STUDY OF EPISTAXIS REGARDING AETIOLOGY, MANAGEMENT AND OUTCOME WITH SPECIAL REFERENCE TO MANAGEMENT OF SPHENOPALATINE ARTERY

Abstract

Background: Epistaxis is one of the most common emergencies encountered in otorhinolaryngology practice. Although most cases are self-limiting, some patients require medical or surgical intervention for effective control of bleeding. Identification of the etiology and bleeding site is essential for appropriate management. In recent years, endoscopic techniques such as endoscopic sphenopalatine artery ligation (ESPAL) have emerged as effective treatment options for refractory posterior epistaxis. Objective: To evaluate the clinical profile, etiology, and outcomes of different treatment modalities in patients presenting with epistaxis, with special reference to the role of the sphenopalatine artery in the management of refractory cases. Materials and Methods: This prospective observational study was conducted in the Department of Otorhinolaryngology at Medical College and Hospital, Kolkata, from January 2014 to June 2015. A total of 84 patients presenting with active epistaxis were included after applying inclusion and exclusion criteria. Detailed clinical evaluation, nasal examination, and diagnostic nasal endoscopy were performed. Relevant hematological and radiological investigations were carried out where indicated. Patients were managed according to the severity and source of bleeding using conservative methods, nasal packing, electro-cautery, endoscopic sphenopalatine artery ligation, or other surgical procedures. Patients were followed up for 12 weeks to assess treatment outcomes. Results: The majority of patients were males (73.8%) with a male-to-female ratio of 2.81:1. The most commonly affected age group was 31–50 years. The anterior nasal septum was the most frequent bleeding site (35.7%). Idiopathic epistaxis accounted for the largest proportion of cases (44.1%), followed by hypertension (21.4%) and trauma (11.9%). Nasal packing was the most commonly used treatment modality. Anterior nasal packing showed a success rate of 89.1%, while posterior nasal packing had a higher recurrence rate. Endoscopic sphenopalatine artery ligation performed in refractory posterior epistaxis demonstrated a success rate of 92.85%. Conclusion: Most cases of epistaxis can be effectively managed with conservative measures and nasal packing. However, endoscopic sphenopalatine artery ligation is a safe and highly effective procedure for the management of intractable posterior epistaxis.