the ANP group (difference = 44%, 95% confidence interval, 26% to 57%; p < 0.001). Additionally, rebleeding was reported in 5 and 10% of patients during the first 24 hours in the TXA and the ANP groups, respectively. At 1 week, 5% of patients in the TXA group and 21% of patients in the ANP group had experienced recurrent bleeding (p = 0.007). Patients in the TXA group reported higher satisfaction scores (median [interquartile range {IQR}], 9 [8–9.25]) compared with the ANP group (median [IQR] = 4 [3–5]; p < 0.001). Discharge from the ED in <2 hours was achieved in 97% of patients in the TXA group versus 13% in the ANP group (p < 0.001). There were no adverse events reported in either group. Conclusions: In our study population, epistaxis treatment with topical application of TXA resulted in faster bleeding cessation, less rebleeding at 1 week, shorter ED LOS, and higher patient satisfaction compared with ANP. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis. Methods: A prospective, randomized controlled trial was conducted on all adult patients consulted to the OHNS service at the tertiary referral centers of the University of Alberta Hospital and Royal Alexandra Hospital for persistent epistaxis. Patients were randomized to the Floseal® (Baxter, USA) or traditional packing study arms. Our main clinical outcome measures were: 1) Hemostasis directly following treatment and at 48 h post-treatment, and 2) self-reported patient comfort at 48 h post-treatment. Further, trial data was used for a formal cost-effectiveness analysis to determine incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis and uncertainty analysis were performed. Results: There were no significant differences between groups for initial hemostasis (76.9% vs. 84.6%, p = 1.000) or, hemostasis at 48 h (76.9% vs. 69.2%, p = 1.000), requirement for admission (15.4% vs. 46.1%, p = 0.2016) or 30-day re-presentation rates (15.4% vs. 46.1%, p = 0.2016). Floseal® (Baxter, USA) was superior for decreased pain during placement (2.42 vs. 7.77, p = 0.0022), treatment (0.50 vs. 4.46, p = 0.0007) and removal (0 vs. 3.85, p = 0.0021). Floseal® (Baxter, USA) provides an average $1567.61 per patient savings from the single-payer system point of view and has an ICER of - $11,891 per re-bleed prevented (95% CI: -$37,658 to +$473). Uncertainty analysis shows that Floseal® has >90% chance of not only being cost-effective, but the dominant (preferred) treatment. Conclusions: Floseal® (Baxter, USA) was demonstrated to be an effective, comfortable and cost-effective alternative treatment of persistent epistaxis when compared to traditional packing methods for patients referred to OHNS with a normal coagulation profile. Trial registration: Trial registration number: NCT02488135. Date registered: June 26, 2015. [ABSTRACT FROM AUTHOR]

Aim: This study reviews our clinical experience of patients with epistaxis and discusses proper management.Patients and Methods: We retrospectively investigated 1,515 patients with epistaxis treated in our department between 2005 and 2010.Results: Men over 50 years old predominated. More than half of the patients (n = 828) first visited after consultation hours, and 40% (n = 606) were brought by ambulance. The most common underlying diseases were circulatory diseases (69%, n = 1,047). Antithrombotics were being administered to 23% (n = 345). Kiesselbach's plexus was the most commonly observed bleeding site (51%, n = 769). In 20% (n = 297), no bleeding point was confirmed because hemostasis had been achieved on arrival. Anterior packing was the most common primary treatment, followed by electrocauterization. Hospitalization was required in 2% (n = 30). Re-bleeding occurred within 14 days after primary treatment in 14% (n = 206). Surgical treatment was performed for 5% (n = 11).Conclusions: Patients showing repeated pulsatile arterial bleeding require hospitalization for surgical therapy, although outpatient therapy is sufficient in most cases. A risk of re-bleeding should be considered if patients show unclarified bleeding points and circulatory diseases. [ABSTRACT FROM AUTHOR]

Objective: Epistaxis is the most frequent rhinologic emergency with a high treatment morbidity. This study assessed the long-term outcome after epistaxis treatment with regard to patient comfort during the treatment, long-term complications and rate of recurrences.Methods: A questionnaire cohort study was performed at the ENT department of the University Hospital Zurich. In April 2014, 363 patients were contacted, who were treated between March 2007 and April 2008 for the reason of epistaxis using a written questionnaire to elucidate the patients' condition after the treatment. The type of treatment, subjective discomfort as well as degree of pain, complications, permanent sequelae and recurrences were assessed.Results: 109 questionnaires were analyzed (response rate of 36%). The overall same-sided recurrence rate after successful treatment during the 6.4-year follow-up was 22%. Discomfort was reported in 48% after cautery, 86% after packing and in 11% after surgery. Strong or very strong pain was perceived in 8% after cautery, 26% after packing and in 0% after surgery alone. Complications consisted of nasal crusting in 15% after cautery and nasal breathing impairment in 24% after packing. Permanent harm was reported in 4% after cautery versus 20% after packing plus surgery.Conclusions: The data confirm the high rate of recurrences despite adequate treatment in the long-term analysis. The rate of post-treatment complications is considerably high with nasal crusting being the main inconvenience. It further shows that patients keep a vivid memory of the treatment even many years later and that packing is extremely uncomfortable to patients. [ABSTRACT FROM AUTHOR]

Background: Many treatment options exist for the management of anterior epistaxis. However, little is known about treatment outcomes. The objective was to identify the currently utilised methods of management and outcomes for patients with anterior epistaxis presenting to the emergency department (ED) at a Canadian tertiary care center. Methods: A retrospective review of ED visits from January 2012-May 2014 for adult patients with a diagnosis of anterior epistaxis was performed. Patient demographic data, comorbidities, and treatment methods were documented. The effectiveness of different treatment modalities was determined. Results: Three hundred fifty-three primary anterior epistaxis cases were included. Mean patient age was 70 years and 49 % of patients were female. Comorbidities included hypertension (56 %), diabetes (19 %), CAD (28 %), and atrial fibrillation (27 %). A large proportion of the cohort (61 %) was on at least one anticoagulant or antiplatelet therapy. The most common utilised treatment modalities were silver nitrate cauterization, Merocel®, petroleum gauze packing, nasal clip and 15 % were simply observed. Initial treatment success was achieved in 74 % of cases. Of patients receiving specific treatment modalities, silver nitrate cauterization had the highest success rate at 80 %. 26 % of patients returned to the ED for recurrence of epistaxis with highest rates occurring in the nasal clip (59 %), Merocel® (26 %), and petroleum gauze packing (42 %) groups. Conclusions: The differences in recurrence rate among the different treatment modalities observed may be due to true differences in effectiveness or differences in treatment selection by the ED physicians based on severity of epistaxis. Cauterization with silver nitrate, however, offers the added benefit of no need for follow up. Further study is needed to elucidate the most efficacious treatment modality based on epistaxis severity. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the histopathological impact, effectiveness, and safety of two hemostatic agents, Ankaferd Blood Stopper (ABS) and microporous polysaccharide hemospheres (MPH), in an experimental rabbit epistaxis model. Rabbits were randomly assigned, using a computerized random number generator, to the following three groups of six animals: group 1 (control, irrigated with saline); group 2 (ABS-treated); and group 3 (MPH-treated). In all groups, a standardized rabbit epistaxis model was used. Hemostasis time and extent of nasal bleeding were measured to compare the hemostatic effect of ABS and MPH among groups. Septums were removed for histopathological analysis, 7 days after the procedure. ABS reduced hemostasis time to 104.2 s and amount of bleeding to 20.5 mg. MPH reduced hemostasis time to 71.7 s and amount of bleeding to 11.5 mg. Mean bleeding time in wounds administered ABS and MPH was significantly shorter compared with wounds administered isotonic saline solution ( p = 0.004). ABS and MPH application decreased bleeding significantly compared with the control group ( p = 0.004). Bleeding time and amount in the MPH group was significantly reduced compared with the ABS group ( p = 0.013 and p = 0.004, respectively). There was no significant difference in the histopathological evaluation results between the ABS, MPH, and control groups. Our data indicate that both ABS and MPH represent safe, effective, and fast-acting hemostatic agents in the management of epistaxis. MPH was more effective than ABS in terms of hemostasis time and amount of bleeding. [ABSTRACT FROM AUTHOR]

The article focuses on the study related to topical tranexamic acid as compared to anterior nasal packing for the treatment of epistaxis in patients having antiplatelet drugs. It mentions that epistaxis is a common complaint presented in the emergency department (ED), with a variety of management options including pressure, vasoconstricting medications and cautery.

Background:FloSeal, a locally applied haemostatic agent, has been shown to be effective in a variety of clinical situations. This study investigated its potential benefits in the management of epistaxis.Methods:The outcomes of a series of patients with epistaxis presenting to one ENT unit, over a two-month period, were compared. Patients were either treated with FloSeal or traditional epistaxis management techniques. Success of FloSeal was classed as complete haemostasis after its application, without the need for further interventions and no readmission with epistaxis within 7 days.Results:Our study comprised 101 adults, with a mean age of 70 years (range, 22–98 years). The overall success rate for FloSeal was 14 per cent (5 out of 36 cases). It was successful in 66 per cent of anterior epistaxis cases (2 out of 3) and in only 9 per cent of posterior epistaxis cases (3 out of 33). There was a significantly higher failure rate of FloSeal compared with nasal packing in posterior epistaxis (p < 0.001).Conclusion:Our findings suggest that FloSeal has a limited role in the management of epistaxis. [ABSTRACT FROM PUBLISHER]

Background:The use of cold nasal packs on the nose and nape of the neck is currently recommended for patients with epistaxis as this is thought to induce reflex nasal vasoconstriction, which decreases the bleeding. There have been a few investigations on the effect of cold compress application to the nose, but none of these focused specifically on nasal cooling of the skin of the nose.Methods:Acoustic rhinometry was performed to obtain baseline measurements. Nasal dorsal skin was then cooled with two ice packs that were held on the left and right side of the nose for a total of 10 minutes by the subjects. The rhinometry measurements were taken at the time of initial application (baseline), and after 5 and 10 minutes of ice pack application.Results:Comparisons of the first and second minimal cross-sectional area values, and total nasal cavity volume measurements revealed no statistical differences.Conclusion:The results of this study indicate that one should be sceptical about the efficiency of cold compress application, which is frequently used in clinical practice in cases with epistaxis. [ABSTRACT FROM PUBLISHER]

Objective:To assess management of epistaxis at a tertiary ENT referral hospital against a recently published standard of best practice.Methods:Fifty consecutive cases of acute epistaxis that required admission to Guy's Hospital in 2009 were evaluated. Epistaxis education sessions were held to introduce our algorithm of best practice in tandem with an emphasis on emergency department care. Similar retrospective reviews were carried out in both 2010 and 2011 (on groups of 50 patients).Results and conclusion:The first audit cycle demonstrated that only 8 per cent of patients underwent a suitable nasal examination in the emergency department prior to transfer, with no documented attempts at nasal cautery. Surgical intervention procedures were performed on only 40 per cent of eligible patients. The audit cycles that followed the introduction of the epistaxis algorithm demonstrated continued improvement in initial evaluation and management of epistaxis. In select patients, sphenopalatine artery ligation can provide timely, definitive management of refractory epistaxis. [ABSTRACT FROM PUBLISHER]

Conclusions: In contrast to the current trend according to which the treatment of hereditary hemorrhagic telangiectasia (HHT) epistaxis depends on clinical severity, argon plasma coagulation (APC) has also proven to be effective as a first-line procedure in patients with severe nosebleeds. Furthermore, with this approach patients are free from requirements for blood transfusions for a long time in the vast majority of cases. Objective: The aim of this study was to test the efficacy of APC treatment as a first-line procedure in HHT patients affected by severe epistaxis. Methods: From 1996 until 2011, 252 HHT patients were treated with APC in our clinic. We selected 26 patients with severe epistaxis for whom the need for blood transfusion had been recorded. This group of patients was asked to answer a questionnaire that aimed to evaluate the severity of epistaxis (defined by its intensity, frequency, and duration), to assess the duration of the benefit of treatment and to evaluate the number of blood transfusions required before and after treatment. Results: After APC treatment, a statistically significant decrease in all epistaxis parameters was recorded and most patients did not need blood transfusions for several years after the procedure. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Many methods are included in the treatment of intractable epistaxis including selective embolization. We report our experience with 10 patients treated with this technique. Patients and methods: Ten patients with posterior idiopathic epistaxis were selected in this study. They were managed by double-balloon device followed by embolization. Results: Study included six males and four females, their age ranged from 49 to 66years (mean 56years). Four patients were hypertensive, two were smokers. Epistaxis was unilateral in six patients and bilateral in four. Six internal maxillary and eight sphenopalatine arteries were embolized with polyvinyl alcohol 150–250μm. Bleeding stopped in all patients after procedure. One patient had recurrent attack 2months later for whom re-embolization successfully stopped bleeding. No major complications encountered but minor complications occurred in two patients (one severe headache and one transient left temporofacial pain). Conclusion: Selective embolization is a clinically effective treatment for severe refractory posterior epistaxis. By this method we can avoid the complications of repeated packs and surgery especially in elderly patients. [Copyright &y& Elsevier]

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. [ABSTRACT FROM PUBLISHER]

Objective:To evaluate endoscopic cauterisation of the sphenopalatine neurovascular bundle, as treatment for intractable posterior epistaxis, with regard to efficacy, safety and post-operative sequelae.Patients and methods:A prospective study reviewed 42 patients with severe posterior epistaxis who were treated with endoscopic cauterisation of the sphenopalatine neurovascular bundle, over a 17-month period.Results:Hypertension and hepatic disease were present as predisposing factors in 66.7 and 35.7 per cent of patients, respectively. Branching of the sphenopalatine artery at its foramen was present in more than 85 per cent of patients. The success rate was 100 per cent, with no recurrent epistaxis in the follow-up period. Severe nasal dryness was present in only four patients (9.5 per cent); hypoaesthesia was found in the nasal mucosa of eight patients, without any patient complaints.Conclusion:Endoscopic sphenopalatine neurovascular bundle cauterisation is an effective treatment for refractory posterior epistaxis. In this study, neurovascular bundle cauterisation did not cause any neurological deficits or major complications. [ABSTRACT FROM PUBLISHER]

Objective:To propose radiofrequency coblation as a potential treatment modality for mild to moderate epistaxis in patients with hereditary haemorrhagic telangiectasia.Method:Case reports and review of the world literature concerning coblation and other treatment modalities for epistaxis in patients with hereditary haemorrhagic telangiectasia.Results:Effective epistaxis control was achieved in four out of five cases of hereditary haemorrhagic telangiectasia. In the fifth case, we struggled to achieve haemostasis due to disease severity.Conclusion:Radiofrequency coblation is a novel technique, which was found to be a safe, effective, quick and well tolerated treatment option for epistaxis management in patients with hereditary haemorrhagic telangiectasia. [ABSTRACT FROM PUBLISHER]

The management of intractable posterior epistaxis is challenging for any physician. Nasal packing, often combined with use of an endonasal balloon system, is painful for the patient, and torturous to maintain for two to three days. If conservative treatment fails, the most commonly used treatment options are currently invasive procedures such as endoscopic coagulation of bleeding arteries, external ligation and, rarely, embolisation. This paper describes a simple, non-invasive technique of treating posterior epistaxis with hot water irrigation. Technical information is presented, and the benefits of the method are discussed. [ABSTRACT FROM PUBLISHER]

Hereditary haemorrhagic telangiectasia (HHT) is a multisystemic vascular dysplasia that leads to nosebleeds, anaemia due to blood loss, and arteriovenous malformations (AVMs) in organs such as the lungs, liver and brain. HHT is estimated to affect 85,000 European citizens, but most health care providers have limited prior HHT exposure or training.Outcome Measures were developed and implemented by the HHT Working Group of the European Reference Network for Rare Vascular Diseases (VASCERN), in order to maximise the number of patients receiving good care. The measures specifically target areas where optimal management reduces morbidity and mortality in HHT patients, and were designed to be robust to emerging new evidence. Thresholds are the percentage of patients in particular settings who have been recommended screening, or provided with written advice. The 5 Outcome Measures cover (1) pulmonary AVM screening; (2) written nosebleed advice, (3) assessment of iron deficiency; (4) antibiotic prophylaxis prior to dental and surgical procedures for patients with pulmonary AVMs, and (5) written advice on pregnancy. They are not a blueprint for detailed HHT management, but are suitable for all clinicians to be aware of and implement.In summary, these 5 Outcome Measures provide metrics to identify healthcare providers of good care, and encourage care improvement by all healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Patients with a ventricular assist device (VAD) are at risk for epistaxis due to the need for anticoagulation. Additionally, these patients develop acquired von Willebrand syndrome (AvWS) due to these devices. Management is complicated by the risk of thrombosis if anticoagulation is reversed. This study sought to characterize the clinical features and management of epistaxis in this high-risk population. Methods: Retrospective review of adults with VAD and epistaxis necessitating inpatient consultation with the otolaryngology service were included. Results: 49 patients met inclusion criteria. All patients had a presumed diagnosis of AvWS. An elevated INR (> 2.0) was present in 18 patients (36.7%). Anticoagulation was held in 14 (28.6%) patients, though active correction was not necessary. Multiple encounters were required in 16 (32.7%) patients. Spontaneous epistaxis was associated with multiple encounters ( p = 0.02). The use of hemostatic material was associated with a lower likelihood of bleeding recurrence ( p = 0.05), whereas cauterization with silver nitrate alone was associated with a higher likelihood of re-intervention (p = 0.05). Surgery or embolization was not required urgently for any patient. Endoscopy under general anesthesia was performed for one patient electively. Mean follow up time was 16.6 months (σ = 6.3). At six months, 18 (36.7%) patients were deceased. Conclusion: While these patients are at risk for recurrent spontaneous epistaxis, nonsurgical treatment without active correction of INR or AvWS was largely successful. Placement of hemostatic material, as opposed to cautery with silver nitrate, should be considered as a first-line treatment in this group. Multidisciplinary collaboration is critical for successful management. [ABSTRACT FROM AUTHOR]

Abstract: Epistaxis is frequently managed both by patients in the community and by health professionals. Many methods have been described in the literature about how to manage this condition. Epistaxis is usually due to anterior circulation bleeding at an area known as Kiesselbach's plexus (Little's area). Five vessels supply Little's area; one of these, the septal branch of the superior labial artery, can be compressed via an easy and novel technique, sub-labial packing. Sub-labial packing is a technique proposed as an adjunct to the standard 15min ala nasi compression as a simple yet effective technique to stop epistaxis. We hereby report two cases of managing epistaxis from Little's area using sub-labial packing. [Copyright &y& Elsevier]

Epistaxis is a common emergency seen by the otolaryngologist. A minority of cases require surgical intervention. Multiple surgical procedures have been tried in the past, including endoscopic ligation of the sphenopalatine artery (ELSPA), which is considered an effective surgical modality in the management of epistaxis. This study examines the outcome of 33 ELSPA procedures over a 5-year period. Three of 4 cases that were not controlled with ELSPA were successfully managed with subsequent anterior ethmoidal ligation. Failed ELSPA procedures may represent an incorrect choice of procedure rather than a failure of the procedure. High-resolution computed tomography can identify the position of the anterior ethmoidal artery; it may be possible to infer vulnerability to hemorrhage from this artery and hence target procedure selection. [ABSTRACT FROM AUTHOR]

A bibliography of previously published content is presented which includes the articles "ENT morbidity at high altitude" by B. K. Prasad, "Rapid Rhino versus Merocel nasal packs in septal surgery" by A. Hesham and A. Ghali, and "Thyroid lymphoma: acute presentation and long-term outcome" by S. E. Penney and J. J. Homer.