Identification of common bleeding points in intractable epistaxis

Area of Science:

• Otolaryngology
• Rhinology
• Medical Diagnostics

Background:

• Intractable epistaxis poses significant clinical challenges.
• Accurate localization of bleeding sources is essential for effective management.
• Previous studies have varied in identifying consistent bleeding points.

Purpose of the Study:

• To precisely localize bleeding points in patients with intractable epistaxis.
• To evaluate the consistency of bleeding site identification.
• To inform first-line treatment strategies for severe epistaxis.

Main Methods:

• Retrospective review of 194 patients with intractable epistaxis.
• Endoscopic nasal examination under anesthesia performed between 1989 and 2024.
• Data collected from a tertiary otolaryngology unit in Ireland.

Main Results:

• Bleeding points were identified in 85% of patients (165 cases).
• Septal bleeding occurred in 46% of patients, predominantly high on the anterosuperior septum.
• Lateral nasal wall bleeding was observed in 40%, with common sites at the posterior ends of the middle and inferior meatus.

Conclusions:

• Remarkably consistent bleeding point localization is achievable in intractable epistaxis.
• Detailed endoscopic examination should be a first-line intervention.
• Direct cauterization is a simple and effective method, often avoiding complex surgical interventions.