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Current Opinion in Otolaryngology & Head & Neck Surgery:
doi: 10.1097/MOO.0b013e328341e1e9
Nose and paranasal sinuses: Edited by Anshul Sama

Epistaxis: update on management

Melia, Louise; McGarry, Gerald W

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Abstract

Purpose of review: This article reviews the literature on epistaxis, with a focus on the past 12–18 month, and aims to classify the literature available for this very common otolaryngology emergency.

Recent findings: Epistaxis can be classified into primary or secondary epistaxis based on cause. It can also be classified as childhood and adult epistaxis. These classifications are useful clinically, as the management of each group is different. Primary epistaxis should be managed by identification of the actual bleeding point and treated with chemical or electrocautery, bipolar diathermy or small packs placed directly over the bleeding point. Secondary epistaxis should be managed by identification of the cause, with application of appropriate nasal therapy and, importantly, corrective systemic medical management. We now have useful guidelines for the management of patients whose epistaxis is secondary to warfarin and a growing body of information regarding complementary medicines that may contribute to bleeding. The literature continues to support the role of antiplatelet drugs as important risk factors for epistaxis. Patients with continued epistaxis despite initial measures should be considered earlier, rather than later, for surgical ligation techniques or embolization. Children with epistaxis should be managed with topical antiseptic cream with or without septal cautery.

Summary: Recent literature focuses on the cause and management of epistaxis. Although the level of evidence available for this topic is low, there have been many clinically useful studies that will contribute to an overall improvement in patient care.

© 2011 Lippincott Williams & Wilkins, Inc.

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