Endoscopic treatment of posterior epistaxis

Posterior epistaxis management remains a challenge. Besides their traumatic character, the usual treatments may cause as much morbidity and even mortality as the underlying pathology. A technique of endoscopically guided monopolar selective cauterisation was introduced in Lausanne at the end of 1987. Since then, 163 patients with a posterior epistaxis have been treated in our department. For 139 of these, endoscopic monopolar cauterization was the first treatment applied. Haemostasis was achieved at the first attempt in 82% of cases. The total success rate, including early recurrences controlled by a new cauterization, was 92%. Endoscopic monopolar cauterization requires the ability to perform nasal endoscopy, but presents few disadvantages. This technique represents a selective, relatively atraumatic, rapid and effective treatment. Moreover, costs are much lower than those of other methods. In our opinion, endoscopic monopolar cauterization should be the treatment of choice for posterior epistaxis.