Nasal endoscope in posterior epistaxis: a preliminary evaluation.
ABSTRACT The findings of a preliminary, prospective evaluation of the role of endoscopy in the management of adult posterior epistaxis are presented. A cohort of patients managed by the endoscopic technique was compared with a control group managed by the traditional methods of nasal packing or epistaxis balloons. The endoscope allowed visualization and direct treatment of previously undiagnosed posterior bleeding points. Patients managed by the endoscopic technique had a significantly shorter duration of in patient stay than those managed by traditional methods.
- Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 10/2012; 37(5):382-9. · 1.87 Impact Factor
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ABSTRACT: BACKGROUND: The advent of endoscopic sphenopalatine artery ligation (ESPAL) for the control of posterior epistaxis provides an effective, low-morbidity treatment option. In the current practice algorithm, ESPAL is pursued after failure of posterior packing. Given the morbidity and limited effectiveness of posterior packing, we sought to determine the cost-effectiveness of first-line ESPAL compared to the current practice model. METHODS: A standard decision analysis model was constructed comparing first-line ESPAL and current practice algorithms. A literature search was performed to determine event probabilities and published Medicare data largely provided cost parameters. The primary outcomes were cost of treatment and resolution of epistaxis. One-way sensitivity analysis was performed for key parameters. RESULTS: Costs for the first-line ESPAL arm and the current practice arm were $6450 and $8246, respectively. One-way sensitivity analyses were performed for key variables including duration of packing. The baseline difference of $1796 in favor of the first-line ESPAL arm was increased to $6263 when the duration of nasal packing was increased from 3 to 5 days. Current practice was favored (cost savings of $437 per patient) if posterior packing duration was decreased from 3 to 2 days. CONCLUSION: This study demonstrates that ESPAL is cost-saving as first-line therapy for posterior epistaxis. Given the improved effectiveness and patient comfort of ESPAL compared to posterior packing, ESPAL should be offered as an initial treatment option for medically stable patients with posterior epistaxis.International Forum of Allergy and Rhinology 01/2013; · 1.00 Impact Factor
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ABSTRACT: To test the hypothesis that potential sites of weakness within normal nasal arteries, when stressed, contribute to the mechanism of epistaxis, we 'stress-tested' nasal arteries in unfixed cadaveric heads, using pressure injection of feeding arteries. Indian ink with latex was injected into maxillary arteries under high pressure (620 mmHg). Stepwise dissection was carried out and areas showing ink leakage were examined. Control heads were injected at standard embalming pressures (375 mmHg). Ink leakage was found in all heads injected at higher pressure, and was restricted to the nasal mucosa. Histological examination of leakage points demonstrated vessel disruption consistent with dissecting aneurysm formation. Results showed that high pressure injection caused leakage from arteries in the posterior nose; the distribution of leakage points was consistent with many clinical investigations. The lesions produced were comparable with our best histopathological model of epistaxis, i.e. dissecting aneurysm formation. This suggests that pre-existing weaknesses in the arterial configuration may exist.The Journal of Laryngology & Otology 07/2010; 124(7):750-2. · 0.68 Impact Factor