“Although data exist on the efficacy of the different epistaxis management techniques, outcome comparisons between the modalities for both primary management as well as management of cases of recurrence are currently lacking,” stated the authors who are affiliated with Massachusetts Eye and Ear and Harvard Medical School.
The study analyzed various treatment outcomes of adult patients with epistaxis presenting to otolaryngologists at a tertiary care center between 2005 and 2011. The authors observed 147 patients (94 men and 53 women) who underwent cauterization, tamponade or nondissolvable packing, and/or proximal vascular control through embolization or surgical ligation. Treatment outcomes were then compared with the intent to derive an algorithm for optimal nosebleed management.
According to the study, nondissolvable packing demonstrated the highest rate of failure or recurrence (57.4 percent) for initial bleed management. Chemical cautery was significantly more successful in achieving lasting hemostasis for the first bleeding episode. The authors also found that the duration of the nondissolvable pack placement had no significant impact on nosebleed recurrence. Furthermore, among patients who failed initial management, those who next underwent more invasive procedures such as cautery, embolization or surgical ligation experienced better outcomes and shorter inpatient stays.
Because the subgroup analyses were limited in size for some of the treatment groups in this study, the authors urge caution when considering these findings.
Although most cases of nosebleed do not require medical intervention, those patients who do present to a tertiary care otolaryngologist and need medical attention require a systematic, stepwise approach to address their condition. This study demonstrates “good outcomes with initial treatment with chemical cautery and with procedures that achieve directed vascular control in patients who develop epistaxis recurrence.”
Otolaryngology–Head and Neck Surgery
is the official scientific journal of the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF). The study’s authors are Josef Shargorodsky, M.D, M.P.H; Benjamin S. Bleier, M.D; Eric H. Holbrook, M.D;Jeffrey M. Cohen; Nicolas Busaba, M.D; Ralph Metson, M.D; and Stacey T. Gray, M.D. Reporters who wish to obtain a copy of the study “Outcomes Analysis in Epistaxis Management: Development of a Therapeutic Algorithm”
should contact Lindsey Walter at 1-703-535-3762, or [email protected]
Mass. Eye and Ear clinicians and scientists are driven by a mission to find cures for blindness, deafness and diseases of the head and neck. After uniting with Schepens Eye Research Institute Mass. Eye and Ear in Boston became the world’s largest vision and hearing research center, offering hope and healing to patients everywhere through discovery and innovation. Mass. Eye and Ear is a Harvard Medical School teaching hospital and trains future medical leaders in ophthalmology and otolaryngology, through residency as well as clinical and research fellowships. Internationally acclaimed since its founding in 1824, Mass. Eye and Ear employs full-time, board-certified physicians who offer high-quality and affordable specialty care that ranges from the routine to the very complex. U.S. News & World Report’s “Best Hospitals Survey” has consistently ranked the Mass. Eye and Ear Departments of Otolaryngology and Ophthalmology as top five in the nation.
The American Academy of Otolaryngology—Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents about 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s vision: “Empowering otolaryngologist-head and neck surgeons to deliver the best patient care.”