[Nasal packing in posterior epistaxis. Comparison of two methods].
OBJECTIVE
To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis.


METHODS
A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects.


RESULTS
In patients with inflatable nasal packing its placement was significantly faster (36+/-19s vs. 228+/-102 s; p<0.001) and less painful (6.7+/-1.7 vs. 8.3+/-1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327+/-202 euro vs. 1648+/-318 euro; p<0.001) and it generated less short and long-term complications


CONCLUSIONS
The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing.
Servicio de Otorrinolaringología, Hospital Clínico Universitario de Valencia, Universidad de Valencia, Valencia, España. jgarciacall@hotmail.com
F Javier
FJ
García Callejo
Noelia
N
Muñoz Fernández
M Teresa
MT
Achiques Martínez
Soledad
S
Frías Moya-Angeler
M José
MJ
Montoro Elena
J Marco
JM
Algarra
D000328:Adult; D000368:Aged; D004638:Emergency Treatment / Q000379:methods*; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013630:Tampons, Surgical