title: Study of hemostasis procedures for posterior epistaxis.
abstract: OBJECTIVE
  Hemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbach's area.
  
  
  METHODS
  The subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis.
  
  
  RESULTS
  The bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures.
  
  
  CONCLUSIONS
  We propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed.
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Daisan Hospital, Japan; Department of Otorhinolaryngology, the Jikei University Hospital, Japan. Electronic address: jiro.ii@icloud.com.
authors.forename: Jiro
authors.initials: J
authors.lastname: Iimura
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Daisan Hospital, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Hatano
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Arai
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Arai
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Shigeta
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Kojima
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Otori
authors.affiliation: Department of Otorhinolaryngology, the Jikei University Hospital, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Wada
mesh_terms: D021721:Balloon Occlusion; D002425:Cautery / Q000379:methods; D004564:Electrocoagulation; D004724:Endoscopy; D004844:Epistaxis / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009296:Nasal Cavity / Q000601:surgery*; D009297:Nasal Mucosa / Q000601:surgery*; D009300:Nasal Septum / Q000601:surgery*; D012008:Recurrence; D012225:Rhinoplasty; D013630:Tampons, Surgical
keywords: Electrocoagulation; Epistaxis; Gauze tampon; Recurrent bleeding factor