E Bequignon1, B Vérillaud2, L Robard3, J Michel4, V Prulière Escabasse5, L Crampette6, O Malard7. 1. Service d'ORL, hôpital Henri-Mondor - A.-Chenevier, AP-HP, 51, avenue du Maréchal-de-Lattre-Tassigny, 94010 Créteil, France. Electronic address: emilie.bequignon@gmail.com. 2. Service d'ORL et chirurgie cervico-faciale, hôpital Lariboisière, AP-HP, 2, rue Ambroise-Paré, 75010 Paris, France. 3. Service d'ORL et chirurgie cervico-faciale, CHU de Caen, avenue de la Côte-de-Nacre, CS 30001, 14033 Caen cedex 9, France. 4. Service d'ORL et chirurgie cervico-faciale, CHU La Conception, AP-HM, 147, boulevard Baille, 13385 Marseille cedex 5, France. 5. Service d'ORL et chirurgie cervico-faciale, CHI de Créteil, 40, avenue de Verdun, 94000 Créteil, France. 6. Service d'ORL et chirurgie cervico-faciale, CHU Gui-De-Chauliac, 80, avenue Augustin-Fliche, 34000 Montpellier, France. 7. Service d'ORL et chirurgie cervico-faciale, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France.
Abstract
OBJECTIVES: The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults. METHODS: A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work-group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS: In first-line, clearing out blood-clots and bidigital compression are recommended. In case of persistent bleeding, local anesthesia with a vasoconstrictor is essential before nasal diagnostic and therapeutic procedures. When the origin of bleeding is not anterior, nasal endoscopy is an essential procedure, identifying the bleeding site in most cases. In case of active bleeding, cauterization is recommended but is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
OBJECTIVES: The authors present the guidelines of the French Otorhinolaryngology-Head and Neck Surgery Society (SFORL) on first-line treatment of epistaxis in adults. METHODS: A multidisciplinary work-group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work-group. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence. RESULTS: In first-line, clearing out blood-clots and bidigital compression are recommended. In case of persistent bleeding, local anesthesia with a vasoconstrictor is essential before nasal diagnostic and therapeutic procedures. When the origin of bleeding is not anterior, nasal endoscopy is an essential procedure, identifying the bleeding site in most cases. In case of active bleeding, cauterization is recommended but is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.