What is your treatment for recurrent epistaxsis. No specific cause.
Nose resumes bleeding from the same site even after cautery and packing.
Nose resumes bleeding from same site even after 6-7 days of packing.
Begins 3-5 days after packing removed.
What specific topical medications would you use?
Any other treatment after packing removed?
Thanks
Reply: ----------------------------
For recurrent epistaxis of this nature it is important to determine whether there are any contributing factors such as high blood pressure, coagulation disorders, medications that may predispose to bleeding (aspirin, anti-inflammatory medications, coumadin, vitamin E, etc.), medical conditions or medications that may be dessicating the mucosal membranes (diuretics, antihistamines, etc.), liver disorders, co-existent nasal or sinus conditions such as allergy or chronic sinusitis, etc. It is also important to carefully examine the nose (preferably with nasal endoscopy) to identify any mucosal lesions or anatomic factors such as septal bone spurs etc. that may be contributing. Acute management of the individual with recurrent epistaxis requires meticulous identification of the exact source of bleeding - this may be difficult especially for non-specialists if bleeding is profuse or if anatomic abnormalities exist such as a deviated septum. Endoscopic examination is often quite helpful. Once the exact location of bleeding is identified, it can usually be temporarily arrested with local infiltration of anesthetic containing adrenalin which causes vasoconstriction - then the area can be discretely cauterized. Electrocautery may be more effective than chemical cautery for problematic cases. Occasionally, profuse bleeding occurs behind a septal deviation or spur and it may occasionally be necessary to perform a septoplasty to allow for adequate visualization. Preventative measures include eliminating all potential aggravating or exacerbating factors such as those previously mentioned. It is important to avoid "picking" or rubbing the nose as well as avoiding any vigorous nose blowing for several days. Strenuous activity should be avoided for several days. Most importantly, proper moisturization of the nose with either nasal saline or emollients such as Ponaris or Pretz solutions is necessary.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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