Clin Exp Otorhinolaryngol.  2016 Jun;9(2):131-135. 10.21053/ceo.2015.00416.

Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis

• Farneti P
• Pasquini E
• Sciarretta V
• Macrì G
• Gramellini G
• Pirodda A

• KMID: 2165055
• DOI: http://doi.org/10.21053/ceo.2015.00416

Abstract

OBJECTIVES
Epistaxis is one of the most common otorhinolaryngologic emergencies representing more than 12% of conditions managed at the Ear, Nose and Throat (ENT) Emergency Consulting Room of our Otorhinolaryngologic Unit each year. The elevated frequency of this pathology makes it necessary to adopt the most effective and least expensive therapeutic strategy available. The aim of this study was to compare the efficacy, costs and morbidity of nasal packing (NP), which is the mainstay of treatment for anterior epistaxis in our ENT Emergency Consulting Room versus submucosal infiltrations of lauromacrogol (LA).
METHODS
A retrospective study was designed from August 2012 to April 2013 involving 53 patients suffering from anterior epistaxis. Anterior NP was used in 27 patients versus 26 patients undergoing 27 procedures performed with submucosal infiltrations of LA (or polidocanol). Outcomes for each treatment were evaluated. Patients in group 1 were treated with LA 400 injection next to the bleeding point: 0.5- to 1-mL single or multiple infiltrations with a 27-gauge needle. The whitening of the nasal mucosa around the bleeding point during infiltration was considered a marker of correct procedure in order to achieve the best results. Bilateral treatment was also performed at the same time. Patients in group 2 were treated with standard NP.
RESULTS
Bleeding recurrence was higher in the NP group even if it was not statistically significant (P=0.2935). However, the LA infiltrations were better tolerated with lower morbidity and costs as compared to NP. No complications were observed in either group.
CONCLUSION
LA infiltrations were shown to be a viable alternative in anterior epistaxis treatment. They are safe, easy to use with good efficacy and have a low cost.

Keyword

Epistaxis; Sclerotherapy; Polidocanol; Nasal Mucosa; Polyethylene Glycol

MeSH Terms

Ear
Emergencies
Epistaxis*
Hemorrhage
Humans
Nasal Mucosa
Needles
Nose
Pathology
Pharynx
Polyethylene Glycols
Recurrence
Retrospective Studies
Sclerotherapy*
Polyethylene Glycols

Reference

1. Daudia A, Jaiswal V, Jones NS. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol. 2008; Dec. 33(6):618–20.

2. Ha JF, Hodge JC, Lewis R. Comparison of nasendoscopic-assisted cautery versus packing for the treatment of epistaxis. ANZ J Surg. 2011; May. 81(5):336–9.

3. Javed F, Foxton C, Daudia A. The application of modified guidelines for epistaxis management: our experience in 30 patients before and 32 patients after audit. Clin Otolaryngol. 2012; Apr. 37(2):151–5.

4. Nikolaou G, Holzmann D, Soyka MB. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol. 2013; Aug. 270(8):2239–44.

5. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. 2005; May. 81(955):309–14.

6. Shukla PA, Chan N, Duffis EJ, Eloy JA, Prestigiacomo CJ, Gandhi CD. Current treatment strategies for epistaxis: a multidisciplinary approach. J Neurointerv Surg. 2013; Mar. 5(2):151–6.

7. Meric Teker A, Korkut AY, Kahya V, Gedikli O. Prospective, randomized, controlled clinical trial of Ankaferd Blood Stopper in patients with acute anterior epistaxis. Eur Arch Otorhinolaryngol. 2010; Sep. 267(9):1377–81.

8. Melia L, McGarry GW. Epistaxis: update on management. Curr Opin Otolaryngol Head Neck Surg. 2011; Feb. 19(1):30–5.

9. Morais D, Millas T, Zarrabeitia R, Botella LM, Almaraz A. Local sclerotherapy with polydocanol (Aethoxysklerol®) for the treatment of Epistaxis in Rendu-Osler-Weber or Hereditary Hemorrhagic Telangiectasia (HHT): 15 years of experience. Rhinology. 2012; Mar. 50(1):80–6.

10. Paul J, Kanotra SP, Kanotra S. Endoscopic management of posterior epistaxis. Indian J Otolaryngol Head Neck Surg. 2011; Apr. 63(2):141–4.

11. Khan A, Khan AR. Results of silver nitrate cauterization in adult patients with epistaxis. J Med Sci. 2010; Jun. 18(2):107–9.

12. Ahmed A, Woolford TJ. Endoscopic bipolar diathermy in the management of epistaxis: an effective and cost-efficient treatment. Clin Otolaryngol Allied Sci. 2003; Jun. 28(3):273–5.

13. Soyka MB, Nikolaou G, Rufibach K, Holzmann D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology. 2011; Oct. 49(4):474–8.

14. Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope. 2005; May. 115(5):899–902.