Early Surgical Intervention versus Conventional Treatment in Posterior Epistaxis: A Systematic Review

Epistaxis is derived from Greek ‘to bleed from nose’. Epistaxis is one of the common presenting problem to Accident and Emergency departments. The bleeding can occur in different places inside the nose commonest being from the Little’s area; cluster of blood vessels around anterior part of septum –the anterior epistaxis. The posterior epistaxis is defined when the bleeding point cannot be visualized with anterior rhinoscopy [1]. Also those patients in whom an anterior bleeding point could not be found were by definition suffering from posterior epistaxis. In one study the authors located the bleeding site of posterior epistaxis on the posterior part of the lateral wall of nose in 80% of cases and in 20% it was found on the septum [2]. Management of patients with posterior epistaxis involves failed conservative therapy of packing and repacking and then surgical treatment. Ancient Egyptians used ashes of papyrus mixed with vinegar to treat nosebleed. Powder made from mummies (mummiavera) was also used at the end of 17th century [3]. Hippocrates used sheep’s wool on pugilistic noses in ancient Greece [4] and also ancient Greeks and Romans practiced bloodletting for treatment of epistaxis. The traditional method of nasal packing for posterior epistaxis is cumbersome and causes pain and discomfort to patient. Pringle et al. [5] recommended use of Merocel nasal tampon for treatment of epistaxis. A Foley’s catheter use to stop posterior bleed was described by Holland in 2001 [6]. However; there is a risk of respiratory complications and patients may develop sleep apnoea after placement of posterior nasal packing [7]. Volume 3 Issue 5 2015