Early operative intervention versus conventional treatment in epistaxis: randomized prospective trial.
OBJECTIVE
This prospective randomized trial was designed to compare intranasal endoscopic sphenopalatine artery ligation (ESAL) with conventional nasal packing in the treatment of recurrent epistaxis.


METHODS
Patients were registered in the study databank following referral for epistaxis control to the otolaryngology service at the University of Alberta. All patients were initially packed using Merocel (Xomed Surgical Products, Jacksonville, FL) nasal dressings bilaterally. Patients were enrolled in the study following failure of Merocel packings. Informed consent was obtained in accordance with the Health Research Ethics Board. The patients were then managed with Vaseline nasal packs or ESAL. Patient demographics, treatment characteristics, number of hospitalization days, and rates of recurrence were recorded prospectively. The total cost of treatment for each patient was calculated.


RESULTS
Nineteen patients were enrolled in the study. There was a significant reduction in cost and length of hospitalization of the patients undergoing ESAL compared with the conventional nasal packings. ESAL was also 89% effective in controlling the bleeding and had minimal sequelae or complications. The overall calculated cost of patients undergoing ESAL was dollars 5133 compared with dollars 12213 in the conservative group, resulting in an average saving of dollars 7080 per patient. There was overwhelming patient satisfaction with ESAL compared with nasal packings.


CONCLUSIONS
ESAL is an excellent, well-tolerated, and cost-effective method of treating recurrent epistaxis.
Moshaver
Ali
A
Division of Otolaryngology-Head and Neck Surgery, University of Alberta, Edmonton, AB.
Harris
Jeffrey Richard
JR
Liu
Richard
R
Diamond
Chris
C
Seikaly
Hadi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery; D017046:Cost Savings; D004724:Endoscopy / Q000191:economics; D004844:Epistaxis / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D005557:Formaldehyde / Q000191:economics / Q000627:therapeutic use; D006490:Hemostatics / Q000191:economics / Q000627:therapeutic use; D006801:Humans; D007902:Length of Stay; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010159:Palate / Q000098:blood supply; D017060:Patient Satisfaction; D011142:Polyvinyl Alcohol / Q000191:economics / Q000627:therapeutic use; D011446:Prospective Studies; D012008:Recurrence; D013100:Sphenoid Bone / Q000098:blood supply; D013630:Tampons, Surgical / Q000191:economics
D006490:Hemostatics; D005557:Formaldehyde; C027490:polyvinyl alcohol formaldehyde foam; D011142:Polyvinyl Alcohol