Is nasal packing required in epistaxis?

OBJECTIVE: To demonstrate the efficacy of identification of bleeding source with nasal endoscopy and cauterization (bipolar or radiofrequency) without nasal packing in adults with posterior epistaxis unable to be treated with nasal packing.

MATERIALS AND METHODS: The average age of patients was 56.16 ± 12.6 (38-72) years, and female-male ratio was 1/5. The average systolic blood pressure was found to be 150 ± 30, while diastolic blood pressure was 90 ± 20 mmHg. Average hemoglobin concentration was 11.2 ± 3.1 (7-15). The bleeding was on the left side in 8 patients and on the right in 4 patients. Probable etiology was considered hypertension crisis (33.3%), use of nasal steroids (8.3%), nasal surgery (8.3%), however in half (50%) of the cases the cause was unidentified. Of the cases, 6 had hypertension, 4 COPD, 10 tobacco use and 5 alcohol use. The source of epistaxis was anterior ethmoidal artery in 2 cases and spheopalatine artery in 10 cases. Two of the cases were treated with radiofrequency coagulation, and ten with bipolar cauterization. Only one of the cases was administered 2 units of packed red blood cells, and one of the cases had postoperative recurrent bleeding. The patients were hospitalized in average 3.2 (2-5) days and no reccurence of hemorrhage was seen in 3 month follow up.

CONCLUSIONS: Dundee epistaxis menagement protocol described by Barnes and Spielman may be applied in adults. Endoscopical detection of the bleeding site and cauterizing the arterial feed source is highly successful in the treatment. Nasal packing may more commonly lead to complication especially in the elderly and in patients with heart and respiratory problems.