The use of Bipolar Diathermy for the outpatient control of posterior epistaxis

Abstract

B.J.McKenzie, J.W.Loock
Email: mckenzie@imaginet.co.za Tel: 021 9389318
Tygerberg Hospital, Faculty of Health Sciences, University of Stellenbosch
South Africa

Objectives:

To assess the effectiveness of controlling posterior epistaxis using nasal endoscopy and bipolar diathermy without nasal packing, by a registrar level ENT trainee, as the first line treatment at a South African teaching hospital.

Study design

Prospective series

Subjects.

All adult patients presenting to Tygerberg Academic hospital between 01/06/2006 and 01/10/2006 with posterior epistaxis were seen by a single investigator and included in the study. Fourteen patients were included in the study.

Outcome measures.

1) The successful control of posterior epistaxis without the need for any nasal packing.
2) The identification of the bleeding site

Results

Fourteen patients were seen at Tygerberg Hospital by the investigator with posterior epistaxis during the time period. In thirteen of these patients the bleeding site was identified. In eleven patients, the bleeding site was localised and cauterised, with no further bleeding. Two patients were initially controlled but bled again during the period of observation. One patient could not be controlled using this method at initial presentation. These three patients received nasal packs and were taken to theatre for control of the epistaxis.

Conclusions
Posterior epistaxis can be effectively managed using nasal endoscopy and bipolar cautery under local anaesthetic, instead of the traditional “blind” nasal packing. This significantly decreases patient morbidity and inpatient hospital time.