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Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

I Z Iqbal ,
G H Jones ,
N Dawe ,
C Mamais ,
M E Smith ,
R J Williams ,
I Kuhn  and
S Carrie
I Z Iqbal*
Affiliation:
Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
G H Jones
Affiliation:
Department of Otolaryngology, Manchester Royal Infirmary, UK
N Dawe
Affiliation:
Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
C Mamais
Affiliation:
Department of Otolaryngology, Aberdeen Royal Infirmary, UK
M E Smith
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
R J Williams
Affiliation:
Institute of Naval Medicine, Gosport, UK
I Kuhn
Affiliation:
University of Cambridge School of Clinical Medicine, UK
S Carrie
Affiliation:
Newcastle University, Newcastle upon Tyne, UK
*
Address for correspondence: Miss Isma Z Iqbal, Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK E-mail: ismaiqbal@doctors.org.uk
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Abstract

Background:

The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.

Method:

A systematic review of the literature was performed using standardised methodology.

Results:

Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.

Conclusion:

Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.

Keywords

EpistaxisTherapyHemorrhagePacking
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1065 - 1092
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Kundi, NA, Raza, M. Duration of nasal packs in the management of epistaxis. J Coll Physicians Surg Pak 2015;25:202–5Google Scholar
2 McGlashan, J, Walsh, R, Dauod, A, Vowles, A, Gleeson, M. A comparative study of calcium sodium alginate (Kaltostat) and bismuth tribromophenate (Xeroform) packing in the management of epistaxis. J Laryngol Otol 1992;106:1067–71Google Scholar
3 Biswas, D, Mal, R. Are systemic prophylactic antibiotics indicated with anterior nasal packing for spontaneous epistaxis? Acta Otolaryngol 2009;129:179–81CrossRefGoogle ScholarPubMed
4 National Institute for Health and Care Excellence. Clinical Knowledge Summaries. Epistaxis (nosebleeds). In: https://cks.nice.org.uk/epistaxis-nosebleeds [2 August 2017]Google Scholar
5 BMJ Best Practice on Epistaxis. In: https://bestpractice.bmj.com/best-practice/monograph-pdf/421.pdf [2 August 2017]Google Scholar
6 Evans, AS, Young, D, Adamson, R. Is the nasal tampon a suitable treatment for epistaxis in Accident & Emergency? A comparison of outcomes for ENT and A&E packed patients. J Laryngol Otol 2004;118:12–14 Google Scholar
7 Badran, K, Malik, T, Belloso, A, Timms, M. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol 2005;30:333–7Google Scholar
8 Khan, M, Conroy, K, Ubayasiri, K, Constable, J, Smith, ME, Williams, RJ et al. Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
9 Pollice, PA, Yoder, MG. Epistaxis: a retrospective review of hospitalized patients. Otolaryngol Head Neck Surg 1997;117:49–53 Google Scholar
10 Singer, AJ, Blanda, M, Cronin, K, LoGiudice-Khwaja, M, Gulla, J, Bradshaw, J et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med 2005;45:134–9CrossRefGoogle ScholarPubMed
11 Corbridge, R, Djazaeri, B, Hellier, W, Hadley, J. A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis. Clin Otolaryngol Allied Sci 1995;20:305–7Google Scholar
12 Mathiasen, RA, Cruz, RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899–902 Google Scholar
13 Kundra, A, Cho, W, Sahota, R, Pau, H, Conboy, P. Epistaxis management: is there a role for floseal? Int J Surg 2014;12(suppl 3):S44 Google Scholar
14 Shikani, AH, Chahine, KA, Alqudah, MA. Endoscopically guided chitosan nasal packing for intractable epistaxis. Am J Rhinol Allergy 2011;25:61–3Google Scholar
15 Bhatnagar, R, Berry, S. Selective surgicel packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4Google Scholar
16 Côté, D, Barber, B, Diamond, C, Wright, E. FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial. J Otolaryngol Head Neck Surg 2010;39:304–8Google Scholar
17 Kilty, SJ, Al-Hajry, M, Al-Mutairi, D, Bonaparte, JP, Duval, M, Hwang, E et al. Prospective clinical trial of gelatin-thrombin matrix as first line treatment of posterior epistaxis. Laryngoscope 2014;124:38–42 Google Scholar
18 Walshe, P. The use of fibrin glue to arrest epistaxis in the presence of a coagulopathy. Laryngoscope 2002;112:1126–8Google Scholar
19 Upile, T, Jerjes, W, Sipaul, F, El Maaytah, M, Singh, S, Hopper, C et al. A change in UK epistaxis management. Eur Arch Otorhinolaryngol 2008;265:1349–54Google Scholar
20 Glicksman, JT, Brandt, MG, Moukarbel, RV, Rotenberg, B, Fung, K. Computer-assisted teaching of epistaxis management: a randomized controlled trial. Laryngoscope 2009;119:466–72CrossRefGoogle ScholarPubMed
21 Lammers, RL. Learning and retention rates after training in posterior epistaxis management. Acad Emerg Med 2008;15:1181–9Google Scholar
22 Sugarman, P, Alderson, D. Training model for nasal packing. J Accid Emerg Med 1995;12:276–8CrossRefGoogle ScholarPubMed
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;263:719–22Google Scholar
24 Murthy, P, Christodoulou, C, Yatigammana, N, Datoo, M. The influence of medical audit on the management of epistaxis in three district general hospitals. J Laryngol Otol 1994;108:38–41 Google Scholar
25 Hettige, R, Mackeith, S, Falzon, A, Draper, M. A study to determine the benefits of bilateral versus unilateral nasal packing with Rapid Rhino packs. Eur Arch Otorhinolaryngol 2014;271:519–23Google Scholar
26 Mackeith, S, Hettige, R, Falzon, A, Draper, M. The relationship between pressure and volume when using Rapid Rhino(r) packs in the management of epistaxis. Rhinology 2011;49:470–3Google Scholar
27 Nikolaou, G, Holzmann, D, Soyka, MB. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol 2013;270:2239–44Google Scholar
28 Wang, TC, Tai, CJ, Tsou, YA, Tsai, LT, Li, YF, Tsai, MH. Absorbable and nonabsorbable packing after functional endoscopic sinus surgery: systematic review and meta-analysis of outcomes. Eur Arch Otorhinolaryngol 2015;272:1825–31Google Scholar
29 Van Wyk, F, Massey, S, Worley, G, Brady, S. Do all epistaxis patients with a nasal pack need admission? A retrospective study of 116 patients managed in accident and emergency according to a peer reviewed protocol. J Laryngol Otol 2007;121:222–7Google Scholar
30 Mehanna, H, Abdelkader, M, Albahnasawy, L, Johnston, A. Early discharge following nasal pack removal: is it feasible? Clin Otolaryngol Allied Sci 2002;27:153–5Google Scholar
31 Wetmore, SJ, Scrima, L, Hiller, FC. Sleep apnea in epistaxis patients treated with nasal packs. Otolaryngol Head Neck Surg 1988;98:596–9CrossRefGoogle ScholarPubMed
32 Herzon, FS. Bacteremia and local infections with nasal packing. Arch Otolaryngol 1971;94:317–20Google Scholar
33 Derkay, CS, Hirsch, BE, Johnson, JT, Wagner, RL. Posterior nasal packing: are intravenous antibiotics really necessary? Arch Otolaryngol Head Neck Surg 1989;115:439–41Google Scholar
34 Pepper, C, Lo, S, Toma, A. Prospective study of the risk of not using prophylactic antibiotics in nasal packing for epistaxis. J Laryngol Otol 2012;126:257–9Google Scholar
35 Biggs, T, Nightingale, K, Patel, N, Salib, R. Should prophylactic antibiotics be used routinely in epistaxis patients with nasal packs? Ann R Coll Surg Engl 2013;95:40–2CrossRefGoogle ScholarPubMed
36 Shargorodsky, J, Bleier, BS, Holbrook, EH, Cohen, JM, Busaba, N, Metson, R et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg 2013;149:390–8Google Scholar
37 Tibbels, EW. Evaluation of a new method of epistaxis management. Laryngoscope 1963;73:306–14Google Scholar
38 Cook, PR, Renner, G, Williams, F. A comparison of nasal balloons and posterior gauze packs for posterior epistaxis. Ear Nose Throat J 1985;64:446–9Google Scholar
39 Pringle, MB, Beasley, P, Brightwell, AP. The use of Merocel nasal packs in the treatment of epistaxis. J Laryngol Otol 1996;110:543–6Google Scholar
40 Soyka, MB, Nikolaou, G, Rufibach, K, Holzmann, D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 2011;49:474–8CrossRefGoogle ScholarPubMed
41 Elwany, S, Kamel, T, Mekhamer, A. Pneumatic nasal catheters: advantages and drawbacks. J Laryngol Otol 1986;100:641–7Google Scholar
42 Kourelis, K, Shikani, AH. Effectiveness of chitosan-based packing in 35 patients with recalcitrant epistaxis in the context of coagulopathy. Clin Otolaryngol 2012;37:309–13Google Scholar
43 Khan, MK, Reda El Badawey, M, Powell, J, Idris, M. The utility of FloSeal haemostatic agent in the management of epistaxis. J Laryngol Otol 2015;129:353–7Google Scholar