Evaluation of conservative measures in the treatment of epistaxis

Epistaxis is a common cause for Emergency Department (ED) visits. Approximately 60% of the population has at least one bleeding episode over the course of a lifetime, fortunately; only 6% of this group requires medical attention. Both conservative and surgical modalities have been used in the treatment of epistaxis. Conservative measures conventionally include cauterization of the bleeding site, anterior nasal packing (ANP) and posterior nasal packing (PNP). The aim of this study is to assess the efficacy of the various conservative treatment modalities. This study was conducted between December 2000 and April 2005 and comprised a total of 200 cases of epistaxis managed in the Department of Otorhinolaryngology, Royal Medical Services (Amman, Jordan). All patients were treated initially by conservative measures and four groups were categorized based on the treatment received. Group I: Cauterization of the bleeding site using 15% silver nitrate was tried in 154 (77%) patients, and was successful in 114 (74.02%) of them. Group II: anterior nasal packing was done in a total of 86 (43%) patients and was successful in 74 (86.04%). Group III: Posterior nasal packing was done in 12 (6%) cases and was successful in 11 (91.6%). Group IV: Embolization of the internal maxillary artery was done in one patient (0.5%) who had intractable epistaxis and the previous measures were unsuccessful to control it. This was effective in stopping the bleeding. This study supports the clinical usefulness of conservative management in the treatment of patients with epistaxis. Most cases were successfully managed with conservative medical management alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. *Corresponding author: Department of ENT. RMS. Jordan Armed Forces, Amman, Jordan, P.O. Box, Sweileh 1834. Email: nemer72@gmail.com