A new approach to the management of acute epistaxis.

A new approach to the management of acute epistaxis is described using suction with the operating microscope to define the bleeding point prior to the application of hot wire cautery. This technique was shown to be completely successful in stopping haemorrhage in 82% of acute referrals in a prospective series of 33 patients. It resulted in a significant reduction both in the use of nasal packing and in the length of hospital stay compared with a group of controls treated by traditional means. It is proposed that in most cases of acute epistaxis the bleeding point is accessible to cautery and nasal packing should be reserved for a minority of refractory cases. This avoids unnecessary patient discomfort and the complications of prolonged nasal packing and hospitalization.