Cost Effective Trend in Epistaxis Management

Background: Epistaxis affects much of the population and is a common medical complaint seen across a variety of medical settings. Current standard of care treatment includes a range of options from topical therapy to invasive intranasal device insertion in the absence of on-demand specialist involvement. Aim: The aim of this article is to not only highlight superior outcomes in patients with acute nontraumatic epistaxis that are treated with noninvasive nebulized tranexamic acid instead of more invasive options, but also monetary benefit to the community through reduced costs. Case Presentation: this case report highlights a successful epistaxis resolution with use of tranexamic acid in a 64-year-old female after she was subjected to intranasal device insertion that did not resolve bleeding. Conclusion: Nebulized tranexamic acid is a cost-effective medication that not only reduces rates of recurrence, but it also increases patient satisfaction while minimizing overall healthcare costs, and therefore should be the first choice therapy in uncomplicated epistaxis management.

Epistaxis in end stage liver disease masquerading as severe upper gastrointestinal hemorrhage

AIM: To describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).

Use of nasal tampons for on-field management of nasal bleeds (epistaxis) in sports

In a medical setting,such as the treatment of post-operative nosebleeds,nasal packing,including the use of nasal packs,nasal plugs or nasal tampons(NTs),is widely used to temporarily control anterior epistaxis.Although some literature has documented the use of NTs as a quick,easy and temporary solution to deal with anterior epistaxis in sports-induced nasal injuries,additional research is needed to appreciate on-field versus off-field efficacy,as well as the efficiency of different brands of NTs and packing materials.

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

Objective:Nasal packing is routinely applied after septoplasty.Patients,however,report feeling very uncomfortable while the packing is in place.The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.Methods:In this study,135 patients undergoing septoplasty were divided into 3 groups:group 1 patients had microdebrider with packing,group 2 received coblation with packing and group 3 had coblation with suture.Early postoperative quality of life and complications were compared between the 3 groups.Results:The patients in group 1 experienced the most postoperative nasal pain,headache,dysphagia,sleep disturbance and bleeding on the night of surgery;while the patients in group 3 experienced the fewest symptoms.No difference in epiphora was observed between the 3 groups.More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3).We noted one case of postoperative bleeding in group 1,one septal hematoma in group 1 and a second septal hematoma in group 2.No such postoperative complications were found in group 3.Conclusion:Nasal septum suture combined with inferior turbinate coblation was not only associated with less pain,increased patient satisfaction and an improved quality of life;but also reduced postoperative complications.Our results confirm that it is a more comfortable,reliable alternative to the more common nasal packing.

Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre

Objective:To estimate the hospital costs of managing anterior epistaxis in the Emergency Department at a Tertiary Care centre in Canada.Material and methods:A cost analysis was conducted based on a retrospective review of Emergency Department visits from January 2012 to May 2014.A consecutive sample of adult patients with a diagnosis of anterior epistaxis was included.Anterior epistaxis was managed via one of:Nasal clip,Merocel(R),Silver Nitrate cautery,Vaseline packing,other treatment or no treatment.Both the direct and indirect hospital costs(SCDN)for anterior epistaxis treatment were calculated from the hospital's perspective.Generalized linear models were used to assess the association between treatment modalities and total hospital costs while controlling for potential confounding factors.Results:Three hundred and fifty-three patients(49%female)with a mean age of(69.9±18.5)years were included in the analysis.The median(interquartile ranges)costs of treatment ranged from CS227.83(CS167.96,CS328.69)for observation to CS763.98(CS632.25,CS830.23)for Merocel(R).The overall median total hospital costs incurred across all modalities was CS566.24(CS459.61,CS753.46)for the management of anterior epistaxis.Silver Nitrate,nasal clip,and observation were statistically associated with a lower cost when compared to Merocel(R)(P<0.001)even after potential confounding factors were controlled.Conclusions:Our results show wide difference in the hospital cost of epistaxis across treatment modalities.These cost estimates can help inform future economic evaluation studies aiming to guide the allocation of health care resources for patients with epistaxis.