title: Management of intractable epistaxis: endoscopy or nasal packing?
abstract: OBJECTIVE
  To investigate common origins of intractable epistaxis, and the efficacy of endoscopic management.
  
  
  METHODS
  Retrospective study of 265 patients with uncontrolled idiopathic epistaxis presenting between July 2008 and July 2009. Patients underwent endoscopic examination and subsequent radiofrequency electrocautery, selective packing or observation.
  
  
  RESULTS
  Nasal endoscopy indicated that the commonest bleeding sources were the superior nasal septum at the olfactory cleft (39.2 per cent), the inferior meatus (27.5 per cent), the sphenoethmoid recess (6.0 per cent), the middle meatus (5.3 per cent) and other locations (3.4 per cent). Bleeding was successfully controlled with nasal endoscopy plus radiofrequency electrocautery or selective packing. In 49 (18.5 per cent) patients, no abnormality was identified; these patients received observation only, and no further bleeding occurred. None of the patients had serious complications or recurrent epistaxis during the three-month follow-up period.
  
  
  CONCLUSIONS
  Thorough endoscopic examination combined with radiofrequency electrocautery should be used as first-line therapy for intractable epistaxis.
authors.affiliation: Department of Otolaryngology, Eye Ear Nose and Throat Hospital, Fudan University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Liu
authors.forename: C
authors.initials: C
authors.lastname: Zheng
authors.forename: W
authors.initials: W
authors.lastname: Wei
authors.forename: Q
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000008:administration & dosage; D017115:Catheter Ablation; D004724:Endoscopy; D004844:Epistaxis / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D013630:Tampons, Surgical; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local