Avoidance Of Nasal Pack By Routine Use Of Nasal Endoscope In Initial Management Of Epistaxis

Introduction - This study was undertaken with the objective to know whether routine use of nasal endoscope in initial management of epistaxis can help to control bleeding without the need of nasal pack so as to achieve targeted haemostasis with minimal discomfort. Material and methods- We conducted a cross sectional study enrolling 21 patients who were treated with nasal pack in other centers within less than 6 hours from onset of bleeding but were still bleeding and were referred to ENTdepartment of our hospital with nasal pack in situ. Deliberate search for bleeding point was made and tried to control bleeding by direct methods. Result- In 19 patients bleeding point was localized precisely whereas in 2 patients it was not. We controlled bleeding in 17 patients by chemical cautery or bipolar diathermy. In 2 patients repacking was done with medicated ribbon gauge as bleeding point could not be localized and bleeding was diffuse. Miniature pack of gelfoam was used to pack the inferior meatus in one patient. One patient had a bleeding polyp which was excised endoscopically and haemostasis achieved. Overall 19 patients (90.47 percent) were managed by various direct therapies in our study. Conclusion- It is expected that routine use of nasal endoscope in initial management of epistaxis will help in accurate identication and good control of bleeding avoiding discomfort and complication of nasal packing.