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Objective: A previous study in 2016 found that the quality of YouTube videos on epistaxis first-aid management was highly variable. This study aimed to reassess the accuracy and patient understandability of such YouTube videos. Method: YouTube was searched using the phrase 'How to stop a nosebleed'. The highest 50 ranking videos, based on relevance, were screened. Each video was assessed objectively using a standardised 'advice score', and subjectively using a video understandability and actionability checklist, the Patient Education Materials Assessment Tool for Audiovisual Materials ('PEMAT-A/V'). Results: The mean advice score was 4.1 out of 8. The mean (standard deviation) understandability and actionability scores were 76 per cent (17 per cent) and 89 per cent (18 per cent), respectively. There was a strong positive correlation between the actionability scores and the advice scores (ρ = 0.634; p < 0.001), and between the actionability scores and the understandability scores (ρ = 0.519; p = 0.002). Conclusion: YouTube videos are providing increasingly relevant advice for patients seeking healthcare information. YouTube is proposed as a useful medium for teaching epistaxis management to patients and community practitioners. [ABSTRACT FROM AUTHOR]

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]

Background: Epistaxis can be life-threatening. Simple first aid management can stem bleeding. This study compared knowledge of first aid management methods of epistaxis between the general public and healthcare workers. Method: A cross-sectional study of 100 healthcare workers and 103 adult members of the public was conducted at a large London teaching hospital. Respondents completed a survey assessing knowledge on nasal pinching site, head tilt and appropriate adjunct treatment use for first aid management of epistaxis. Results: Twenty-four per cent and 68 per cent of healthcare workers compared with 25.2 per cent and 37.9 per cent of the public answered correctly on nasal pinching position and head tilt position, respectively, with a statistical difference for head tilt position. Two per cent, 2 per cent and 24 per cent of healthcare workers mentioned ice use on the nose, ice use in the mouth or ice use but not site, respectively, compared with 0 per cent, 0 per cent and 4.9 per cent of the public, with a statistical difference for ice without site. Conclusion: Healthcare workers and the public lack knowledge on first aid management of epistaxis. Improved education on first aid management is required, targeting healthcare workers and the public. [ABSTRACT FROM AUTHOR]

Copyright of ScienceRise: Medical Science is the property of PC TECHNOLOGY CENTER and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article delves into the challenges faced by junior doctors in otolaryngology, highlighting a study from Cardiff revealing a lack of preparedness among new ENT juniors. It also discusses a study on vestibular schwannoma patients' handicaps over time and compares two nasal packs for epistaxis control, along with a recommendation for rigid endoscopy in young children with obstructive sleep apnoea.

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment. [ABSTRACT FROM AUTHOR]

Copyright of Praxis of Otorhinolaryngology / Kulak Burun Boğaz Uygulamaları is the property of Official Journal of ENT-HNS Society of Istanbul and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis. Methods: Anonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013. Results: Epistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups. Conclusion: The outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 65-year-old man presents to the emergency department with a 2-hour history of epistaxis has hypertension and atrial fibrillation and takes amlodipine, hydrochlorothiazide, and warfarin. Topics include the nose is well vascularized with arteries that originate from branches of the internal carotid and external carotid arteries, and the management of this condition is straightforward in most cases but can be difficult in patients with cardiovascular disease.

Objectives: To quantify the utilization of epistaxis procedures in the elderly population and assess whether the geographic variability of these procedures is associated with hypertension and direct oral anticoagulant (DOAC) use. Methods: A cross-sectional study was performed on publicly available Medicare procedure and beneficiary data from 2013 to 2016 for all epistaxis procedures categorized by Common Procedural Terminology (CPT). Epistaxis procedures were analyzed by state, complexity, and provider type. Pearson's correlation coefficient was calculated. Results: Over 4 years, 2 19 827 epistaxis procedures were performed on Medicare patients, 44.3% of which were categorized as simple (control of nasal hemorrhage: anterior simple or posterior primary). Otolaryngologists performed 92.6% of all epistaxis procedures. The frequency of epistaxis procedures performed by state ranged from 0.99 procedures per 10 000 Medicare beneficiaries (PP10K) in Hawaii to 25.7 PP10K in New Jersey. The percentage of epistaxis interventions categorized as complex (anterior complex, posterior subsequent, with nasal endoscopy, or open procedures) in each state varied from 0% in North Dakota to 72.6% in Hawaii. Epistaxis procedure utilization was weakly correlated with the prevalence of hypertension (R 2 = 0.08, P =.04) and higher percentage of DOAC among all anticoagulants prescribed (R 2 = 0.08, P =.04) in a state's Medicare population. Utilization of complex epistaxis interventions was not correlated with the prevalence of hypertension or DOAC use. Conclusions: Otolaryngologists perform the vast majority of epistaxis procedures in the Medicare population. However, practice patterns vary across the United States. Hypertension and DOAC use are weakly associated with the utilization of epistaxis interventions. [ABSTRACT FROM AUTHOR]

Background: Individuals on anticoagulation therapy are at increased risk of bleeding, including epistaxis. There is a lack of available reversal agents for novel oral anticoagulation therapy. Objective: This paper reviews the current literature on epistaxis in the context of novel oral anticoagulation use, in order to recommend guidelines on management. Method: A comprehensive search of published literature was conducted to identify all relevant articles published up to April 2019. Results: Patients on oral anticoagulation therapy are over-represented in individuals with epistaxis. Those on novel oral anticoagulation therapy were more likely to relapse compared to patients on classic oral anticoagulants or non-anticoagulated patients. Idarucizumab is an effective antidote for bleeding associated with dabigatran use. Recommendations for epistaxis management in patients on novel oral anticoagulation therapy are outlined. Conclusion: Clinicians need to be aware of the potential severity of epistaxis and the increased likelihood of recurrence. High-quality studies are required to determine the efficacy and safety of andexanet alfa and ciraparantag, as well as non-specific reversal agents. [ABSTRACT FROM AUTHOR]

In a medical setting, such as the treatment of post-operative nosebleeds, nasal packing, including the use of nasal packs, nasal plugs or nasal tampons (NTs), is widely used to temporarily control anterior epistaxis. Although some literature has documented the use of NTs as a quick, easy and temporary solution to deal with anterior epistaxis in sports-induced nasal injuries, additional research is needed to appreciate on-field versus off-field efficacy, as well as the efficiency of different brands of NTs and packing materials. [ABSTRACT FROM AUTHOR]

Objective To summarize the causes, treatment and prognosis of severe epistaxis after transnasal endoscopic skull base surgery. Methods and Results There were 12 patients with delayed severe epistaxis after transnasal endoscopic skull base surgery from February 2007 to January 2018. Surgical methods included endoscopic electrocoagulation hemostasis in 7 cases (7/12), DSA - assisted endoscopic electrocoagulation hemostasis in one case (1/12), DSA - assisted superselective arterial embolization in 3 cases (3/12), and DSA - assisted superselective arterial embolization combined with endoscopic electrocoagulation hemostasis in one case (1/12). Successful hemostasis occurred in 11 cases, and one case died. Patients were followed up for (17.21 ± 3.42) months without epistaxis recurrence. Conclusions Epistaxis mainly occurs over 7 to 14 d after transnasal endoscopic skull base surgery. The choice of operation methods is related to the location of bleeding and responsible artery. Endoscopic electrocoagulation hemostasis is an effective method without serious complications. Patients with internal carotid artery (ICA) pseudoaneurysms can be cured by endoscopic electrocoagulation hemostasis plus arterial embolization. [ABSTRACT FROM AUTHOR]

Is your patient's nosebleed a self-limiting occurrence, or a sign of something more worrisome? And which treatments are best in which situations? [ABSTRACT FROM AUTHOR]

A case study of 56-year-old female patient is presented who came into the emergency room for epistaxis and the appearance of hemorrhagic petechiae on the hips and abdomen. Topics include examines she had a clinical history of primary melanoma of the nasal mucosa, a rare subtype of melanoma, characterized, compared with all malignant melanomas by later onset, worse five years survival and advanced stage at diagnosis.

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]

Objectives: Epistaxis is a common condition that rarely warrants hospital admission in the pediatric population, making its inpatient management difficult to study. This study aims to use a nationwide database to analyze trends in the treatment of pediatric patients admitted with epistaxis and determine factors impacting total charges. Methods: The latest (2012) version of the Kids’ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality was used to identify weighted discharges with the primary diagnosis of epistaxis. Information regarding demographics, comorbidities, treatment, hospital burden, and other admission details were obtained. Linear regression was used to analyze factors suspected to increase cost. Results: Among 372 weighted discharges, the mean age was 9.68 years (SD = 5.79), and 60.0% were male. The most common comorbidities were thrombocytopenia, von Willebrand disease, and chronic sinusitis. The majority of admissions with epistaxis (56.7%) did not undergo any procedure to control epistaxis. Mean total charges was $30 208 (SD = $62 683) with a mean length of stay of 2.46 days (SD = 3.31). Independent predictors of increased charges included longer length of stay, admission from the emergency department, and median household income within the third quartile for patients’ ZIP codes. Midwest hospital region independently predicted decreased charges. Having a procedure to control epistaxis did not significantly impact cost. Conclusions: Pediatric epistaxis admissions often do not require long hospital stays or procedural control of the bleed. However, significant charges are incurred treating epistaxis. Awareness of factors impacting these charges can potentially improve resource utilization. [ABSTRACT FROM AUTHOR]

Background: Treatment for epistaxis includes application of intranasal vasoconstrictors. These medications have a precaution against use in patients with hypertension. Given that many patients who present with epistaxis are hypertensive, these warnings are commonly overridden by clinical necessity.Objective: Our aim was to determine the effects of intranasal vasoconstrictors on blood pressure.Methods: We conducted a single-center, randomized, double-blind, placebo-controlled trial from November 2014 through July 2016. Adult patients being discharged from the emergency department (ED) at Mayo Clinic (Rochester, Minnesota) were recruited. Patients were ineligible if they had a contraindication to study medications, had a history of hypertension, were currently taking antihypertensive or antidysrhythmic medications, or had nasal abnormalities, such as epistaxis. Subjects were randomized to one of four study arms (phenylephrine 0.25%; oxymetazoline 0.05%; lidocaine 1% with epinephrine 1:100,000; or bacteriostatic 0.9% sodium chloride [saline]). Blood pressure and heart rate were measured every 5 min for 30 min.Results: Sixty-eight patients were enrolled in the study; of these, 63 patients completed the study (oxymetazoline, n = 15; phenylephrine, n = 20; lidocaine with epinephrine, n = 11; saline, n = 17). We did not observe any significant differences in mean arterial pressure over time between phenylephrine and saline, oxymetazoline and saline, or lidocaine with epinephrine and saline. The mean greatest increases from baseline in mean arterial pressure, systolic and diastolic blood pressure, and heart rate for each treatment group were also not significantly different from the saline group.Conclusions: Intranasal vasoconstrictors did not significantly increase blood pressure in patients without a history of hypertension. Our findings reinforce the practice of administering these medications to patients who present to the ED with epistaxis, regardless of high blood pressure. [ABSTRACT FROM AUTHOR]

Epistaxis is a common emergency encountered by primary care physicians. Up to 60% of the general population experience epistaxis, and 6% seek medical attention for it. More than 90% of cases arise from the anterior nasal circulation, and most treatments can be easily performed in the outpatient setting. Evaluation of a patient presenting with epistaxis should begin with assessment of vital signs, mental status, and airway patency. When examining the nose, a nasal speculum and a good light source, such as a headlamp, can be useful. Compressive therapy is the first step to controlling anterior epistaxis. Oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1: 1,000 may be useful adjuncts to compressive therapy. Directive nasal cautery, most commonly using silver nitrate, can be used to control localized continued bleeding or prominent vessels that are the suspected bleeding source. Finally, topical therapy and nasal packing can be used if other methods are unsuccessful. Compared with anterior epistaxis, posterior epistaxis is more likely to require hospitalization and twice as likely to need nasal packing. Posterior nasal packing is often associated with pain and a risk of aspiration if it is dislodged. After stabilization, patients with posterior packing often require referral to otolaryngology or the emergency department for definitive treatments. [ABSTRACT FROM AUTHOR]

Objective: To compare efficacy of chemical cautery with silver nitrate along with fucidin ointment versus topical vasoconstrictor spray (xylometazoline 0.05%) and fucidin ointment application in idiopathic pediatric anterior epistaxis. Study Design: Randomized controlled trial. Place and Duration of Study: Study was carried out at Combined Military Hospital (CMH) Bahawalpur from Jan 2016 to Dec 2016. Material and Methods: Total 112 patients fulfilling the inclusion criteria were selected from Ear Nose Throat (ENT) outpatient department at CMH Bahawalpur. They were randomly divided into two groups of 56 cases in each group. Group A individuals were treated by cauterization with 75% silver nitrate followed by fucidic acid ointment. Group-B individuals were treated with topical vasoconstrictor spray (xylometazoline 0.05% twice a day for one week) along with fucidic acid ointment. Efficacy was determined in terms of control of epistaxis, whether the procedure was effective in controlling epistaxis or otherwise i.e. patient again developed bleeding from same side of nose and needed further treatment to control epistaxis. All the cases were followed up for two months after procedure to check their efficacy. Results: There were total 61 (54.46%) males and 51 (45.54%) females among the cases. Mean age of patients was 8.27 (± 2.34) years. Both the groups were comparable as regards the gender (p=0.817) and age (p=0.749). Group-A were treated with silver nitrate cauterization followed by fucidic acid ointmnet application and group-B were treated by vasoconstrictor nasal spray along with fucidic acid ointment. In group A (silver nitrate cautery), 87.5% cases had no rebleed during two months follow up and in group-B, 67.8% children had no rebleed during two months follow up period (p=0.022). Conclusion: Chemical cauterization with silver nitrate along with fucidic acid ointment application was found to be more effective as compared to xylometazoline nasal spray and fucidic Acid ointment application in treating idiopathic pediatric epistaxis. [ABSTRACT FROM AUTHOR]

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant hereditary disorder resulting in vascular dysplasia and formation of arteriovenous malformations. Recurrent epistaxis is a hallmark of the disease. An array of medical therapies are used in this patient population, but robust evidence‐based recommendations regarding the medical treatment of epistaxis are lacking. This systematic review was performed to look at the current literature and make meaningful evidence‐based recommendations. Methods: A search of the Ovid MEDLINE, Embase, and Cochrane databases was conducted by a research librarian. Abstracts in the English language and published in a peer‐review journal were reviewed for relevance and inclusion. PRISMA guidelines were followed. Results: Eighteen studies met the inclusion criteria. In a few small studies, thalidomide was shown to consistently improve severity and frequency of epistaxis and improve hemoglobin concentrations while decreasing the need for transfusion. Tranexamic acid appeared to only impact the epistaxis severity score and not other clinical outcomes. Selective estrogen modulators (SERMs), propranolol, rose geranium oil, and N‐acetylcysteine, have demonstrated promising efficacy in small trials. Conclusion: Appropriate medical therapies for epistaxis outcomes in HHT remain undefined, and there is no “gold standard.” Many of the studies are small and the data reported are heterogeneous, and therefore the ability to make strong evidence‐based recommendations is limited. However, many different medications appear to be promising options. [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]

Abstract: Objectives: Treatment of epistaxis in patients on anticoagulants is challenging and associated with higher admission rates and longer hospital stays compared with patients without anticoagulation. However, there is little information about epistaxis in patients taking new direct oral anticoagulants such as rivaroxaban compared with patients on traditional vitamin K antagonists such as phenprocoumon. Design: Retrospective cohort study. Setting: The study was conducted at the emergency department of the University Hospital Inselspital, Bern, Switzerland. Participants: All admissions to the emergency department of the University Hospital Inselspital, Bern, Switzerland from 1st July 2012 to 30th June 2016 with non‐traumatic epistaxis on anticoagulant therapy with phenprocoumon or rivaroxaban were included. Main outcome measures: We compared clinical outcome parameters (admission rates, length of hospital stay and mortality) for both anticoagulant groups. Results: We included 440 patients with epistaxis, 123 (28%) on rivaroxaban and 317 (72%) on phenprocoumon. Fewer hospital admissions and shorter hospital stays were found in patients under rivaroxaban (12 (10.4%) vs 57 (18.0%) patients, P=.033; 0.7±2.2 vs 1.5±3.7 days, P=.011) compared with phenprocoumon. Anterior epistaxis was more common in the rivaroxaban group in contrast to posterior epistaxis in patients on phenprocoumon (74 (60.2%) vs 139 (43.8%) patients, P=.002; 7 (5.7%) vs 39 (12.3%) patients, P=.042). Conclusions: Our data suggests that epistaxis on direct oral anticoagulation with rivaroxaban is associated with shorter hospital stays and fewer hospital admissions than epistaxis on vitamin K antagonist phenprocoumon. [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]

Background: The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment. Methods: This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience. Results: There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding satisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk. Conclusion: The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable. [ABSTRACT FROM AUTHOR]

Background: the incidence of epistaxis has increased secondary to increased life expectancy and morbidities. This study sought to assess the knowledge, practice and opinion relating to adequacy of training of advanced nurse practitioners (ANPs) and staff nurses (SNs) in the emergency department. Methods: a national survey was distributed over an 8-week period; this included a 3-point scoring system based on the National Institute for Health and Care Excellence Clinical Knowledge Summaries guidance on epistaxis management to assess overall performance. Results: analysis included 109 ANPs and 101 SNs; 12% of ANPs achieved the maximum score, 40% scored 2, 25% scored 1, and 23% scored 0, while 14% of SNs achieved the maximum score, 24% scored 2, 29% scored 1, and 32% scored 0. Overall 88% of respondents advocated further training. Conclusion: significant deficits in knowledge regarding epistaxis management were highlighted. Further training could help to empower patients in basic first aid measures, subsequently reducing admissions rates. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common medical emergency with possible life-threatening complications. In the prehospital setting, epistaxis can be treated with nasal tampons. HemCon® Nasal Plug is a nasal tampon impregnated with oxidized cellulose, which has hemostatic properties. Objective: The objective of this study was to determine the effectiveness and usability of HemCon Nasal Plugs in the treatment of severe epistaxis in the prehospital setting. Methods: From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with HemCon Nasal Plugs. The plug was used according to protocol; if conventional treatment failed to control severe epistaxis or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use. Results: Atotal of 33 patients were treated with HemCon Nasal Plugs. Twentyfour patients were taking anticoagulants or suffered from a clotting disorder. The cause of epistaxis was idiopathic in the majority of the patients. Inserting HemCon Nasal Plugs resulted in cessation of epistaxis in 25/33 patients and resulted in reduction of epistaxis in 4/33 patients. HemCon Nasal Plugs failed to control epistaxis in 4/33 patients, possible due to an unreachable site of bleeding. Conclusion: This study demonstrated that HemCon Nasal Plug is an effective adjunct in the prehospital treatment of severe and uncontrolled epistaxis. [ABSTRACT FROM AUTHOR]

Background: The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis- specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. Method: A systematic review of the literature was performed using a standardised methodology and search strategy. Results: Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. Conclusion: The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis. [ABSTRACT FROM AUTHOR]

Background: The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use. Method: A systematic review of the literature was performed using standardised methodology. Results: Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non- dissolvable packs. Conclusion: Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use. [ABSTRACT FROM AUTHOR]

Background: The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted. Method: A systematic review of the literature was performed using a standardised methodology and search strategy. Results: Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies. Conclusion: Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses. [ABSTRACT FROM AUTHOR]

Background: Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment. Method: A systematic review of the literature was performed using a standardised methodology and search strategy. Results: Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures. Conclusion: Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common condition that can be associated with significant morbidity, and it places a considerable burden on our healthcare system. This national audit of management sought to assess current practice against newly created consensus recommendations and to expand our current evidence base. Methods: The management of epistaxis patients who met the inclusion criteria, at 113 registered sites across the UK, was compared with audit standards during a 30-day window. Data were further utilised for explorative analysis. Results: Data for 1826 cases were uploaded to the database, representing 94 per cent of all cases that met the inclusion criteria at participating sites. Sixty-two per cent of patients were successfully treated by ENT clinicians within 24 hours. The 30-day recurrent presentation rate across the dataset was 13.9 per cent. Significant event analysis revealed an all-cause 30-day mortality rate of 3.4 per cent. Conclusion: Audit findings demonstrate a varying alignment with consensus guidance, with explorative analysis countering some previously well-established tenets of management. [ABSTRACT FROM AUTHOR]

Objective: Epistaxis is a common ENT emergency in the UK; however, despite the high incidence, there are currently no nationally accepted guidelines for its management. This paper seeks to recommend evidence-based best practice for the hospital management of epistaxis in adults. Methods: Recommendations were developed using an Appraisal of Guidelines for Research and Evaluation ('AGREE II') framework. A multifaceted systematic review of the relevant literature was performed and a multidisciplinary consensus event held. Management recommendations were generated that linked the level of supporting evidence and a Grading of Recommendations Assessment, Development and Evaluation ('GRADE') score explaining the strength of recommendation. Recommendations: Despite a paucity of high-level evidence, management recommendations were formed across five management domains (initial assessment, cautery, intranasal agents, haematological factors, and surgery and radiological intervention). Conclusion: These consensus recommendations combine a wide-ranging review of the relevant literature with established and rigorous methods of guideline generation. Given the lack of high-level evidence supporting the recommendations, an element of caution should be used when implementing these findings. [ABSTRACT FROM AUTHOR]

Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed. The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring into discussion the treatment applied for patients diagnosed with hereditary hemorrhagic telangiectasia. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular disorder which manifests as recurrent, episodic, and potentially debilitating epistaxis. In this study, we aim to (1) characterize baseline sinonasal symptoms for HHT patients and to (2) analyze changes in sinonasal symptoms before and after laser surgical treatment for HHT. We performed a retrospective chart review of sinonasal outcome test-22 (SNOT-22) scores before and after one or more laser surgical treatments for HHT-related epistaxis between January 1, 2010 and December 1, 2015 at a tertiary academic medical center with an HHT Foundation-approved Center of Excellence. Preoperative and all subsequent postoperative SNOT-22 scores (short-term, <45 days and long-term, ≥45 days) were compared. Twenty consecutive HHT patients underwent 51 laser surgeries for recurrent epistaxis. Mean preoperative, short-term postoperative, and long-term postoperative SNOT-22 scores were 34.6 ± 5.4, 33.9 ± 5.5, and 18.8 ± 4.6, respectively. When analyzing subcategory scores, there was a significant improvement in the rhinologic domain from short-term to long-term postoperatively (13.5 vs. 7.3; p = 0.004), in the non-rhinologic otolaryngic domain from short-term to long-term postoperatively (2.8 vs. 1.7; p = 0.014), and in the psychological domain from preoperative and short-term postoperative to long-term postoperatively (12.2 and 10.0 vs. 6.0; p = 0.015 and 0.01, respectively). Following laser surgery for HHT-related epistaxis, patients' rhinologic symptoms worsened on the short run postoperatively but improved over time. The main benefit of laser treatment appears to be long-term improvement in psychological factors. This study once again underscores the important role of the otolaryngologist in managing sinonasal manifestations of HHT. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 73-year-old multiple chronic medical illness patient with confusion and recurrent epistaxis. Topics discussed include the differential diagnosis of the patient's case according to physician Robert L. Fogerty, the common causes of confusion in an elderly patient like medication-related changes in mental status, the diagnostic criteria for hepatic encephalopathy (HHT) and the patient's diagnostic testing which revealed that he has HHT.

Esthesioneuroblastoma is a rare malignant neoplasm of oflactory neuroepithelium and usually located at the olfactory cleft at superior nasal cavity. Ectopic localization of esthesioneuroblastoma is even rarer and usually posed with a diagnostic dilemma and delay in the diagnosis and management, We report a rare case of ectopic esthesioneuroblastoma of the sphenoclivus with the presentation of intermittent unilateral epistaxis, intermittent intractable headache without anosmia. Nasal endoscopy findings showed a pulsatile mass at the anterior face of the sphenoid sinus with extension posteriorly towards the clivus region and occupying the floor of the sphenoid sinus. Endonasal transclival endoscopic excision of tumour was performed which involved otorhinolaryngology surgeon and neurosurgeon with intraoperative navigation imaging and frozen section. The histopathological findings was esthesioneuroblastoma. Due to its rarity and unusual presentation, the diagnosis of ectopic esthesioneuroblastoma is difficult and can be misdiagnosed with the other type of malignancy. Therefore, the histopathological result is important in confirming the type of tumour and can lead to the next step of management. [ABSTRACT FROM AUTHOR]

Purpose: Numerous techniques have been used to reduce epistaxis during nasotracheal intubation. Rhinometry can assess nasal patency in preoperative conditions. However, the possible role of rhinometry in routine nasotracheal intubation has not been studied. Methods: One hundred and one patients undergoing dental and maxillofacial surgery that required general anesthesia and nasotracheal intubation were enrolled. We examined whether symmetry or any asymmetry in bilateral airflow patterns by condensation of the expiration, assessed by preoperative rhinometry on seated position, increased the incidence of epistaxis and the need for a nasogastric catheter to guide the endotracheal tube into the oropharynx. We also compared the incidence of changing the site of nasal intubation between the assessment by rhinometry and by cone-beam computed tomography analysis of nasal airspace in the inferior meatus. Results: Patients with any asymmetry in bilateral airflow patterns were 18 % ( n = 18), the remaining 82 % ( n = 83) had symmetric bilateral nasal cavities. Patients with any asymmetry were more likely to need a guiding nasogastric catheter than patients with symmetry (22 vs. 3.6 %, p = 0.018). The incidence of epistaxis was higher in patients with any asymmetry (39 %) than those with symmetry (16 %), but there was no significant difference between groups ( p = 0.055). The site of intubation was changed more frequently based on cone-beam computed tomography analysis than by rhinometry (38 vs. 11 %, p = 0.043). Conclusion: Preoperative rhinometry may be a valuable objective tool to assess nasal patency for nasotracheal intubation in patients who undergo dental and maxillofacial surgery. [ABSTRACT FROM AUTHOR]

Background In severe cases of epistaxis, in spite of several procedures described in the literature for its management, surgical treatment has been recognized by most authors as 1 of the most effective, especially when it includes ligation and/or electrocoagulation of the nasal branches of the sphenopalatine artery. The objective of this study is to determine the importance of ethmoid crest resection during sphenopalatine artery surgery, in the management of severe epistaxis. Methods We report a double-blinded randomized clinical trial, in which intervention was the ethmoid crest resection during electrocoagulation of the sphenopalatine artery. The study participants consisted of 42 patients with severe epistaxis and indication for surgical treatment, treated at the Otorhinolaryngology Emergency Room (ORL ER) of Hospital Sao Paulo, the teaching hospital of the Federal University of Sao Paulo. Results There was significant greater exposure of the arterial branch after removal of the ethmoidal crest ( p = 0.009). The rate of bleeding within 48 hours of the procedure was significantly lower in the crest removal group. Conclusion Resection of the ethmoid crest during sphenopalatine surgery proved to be feasible without additional risks, including promoting decrease in the overall surgical time. It provided better exposure of arterial branches of the sphenopalatine foramen, leading to a lower rebleeding rate within 48 hours. [ABSTRACT FROM AUTHOR]

Background The role of tranexamic acid in the management of epistaxis remains unclear. There is uncertainty about its safety and about the contraindications for its use. We performed a systematic review of the use of systemic and topical tranexamic acid in epistaxis and a comparative review of its use in other specialties. Objective of review This review assesses and summarises the existing evidence for the efficacy and safety of tranexamic acid in the management of epistaxis. Type of review Systematic review. Search strategy MEDLINE and EMBASE were searched for 'epistaxis' and equivalent MESH terms, combined with the Boolean operator ' OR' and 'tranexamic acid'. The Cochrane library and society guidelines were reviewed for evidence regarding the use of tranexamic acid in other specialties. Evaluation method All five relevant RCTs were included in the review and were evaluated according to the recommendations of the Cochrane Handbook for Systematic Reviews. Results Three RCTS pertained to spontaneous epistaxis; of these, one trial found no benefit of oral tranexamic acid in acute epistaxis, one trial found no significant benefit of topical tranexamic acid, but the largest of the trials showed significant benefit of topical tranexamic acid in acute epistaxis management. Two RCTs examined oral tranexamic acid for prophylaxis of recurrent epistaxes in patients with hereditary haemorrhagic telangiectasia; both showed significant reduction in severity and frequency. Conclusions Tranexamic acid, as a WHO 'essential medicine', is a powerful, readily available tool, the use of which in epistaxis has been limited by uncertainty over its efficacy and its safety profile. This systematic review summarises the existing evidence and extrapolates from the wealth of data for other specialties to address the clinical question - does TXA have a role in epistaxis management? [ABSTRACT FROM AUTHOR]

In this work nasal powder formulations of thalidomide were designed and studied to be used by persons affected by hereditary hemorrhagic telangiectasia as a complementary anti-epistaxis therapy, with the goal of sustaining the effect obtained with thalidomide oral treatment after its discontinuation for adverse effects. Three nasal powders were prepared using as carriers β-CD or its more hydrophilic derivatives such as hydropropyl-β-CD and sulphobutylether-β-CD and tested with respect to technological and biopharmaceutical features after emission with active and passive nasal powder devices. For all formulated powders, improved dissolution rate was found compared to that of the raw material, making thalidomide promptly available in the nasal environment at a concentration favouring an accumulation in the mucosa. The very limited transmucosal transport measured in vitro suggests a low likelihood of significant systemic absorption. The topical action on bleeding could benefit from the poor absorption and from the fact that about 2–3% of the thalidomide applied on the nasal mucosa was accumulated within the tissue, particularly with the β-CD nasal powder. [ABSTRACT FROM AUTHOR]

A 50-year-old man, with no previous history of epistaxis, was hospitalized at our facility for left recurrent posterior epistaxis. The patient underwent surgical treatment three times and only the operator’s experience and radiological support (cranial angiography) allowed us to control the epistaxis and stop the bleeding. The difficult bleeding management and control was attributed to an abnormal course of the left posterior ethmoidal artery. When bleeding seems to come from the roof of the nasal cavity, it is important to identify the ethmoid arteries always bearing in mind the possible existence of anomalous courses. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is one of the most common encountered otolaryngologic emergency and affects up to 60% of the population in their lifetime, of which 6% require medical attention. This study was done to find out the relationship between general diseases and the occurrence of epistaxis and to evaluate the methods required to manage bleeding from the nose. Materials and methods: Cases were taken for this study from various indoor and outpatient departments of N.S.C.B Medical College and Hospital Jabalpur from October 2013 till September 2014. Detailed history, clinical information was noted for all patients. All included patients underwent investigations as ordered by their doctor, and relevant clinical examinations were performed. Data was analyzed using appropriate statistical methods. Results: In this study, maximum number of subjects had bleeding from both nares followed by left and right nares respectively. Deviation to left was more common in this study with not much significant difference between the two sides. Tumors of nose (17.78%) were the most common associated disease in this study followed by hypertension (13.3%), diabetes mellitus was associated with 6.67% of subjects. 11.11% patients had nasal bone fracture and 11.11% of patients had enlarged external framework of nose mainly due to nasal masses. Most commonly used modality was anterior nasal packing in 40% cases, followed by surgery in 35.56% cases. Conclusions: These results illustrate the relation of epistaxis with past medical history, duration of bleeding. More research is required to understand the management patterns in different geographical locations. [ABSTRACT FROM AUTHOR]

The goal of this study was to evaluate independent risk factors for long-term epistaxis recurrences and their severity. Individual retrospective cohort study-2b level of evidence. The medical information of 603 emergency epistaxis patients was acquired during a former study. This cohort has been contacted 6 years later by conventional mail and asked to answer a specific paper questionnaire. The following parameters were evaluated: recurrent epistaxis episodes, need for a surgical intervention to stop the recurrent bleeding, patient's history for hypertension and diabetes, intake of hemostasis impairing medication now and in the past. One hundred and six (106) patients were included in the study (35.8 % response rate). The mean observation period was 76.58 months. Almost half of the patients (41.5 % = 44/106) reported at least one recurrent epistaxis episode. Patients with exposure to VKA (vitamin K antagonists) showed significantly more frequently a recurrent epistaxis episode. The binary logistic regression confirmed the intake of VKA as an independent and significant risk factor with an odds ratio of 11.6. Every single patient who had to undergo a surgical intervention to stop a recurrent bleeding stated ASA (Acetylsalicylic Acid) intake. We provide evidence that the intake of a vitamin K antagonist is an independent long-term risk factor for recurrent epistaxis episodes. The intake of ASA is a risk factor for the severity of recurrent epistaxis with the increased need for a surgical intervention not only in a short- but also in a long-term perspective. Level of evidence: This prognostic investigation, designed as a combined prospective and retrospective cohort study, reaches level 2b level of evidence as it includes retrospective aspects. [ABSTRACT FROM AUTHOR]

Objective:To evaluate the short- to medium-term effectiveness of potassium titanyl phosphate (KTP) laser Dermastat in patients with recurrent anterior epistaxis.Method:Fifty-eight patients presenting with recurrent anterior epistaxis were treated using potassium titanyl phosphate laser Dermastat. Those with recurrent epistaxis arising from prominent vessels in Little's area, and/or those for whom treatment with silver nitrate cautery failed, were included. The main outcome measure was resolution of epistaxis at two months.Results:Fifty-eight patients were treated; 27 were under 18 years old. Thirty patients had prominent vessels. Thirty-one patients had undergone previous cautery treatment. Thirty-eight patients had treatment to the left side, 19 to the right and 1 to both. At two months, 74 per cent reported resolution of epistaxis with no complications. This increased to 78 per cent at further follow up.Conclusion:Our technique is a successful, safe treatment for recurrent anterior epistaxis in an otherwise treatment-resistant group. A single procedure is effective. The handpiece and tip are reusable and sterilisable, resulting in cost-effectiveness. [ABSTRACT FROM AUTHOR]

Posterior epistaxis is a serious condition that can be difficult to treat in a wilderness setting. The initial standard of care involves packing the affected nostril with a 7 to 9 cm nasal pack to tamponade the bleed. These packs are often unavailable outside of the emergency or operating room. This study set out to determine whether a posterior nasal pack could be constructed from the supplies present in a basic first aid kit in order to control massive nasal hemorrhage in a wilderness setting. A basic first aid kit was utilized to construct a posterior nasal pack that was inserted into an anatomical model and visibly compared with the Rapid Rhino (Posterior, 7.5 cm; Smith & Nephew, Austin, TX) nasal packing. The shape, size, and anatomical areas of compression (ie, into nasopharynx and posterior aspect of inferior turbinate) of this pack was similar to the commercially available posterior nasal pack. Placement in an anatomical model appears to provide similar compression as the commercially available posterior pack. This technique may provide short-term hemorrhage control in cases of serious posterior nasal hemorrhage where standard treatment options are not available. [ABSTRACT FROM AUTHOR]

Conclusions: Transarterial embolization (TAE) appears to be a safe and effective treatment for patients with intractable epistaxis, despite different etiologies or angiography findings. Idiopathic epistaxis is prone to present with negative angiographic findings.Objective: To retrospectively evaluate the safety and effectiveness of TAE for intractable epistaxis, and focus on the factors of etiology and angiographic findings.Materials and methods: From March 2008 to December 2014, the data of 43 patients with intractable bleeding undergoing TAE were reviewed. The outcomes of interventional therapy were assessed according to different etiology (malignant or benign disease) and angiographic finding (positive or negative angiogram).Results: Positive angiographic findings were found in 11 of 12 cases with malignant diseases and 22 of 31 cases with benign diseases, respectively (p = 0.237). Among the 10 cases with negative angiographic findings, the negative angiography rate of idiopathic epistaxis was higher than that of epistaxis with definite etiology (p = 0.003). Bleeding was controlled successfully in all of the 43 patients after embolization. During the mean follow-up period of 24.0 ± 16.7 months, five patients relapsed. No significant difference was found in recurrence rates between malignant and benign diseases or between positive and negative angiography (p = 0.241,p = 0.704, respectively). [ABSTRACT FROM PUBLISHER]

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:Video hosting websites are increasingly being used to disseminate health education messages. This study aimed to assess the quality of advice contained within YouTube videos on the conservative management of epistaxis.Method:YouTube.com was searched using the phrase ‘how to stop a nosebleed’. The first 50 videos were screened. Objective advice scores and subjective production quality scores were attributed by independent raters.Results:Forty-five videos were analysed. The mean advice score was 2.0 out of 8 and the mean production quality score was 1.6 out of 3. There were no correlations between a video's advice score and its search results rank (ρ = −0.28, p = 0.068), its view count (ρ = 0.20, p = 0.19) or its number of ‘likes’ (ρ = 0.21, p = 0.18).Conclusion:The quality of information on conservative epistaxis management within YouTube videos is extremely variable. A high search rank is no indication of video quality. Many videos proffer inappropriate and dangerous ‘alternative’ advice. We do not recommend YouTube as a source for patient information. [ABSTRACT FROM PUBLISHER]