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Intranasal cautery for the management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

R W J Mcleod ,
A Price ,
R J Williams ,
M E Smith ,
M Smith  and
D Owens
R W J Mcleod*
Affiliation:
ENT Department, University Hospital of Wales, Cardiff, UK
A Price
Affiliation:
ENT Department, University Hospital of Wales, Cardiff, UK
R J Williams
Affiliation:
Institute of Naval Medicine, Gosport, UK
M E Smith
Affiliation:
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
M Smith
Affiliation:
Exeter Health Library, Peninsula Medical School, UK
D Owens
Affiliation:
ENT Department, University Hospital of Wales, Cardiff, UK
*
Address for correspondence: Mr Robert Mcleod, ENT Department, University Hospital of Wales Main Building, Heath Park, Cardiff University, Cardiff CF14 4XN, Wales, UK E-mail: [email protected]
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Abstract

Background:

Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment.

Method:

A systematic review of the literature was performed using a standardised methodology and search strategy.

Results:

Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures.

Conclusion:

Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

Keywords

EpistaxisCauteryElectrocoagulationTherapy
Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 131 , Issue 12 , December 2017 , pp. 1056 - 1064
Copyright
Copyright © JLO (1984) Limited 2017 

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References

1 Key, G. Stopping nosebleeds in the elderly: pressure, cautery, or packing? Geriatrics 1981;36:74–80 Google Scholar
2 Frazee, TA, Hauser, MS. Nonsurgical management of epistaxis. J Oral Maxillofac Surg 2000;58:419–24Google Scholar
3 Barnes, ML, Spielmann, PM, White, PS. Epistaxis: a contemporary evidence based approach. Otolaryngol Clin North Am 2012;45:1005–17Google Scholar
4 Badran, K, Arya, AK. An innovative method of nasal chemical cautery in active anterior epistaxis. J Laryngol Otol 2005;119:729–30Google Scholar
5 Bray, D. A third hand for nasal cautery. Clin Otolaryngol 2007;32:209 Google Scholar
6 Alderson, D. Simple device for chemical cauterization of posterior bleeding points in the nose. J Laryngol Otol 2000;114:616–17CrossRefGoogle ScholarPubMed
7 Benson, M, Carlsson, L, Adner, M, Jernas, M, Rudemo, M, Sjogren, A et al. Gene profiling reveals increased expression of uteroglobin and other anti-inflammatory genes in glucocorticoid-treated nasal polyps. J Allergy Clin Immunol 2004;113:1137–43Google Scholar
8 Eng, CY, Hilmi, O, Ram, B. “Sheathed” silver nitrate stick to cauterise posterior epistaxis. Ann R Coll Surg Engl 2004;86:475–6Google Scholar
9 Judd, O. Novel method for safe cauterisation of posterior epistaxis. J Laryngol Otol 2009;123:910–11CrossRefGoogle ScholarPubMed
10 Maitra, S, Gupta, D. A simple technique to avoid staining of skin around nasal vestibule following cautery. Clin Otolaryngol 2007;32:74 Google Scholar
11 Nikolaou, G, Holzmann, D, Soyka, MB. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol 2013;270:2239–44CrossRefGoogle ScholarPubMed
12 Mackway-Jones, K. The management of anterior epistaxis. J Accid Emerg Med 1999;16:61–2Google Scholar
13 Toner, J, Walby, A. Comparison of electro and chemical cautery in the treatment of anterior epistaxis. J Laryngol Otol 1990;104:617–18CrossRefGoogle ScholarPubMed
14 Khan, M, Conroy, K, Ubayasiri, K, Constable, J, Smith, ME, Williams, RJ et al. Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In pressGoogle Scholar
15 Soyka, MB, Nikolaou, G, Rufibach, K, Holzmann, D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 2011;49:474–8Google Scholar
16 Henderson, AH, Larkins, A, Repanos, C. The use of bipolar electrocautery in adult epistaxis management: using audit of one hundred and twenty-four cases to define a standardised protocol. Clin Otolaryngol 2013;38:554–8Google Scholar
17 Ando, Y, Iimura, J, Arai, S, Arai, C, Komori, M, Tsuyumu, M et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx 2014;41:41–5Google Scholar
18 Shargorodsky, J, Bleier, BS, Holbrook, EH, Cohen, JM, Busaba, N, Metson, R et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg 2013;149:390–8Google Scholar
19 Nicolaides, A, Gray, R, Pfleiderer, A. A new approach to the management of acute epistaxis. Clin Otolaryngol 1991;16:59–61 Google Scholar
20 Mattoo, O, Yousuf, A, Mir, A, Muzaffar, R, Pampori, R. Control of anterior epistaxis: a comparative analysis of the decongestive effect of xylometazoline and adrenaline in idiopathic epistaxis in emergency settings. Clin Rhinol 2011;4:130–5Google Scholar