Study on Evaluation of Epistaxis sites and its Management in a Tertiary Care Centre

Abstract

Introduction: Epistaxis is defined as bleeding from inside the nose or nasal cavity and it is one of the most common emergencies in Otorhinolaryngology. The study aimed at evaluating the epistaxis sites and its different management.

 Methods: This was a descriptive cross- sectional study conducted on 109 epistaxis patients. Patients presenting in Otorhinolaryngology outpatient department or emergency with epistaxis without definite cause were selected. Study was conducted from 17^th February 2021 to 16^th February 2022.  Data regarding age, sex, side, site of epistaxis and mode of management were noted. Data were entered and analyzed using the Statistical Package for the Social Sciences version 20.0 and the descriptive statistical analysis was done.

 Results: The age of the patients was between 17 to 81 years with mean age of 51.16 ± 16.98 years. There were more males (57.8%) compared to female with male to female ratio of 1.36:1. Bleeding from right side was seen in 58(53.2%) patients. According to the bleeding site 61 patients (56.0%) had bleeding from anterior part of septum, 24(22%) had bleeding from posterior part of septum and nine (8.3%) had bleeding from lateral nasal wall, while in 15(13.8%) cases  exact site could not be identified. 55 patients (50.4%) were managed with silver nitrate chemical cautery or bipolar electrocautery, 22 patients (20.2%) had endoscopic cauterization, 11(10.1%) had SPA cauterization,  five patients (4.6%) had anterior nasal packing and only one patient (0.9%) had posterior nasal packing . Successful control of posterior epistaxis was seen in 29 (87.87%) patients with cauterization.

Conclusion: Nasal septum was the main site of bleeding in anterior and posterior epistaxis. The septum should be examined closely in cases of idiopathic bleeding. Anterior epistaxis can be managed with chemical cautery or bipolar electrocautery. If the bleeding source is not identified by anterior rhinoscopy, a nasal endoscopy is necessary to identify the site of epistaxis which is safe and less invasive procedure. Endoscopic electrocautery is the procedure of choice for posterior epistaxis. If this fails, there is still option of nasal packing.