[Epistaxis strategy--experiences with the last 360 hospitalizations]

The purpose of this study was to analyze the therapy concept used in the management of severe epistaxis in order to optimize the quality of our treatment and to arrive at an optimal therapeutic concept.

The study was performed as a retrospective analysis of the charts of all 335 patients treated as inpatients for epistaxis over a period of 6 years.

An increased rate of complications was found in the following three situations: 1. Age > 65 years, 2. chronic obstructive pulmonary disease, 3. several systemic illnesses. Recurrence was increased with septal perforations and Osler's disease.

Localization of the site of bleeding is the first priority and allows treatment of bleeding with bipolar electrocautery. If the bleeding vessel is not found, insertion of a Merocel pack is recommended. Patients with persistent or recurrent bleeding are treated in the operating theater under general anesthesia if they are at an elevated risk for complications or have a septal deviation which is clinically significant. The nose is systematically visualized with the endoscope, bleeding vessels are coagulated under endoscopic control, and, where appropriate, a septoplasty is performed. In the remaining cases an epipharynx balloon is inserted, combined with an anterior pack. Angiography with superselective embolization, external ligation of the ethmoidal arteries, and endonasal obliteration of the sphenopalatine artery is reserved for cases where the measures discussed above have failed.