title: Endoscopically guided chitosan nasal packing for intractable epistaxis.
abstract: BACKGROUND
  The purpose of this study was to evaluate the effectiveness and safety of endoscopically guided chitosan packing in controlling intractable epistaxis. A prospective case series was performed.
  
  
  METHODS
  This is a prospective clinical study conducted in a tertiary rhinology fellowship training hospital between January 2009 and November 2009. The study population consisted of patients with intractable epistaxis that failed to respond to traditional anterior-posterior nasal packing using either a 10-cm Pope PVA Merocel or a Rapid-Rhino. The bleeding site was identified using a nasal endoscope and controlled using a pack made of a ChitoFlex chitosan dressing wrapped around a polyvinyl acetal nasal sponge.
  
  
  RESULTS
  The intent-to-treat population consisted of 20 severe epistaxis subjects (8 men and 12 women) who continued to bleed despite traditional anterior-posterior nasal packing. The mean age was 67 years (±19 years). Sixteen subjects were on antiplatelets and/or anticoagulants. Eleven subjects (55%) presented with anterior epistaxis, and 7 subjects (35%) presented with posterior epistaxis. Chitosan nasal packing was performed on an outpatient basis and resulted in effective and immediate hemostasis in 19/20 subjects (95%). One subject had persistent bleeding after the first packing attempt and was successfully repacked within 30 minutes. Time to complete cessation of bleeding was 3.6 ± 2.2 minutes in the 19 subjects; the pack was removed after 48 hours, without any evidence of rebleeding or any serious side effects.
  
  
  CONCLUSIONS
  Endoscopically guided chitosan packing is a safe, effective, and well-tolerated outpatient treatment for the management of intractable epistaxis.
authors.affiliation: Division of Rhinology, The Union Memorial Hospital, Baltimore, Maryland, USA. ashikani@aol.com
authors.forename: Alan H
authors.initials: AH
authors.lastname: Shikani
authors.forename: Karim A
authors.initials: KA
authors.lastname: Chahine
authors.forename: Mohannad A
authors.initials: MA
authors.lastname: Alqudah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D048271:Chitosan / Q000008:administration & dosage* / Q000009:adverse effects; D019723:Endoscopes / Q000706:statistics & numerical data; D004844:Epistaxis / Q000473:pathology / Q000503:physiopathology / Q000517:prevention & control*; D005240:Feasibility Studies; D005260:Female; D006490:Hemostatics / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000378:metabolism; D009666:Nose / Q000187:drug effects* / Q000473:pathology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D006490:Hemostatics; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate; D048271:Chitosan