Jubilee Hospital, Trivandrum, Kerala, India.
Nasal Bleeding (Epistaxis) remains a common clinical condition managed by ENT surgeons everyday.
Epistaxis is broadly categorized as anterior or posterior. Approximately 80% of nasal bleeding is anterior, occurring at the anterior inferior septum supplied by the Kiesselbach plexus (littles area).
It is generally accepted that management of anterior epistaxis includes cautery, anterior nasal packing, or both, the cautery usually by chemical-Silver nitrate.
In patients whose bleeding can be localized, I use a Co2 laser with a nasal attachment to point coagulate any bleeding vessels. First the nose is sprayed with a local anesthetic like 10% lignocaine spray and some xylometazoline decongestant. The procedure takes only few minutes and no need of hospital stay. A very low voltage setting, say 3 W (CW) is more than enough.
In children, the laser cautery may have to be done under a short anesthesia as a day case procedure.
If this attempt fails or and still bleeding soft-sponge packing, such as Merocel packing, can be placed after being coated with Neosporin or Sicastat ointment or a similar water-soluble antibiotic gel. The patient is then admitted in the hospital for further investigation and management.
Please watch the videos:
Laser Cautery Epistaxis
