Epistaxis management - our point of view and literature review

Open access


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.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Daudia A Jaiswal V Jones NS. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clinical Otolaryngol. 2008;33(6):618–20. DOI:10.1111/j.1749-4486.2008.01795.x.

  • 2. Paul J Kanotra SP Kanotra S. Endoscopic Management of Posterior Epistaxis. Indian J Otolaryngol Head Neck Surg. 2011;63(2):141-4. DOI: 10.1007/s12070-010-0054-0.

  • 3. Pond F Sizeland A. Epistaxis strategies for management. Australian Family Physician. 2000;29(10):933-8.

  • 4. Beran M Petruson B. Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiological factors. ORL J Otorhinolaryngol Relat Spec. 1986;48(5):297-303.

  • 5. Manfredini R Portaluppi F Salmi R Martini A Gallerani M. Circadian variation in onset of epistaxis: analysis of hospital admissions. BMJ. 2000;321:1112. DOI: https://doi.org/10.1136/bmj.321.7269.1112.

  • 6. Kaluskar SK. Endoscopic sinus surgery: a practical approach. London: Springer-Verlag; 1977 p.107–110.

  • 7. Résultats de l’Observatoire français de l’épistaxis. Revue Officielle de la Société Française d’O.R.L. 2002;75:62-67.

  • 8. Tabassom A Cho JJ. Epistaxis (Nose Bleed). [Update 2017 May 25] In: StatPearls [Internet]. Treasure Island (FL): Stat Pearls Publishing; 2017. Available from: https://www.ncbi.nlm.nih.gov/books/NBK435997/

  • 9. Klotz DA Winkle MR Richmon J Hengerer AS. Surgical management of posterior epistaxis: a changing paradigm. Laryngoscope. 2002;112(9):1577-82.

  • 10. Viehweg TL Roberson JB Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg. 2006;64(3):511-8. DOI:S0278-2391(05)01815-X.

  • 11. Loukil H Snoussi M Fourati H Frikha F Salah RB Jallouli M et al. Liver involvement in Rendu-Osler disease: a case report and review of literature. Pan Afr Med J. 2016;24:326. DOI: 10.11604/pamj.2016.24.326.9816.

  • 12. Boujrad S El Hasbaoui B Echahdi H Malih M Agadr A. Factor V congenital deficiency: about a case. Pan Afr Med J. 2017;27:182. DOI: 10.11604/pamj.2017.27.182.12285.

  • 13. Mohamed OM Govindan A Filimonov A Sylvester MJ Zaki M Baredes S et al. Impact of liver disease on outcomes of patients hospitalized for epistaxis. Laryngoscope. 2017. DOI: 10.1002/lary.26624. [Epub ahead of print]

  • 14. Bertrand B Eloy Ph Rombaux Ph Lamarque C Watelet JB Collet S. Guidelines to the management of epistaxis. B-ENT. 2005;1(Suppl. 1):27-43.

  • 15. Guarisco JL Graham HD 3rd. Epistaxis in children: causes diagnosis and treatment. Ear Nose Throat J. 1989;68(7):522 528-30 532 passim.

  • 16. Bailey BJ. Johnson JT Newlands SD Calhoun KH Deskin RW eds. Head and Neck Surgery–Otolaryngology. 4th ed. Philadelphia PA: Lippincott Williams & Wilkins; 2006.

  • 17. Lloyd S Almeyda J Di Cuffa R Shah K. The effect of silver nitrate on nasal septal cartilage. Ear Nose Throat J. 2005;84(1):41-4.

  • 18. Cho JH Kim YH. Epistaxis. In: Gendeh BS (ed.). Otolaryngology. InTech; 2012. DOI: 10.5772/37129. Available from: https://www.intechopen.com/books/otolaryngology/epistaxis

  • 19. Newton E Lasso A Petrcich W Kilty SJ. An outcomes analysis of anterior epistaxis management in the emergency department. J Otolaryngol Head Neck Surg. 2016;45:24. DOI:10.1186/s40463-016-0138-2.

  • 20. Johnson N Faria J Behar P. A Comparison of Bipolar Electrocautery and Chemical Cautery for Control of Pediatric Recurrent Anterior Epistaxis. Otolaryngol Head Neck Surg. 2015;153(5):851-6. DOI: 10.1177/0194599815589583. Epub 2015 Jun 30.

  • 21. Schreiner L. Complications and errors in the management of nose bleeding (author’s transl). Laryngol Rhinol Otol (Stuttg). 1976;55:257-63.

  • 22. Manea C Sabaru I Sanda C. Nasal packing in endonasal surgery - a literature review. Romanian Journal of Rhinology. 2011;1(4):210-4.

  • 23. Moumoulidis I Draper MR Patel H Jani P Price T. A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. Eur Arch Otorhinolaryngol. 2006;263(8):719-22. Epub 2006 May 10.

  • 24. Derkay CS Hirsch BE Johnson JT Wagner RL. Posterior nasal packing. Are intravenous antibiotics really necessary? Arch Otolaryngol Head neck Surg. 1989;115(4):439-41.

  • 25. García Callejo FJ Muñoz Fernández N Achiques Martínez MT Frías Moya-Angeler S Montoro Elena MJ Algarra JM. Nasal packing in posterior epistaxis. Comparison of two methods. Acta Otorrinolaringologica Esp. 2010;61(3):196-201. DOI: 10.1016/j.otorri.2009.11.005. Epub 2010 Feb 6.

  • 26. Pritikin JB Caldarelli DD Panje WR. Endoscopic ligation of the internal maxillary artery for treatment of intractable posterior epistaxis. Ann Otol Rhinol Laryngol. 1998;107(2):85–91.

  • 27. Hashmi S Gopaul S Prinsley PR Sansom JR. Swallowed nasal pack: a rare but serious complication of the management of epistaxis. J Laryngol Otol. 2004;118(5):372-3.

  • 28. Civelek B Kargi AE Sensöz O Erdogan B. Rare complication of nasal packing: alar region necrosis. Otolaryngol Head Neck Surg. 2000;123(5):656-7.

  • 29. Nahass RG Gocke DJ. Toxic shock syndrome associated with use of a nasal tampon. Am J Med. 1988;84(3 Pt 2):629-31.

  • 30. Pinto JA Cintra PPV da C Sônego TB Leal C de FA Artico MS Soares J dos S. Severe complication of posterior nasal packing: Case Report. Int Arch Otorhinolaryngol. 2012;16(4):527-9. DOI: 10.7162/S1809-97772012000400016.

  • 31. Odat H Al-Qudah M. Endoscopic monopolar cauterization of the sphenopalatine artery: a single surgeons experience. Ann Saudi Med. 2016;36(6):422-6.

  • 32. O’Donnell M Robertson G McGarry GW. A new bipolar diathermy probe for the outpatient management of adult acute epistaxis. Clin Otolaryngol Allied Sci. 1999;24(6):537-41.

  • 33. Zou Y Deng YQ Xiao CW Kong YG Xu Y Tao ZZ et al. Comparison of outcomes between endoscopic surgery and conventional nasal packing for epistaxis in the posterior fornix of the inferior nasal meatus. Pak J Med Scie. 2015;31(6):1361-5. DOI: 10.12669/pjms.316.8340.

  • 34. Wurman LH Sack JG Flannery JV Jr. Paulson TO. Selective endoscopic electrocautery for posterior epistaxis. Laryngoscope. 1988;98(12):1348-9. DOI: 10.1288/00005537-198812000-00013.

  • 35. Cummings CW. Cummings Otolaryngology - Head and Neck Surgery. 4th ed. Philadelphia PA: Elsevier Mosby; 2005.

  • 36. Small M Maran AG. Epistaxis and arterial ligation. J Laryngol Otol. 1984;98(3):281-4. DOI: 10.1017/S0022215100146572.

  • 37. Metson R Lane R. Internal maxillary artery ligation for epistaxis: an analysis of failures. Laryngosocope. 1988;98(7):760-4.

  • 38. Strong EB Bell DA Johnson LP Jacobs JM. Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis. Otolaryngol Head Neck Surg. 1995;113(6):674-8.

  • 39. Sokoloff J Wickbom I McDonald D Brahme F Goergen TC Goldberger LE. Therapeutic percutaneous embolization in intractable epistaxis. Radiology. 1974;111(2):285-7. DOI: 10.1148/111.2.285.

  • 40. Chandler JR Serrins AJ. Transantral ligation of the internal maxillary artery for epistaxis. Laryngoscope. 1965;75(7):1151-9.

  • 41. Stamm AC Pinto JA Neto AF Menon AD. Microsurgery in severe posterior epistaxis. Rhinology. 1985;23(4):321-5.

  • 42. Elden L Montanera W Terbrugge K Willinsky R Lasjaunias P Charles D. Angiographic embolization for the treatment of epistaxis: a review of 108 cases. Otolaryngol Head Neck Surg. 1994;111(1):44–50.

  • 43. Strach K Schröck A Wilhelm K Greschus S Tschampa H Mohlenbruch M et al. Endovascular treatment of epistaxis: indications management and outcome. Cardiovasc Intervent Radiol. 2011;34(6):1190-8. DOI: 10.1007/s00270-011-0155-5. Epub 2011 Apr 7.

  • 44. Loaëc M Moriniere S Hitier M Ferrant O Plauchu H Babin E. Psychosocial quality of life in hereditary haemorrhagic telangiectasia patients. Rhinology. 2011;49(2):164-7. DOI: 10.4193/Rhino10.090.

  • 45. Sadick H Naim R Oulmi J Hormann K Bergler W. Plasma surgery and topical estriol: effects on the nasal mucosa and long-term results in patients with Osler’s disease. Otolaryngol Head Neck Surg. 2003;129(3):233-8.

  • 46. Rimmer J Lund VJ. Hereditary haemorrhagic telangiectasia. Rhinology. 2015;53(3):195-203.

  • 47. Wang B Zu QQ Liu XL Zhou CG Xia JG Zhao LB et al. Transarterial embolization in the management of intractable epistaxis: the angiographic findings and results based on etiologies. Acta Otolaryngol. 2016;136(8):864-8. DOI: 10.3109/00016489.2016.1164896. Epub 2016 Apr 8.

Journal information
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 431 177 10
PDF Downloads 318 194 26