Obra

Epistaxis: update on management
Louise Melia and Gerald W. McGarry
Department of Otolaryngology and Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK Correspondence to Louise Melia, MBChB, MRCS, Department of Otolaryngology and Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, UK Tel: +44 1412114423; e-mail: louisemelia07@gmail.com Current Opinion in Otolaryngology & Head andNeck Surgery 2011, 19:30–35

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 classificationsare 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 despiteinitial 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 usefulstudies that will contribute to an overall improvement in patient care. Keywords epistaxis, ethmoid artery, maxillary artery, nosebleeds, sphenopalatine artery
Curr Opin Otolaryngol Head Neck Surg 19:30–35 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins 1068-9508

Introduction
Epistaxis provides a challenge to all otolaryngologists. Most cases are mild and self-limiting; however, aproportion of cases are severe and lead to significant morbidity and mortality. These severe cases can be responsible for up to one-third of all ENT admissions [1]. Review of the Scottish Audit of Surgical Mortality shows death from epistaxis to be a recurring problem in hospital ENT departments. The need for hospital admission and the duration of inpatient stay are directly related to methods chosenfor initial, and indeed subsequent, treatment. A literature search spanning more than 10 years was conducted. Over 12 000 articles were identified and the overwhelming majority found to consist of level III evidence. A detailed analysis was made of articles from the past 12 months, and the structure of the literature was classified depending on evidence level (Fig. 1). The focus of the search wasto identify new concepts or information regarding the cause and management of epistaxis.
1068-9508 ß 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Despite its being the number one emergency for otolaryngologists in the UK, the level of evidence for the cause and management of epistaxis is poor. Despite these shortcomings of the evidence base, however, it is worth noting many of theclinically useful findings of recent research.

Background
In the United Kingdom healthcare system, epistaxis is the number one ENT emergency and in Scotland it accounts for a mean of six admissions each day to ENT units, with a mean inpatient stay of 5 days [1]. This burden of approximately 6000 inpatient days per annum represents a significant healthcare cost and presents us with the...