Search

Background and Aim: Epistaxis is one of the most common symptoms referring to emergency department, which suitable and effective treatment needs in short term. Therefore the purpose of the present study was to compare the outcome of topical tranexamic acid (TA) with nasal tampon in management of epistaxis. Materials and Methods: The present clinical trial study was performed on 150 patients with epistaxis in three groups. The patients of the first group were treated as a control group with a tampon that was lubricated with tetracycline ointment. The second group (TA group) received 15 cm gauze coated with TA and put in the nasal cavity. The third group received 15 cm gauze coated with TA and then nasal tampon coated with lubricant and tetracycline ointment. Then bleeding and nausea were assessed and recorded in the first 24 hours and the first week after intervention. Finally, statistical analysis was performed with SPSS software and Chi-square and one-way analysis of variance tests were used. Results: The time of bleeding cessation was significantly more in control groups as compared to intervention groups(P=0.04). The incidence of complications such as nausea and vomiting was much lower in the TA group than in the control group (P

Objective: To assess safety and efficacy of an asymmetrical balloon in the treatment of epistaxis in adult patients (≥18 years) managed in an emergency setting. Methodology: Pilot, open label, monocenter, prospective, interventional non comparative study in adult patients. The patients were hospitalized for 48h, timepoint at which the device was removed. Primary endpoints were the assessment of bleeding arrest and pain score evaluated on a Visual Analogic Scale. Secondary endpoints were the nature and number of adverse events reported and patient quality of life evaluated with the RhinoQoL questionnaire. Results: Ten patients were included, and nine were treated. In Intent to Treat (ITT), bleeding was stopped upon positioning in 9/10 patients. Efficacy was maintained in 8/10 patients during treatment. Pain was moderate at insertion, inflation and during treatment and mild upon and post-removal. Minor bleeding recurrence occurred in two patients during the post-treatment period. The reported adverse events considered device-related were consistent with the ones observed with other intranasal devices. The mean and median RhinoQoL impact scores tend to decrease upon the different control visits. Conclusion: This pilot study provides promising preliminary safety and efficacy data for CAVI-T™ in the management of epistaxis in an emergency setting.

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.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.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.A total of 33 patients were treated with HemCon Nasal Plugs. Twenty-four 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.This study demonstrated that HemCon Nasal Plug is an effective adjunct in the prehospital treatment of severe and uncontrolled epistaxis.

Anterior nasal packing, which is a common procedure in otorhinolaryngology practice, has different complications. Pain during introduction and removal of pack, bleeding after removal due to mucosal damage and synechia formation are common among them. A continuous effort is going on worldwide to combat those by modifying the nature of pack material or inventing new materials for nasal packing. In the present study an effort was made to compare a new modification of conventional gauze pack by using aluminum foil prepared from the cover of suture materials as septal splint (to reduce the mucosal damage) with conventional gauze pack and another costly material, nasal tampon (merocel). Comparisons were done in terms of cost, efficacy and complications. Prospective hospital based interventional study. Patients were distributed into three groups according to the material used for anterior nasal packing. Comparisons were made in terms of cost of the material used, pain during introduction of pack, rise of systolic blood pressure, incidences of bleeding while pack in situ, incidences of bleeding after removal of pack that required repacking and incidences of synechia formation after pack removal. The episodes of bleeding while pack in situ, within first 48 h and forced for repacking was observed to be significantly more prevalent among nasal tampon groups (12.5%) of patients but only 2.1 and 2.4% with use of conventional gauze pack and our modification respectively. Regarding bleeding after removal of pack, 10.6% patients experienced bleeding with conventional gauze pack, whereas with our modification it was only 2.4%. Synechia formation was found to be highest among the cases with conventional gauze pack (14.9%), but with our modification it is only 2.4%. In this study it is found that use of aluminum foil prepared from the cover of suture materials can be very useful and cost effective method to reduce some of the complications of anterior nasal packing.

The purpose of this study was to compare the pain and discomfort associated with the removal of two commercially available nasal tampons after nasal surgery.Prospective, paired, randomized clinical trial.Consecutive, consenting, adult patients undergoing nasal surgery.The nose was packed with a Rapid Rhino tampon (Applied Therapeutics, Tampa, FL) on one side and a Rhino Rocket tampon (Shippert Medical Technologies Corporation, Centennial, CO) on the other.The pain of packing removal was assessed with a validated 100-mm visual analog scale. Patient satisfaction was measured on a Likert scale from 1 to 5.In all 13 patients, the pain of removal was greater with the Rhino Rocket Tampon (82.7 +/- 20.9 mm) than with the Rapid Rhino tampon (12.0 +/- 11.9 mm); the mean difference was 70.7 mm (95% confidence interval [CI], 47.1-78.2 mm; P0.0001). Patient satisfaction was significantly higher with the Rapid Rhino nasal tampon (4.6 +/- 1.1 vs 1.5 +/- 0.7; mean difference 3.1 [95% CI, 2.6-3.6]; P0.001).Removal of the Rapid Rhino nasal tampon was significantly less painful and was associated with higher patient satisfaction than the removal of the Rhino Rocket nasal tampon.

This retrospective observational study aimed to establish the outcome for patients packed with a nasal tampon as first-line therapy for epistaxis in Accident & Emergency compared to those packed by ENT. During our study period, 189 admissions were treated with a nasal tampon as first-line therapy; 89 were inserted by ENT and 100 by A&E. A significantly higher number of patients packed by A&E required further treatment to control bleeding (p = 0.004; 95 per cent CI 7–34) than those in the group packed by ENT. A significantly greater proportion from the A&E group required additional cautery alone to control bleeding (p = 0.005; 95 per cent CI 5–30). We suggest that this may be due to inadequate initial assessment and inappropriate first-line therapy in the A&E department. It is recommended that ENT review patients prior to packing, in order to reduce the morbidity associated with multiple treatments.

To absorb bleeding and pack the nasal cavities after rhinoplasty, a sterile commercial vaginal tampon was used. It has the following advantages: high absorbency, round configuration, and safety removal cord included to preclude gliding into the nasopharynx.

Anterior epistaxis is commonly treated with Merocel nasal tampon insertion in preference to gauze packing. An 89-year-old patient was found to have cerebrospinal fluid rhinorrhea and massive pneumocephalus immediately after removal of a Merocel tampon used for spontaneous anterior epistaxis. She later developed fever and mild confusion, but was well at three-month follow-up. The advantages and complications of Merocel nasal tamponade are briefly reviewed and compared with those of other methods of control of anterior epistaxis.

The cause of the shock induced by local anesthetics remains to be unexplained. The measurements of serum electrolytes, blood sugar and serum catecholamine, the recording of electrocardiogram and blood gas analyses were performed in 46 patients during surgical intervention under local anesthesia. The results showed that the administration of epinephrine mixed with local anesthetics caused severe degree of hypopotasium. Especially in the case of nasal operation using nasal tampon immersed with epinephrine, the condition of hypopotasium stayed well over sixty minutes. Hypopotasium brought, about by the application of epinephrine is suspected to be one of the causes of the shock during operation, The authors emphasized that special attention to the level of serum electrolytes should be paid when local anesthetics are used with epinephrine.

Toxic shock syndrome has been noted to occur with nasal surgery, both with and without packing. A new synthetic sponge, described as a nasal tampon, has become available for use as packing after surgery. Herein is reported the first case of toxic shock syndrome associated with the use of this nasal tampon.

Epistaxis is the second most common cause of spontaneous bleeding. Of the two categories of epistaxis, mundane and severe, the mundane, usually anterior epistaxis, is the more common. It has been reported that 60% of individuals report at least one episode of epistaxis during their lifetime. Eighty percent of epistaxis occurs in Kiesselbach's plexus, a vascular network in the anterior portion of the nasal septum. We have designed a nasal tampon to control this common variety of epistaxis which is a fast, efficient, and cost-effective method of anterior epistaxis control. The material used in the manufacture of the device (MerocelTM) has been used for over 5 years by the author, both in treatment of severe epistaxis and as a postoperative nasal packing. The design presented here has been used for anterior epistaxis for 18 months without untoward sequelae and with universal success.