Re: Ha JF, Hodge JC, Lewis R. Comparison of nasendoscopic‐assisted cautery versus packing for the treatment of epistaxis. (ANZ J. Surg. 2011; 81: 336-339)
We read with great interest the article of Ha et al. published recently in ANZ Journal of Surgery1 and would like to make comments on this study.
First, the authors report successful nasal examination with a rigid nasal endoscope and identification of the initial bleeding site in 100% of cases, even after nasal packing removal. In this study 97% of patients were treated initially with packings! However, these packings could lead to intranasal injuries and cause recurrent bleeding upon removal, especially if placed by an inexperienced physician. Furthermore, in case of septal deviation, such packings may traumatise the nasal (septal and/or turbinate) mucosa and create more sites of bleeding. Traditionally, prior to otolaryngological examination both sides of the nose are already packed.2 That is why, the identification of the site of bleeding after packing removal is frequently a difficult problem. Moreover, septal deformation and hypertrophic turbinates often make it difficult to visualise the bleeding regions.3 Nevertheless, Ha et al. have discussed neither these common issues nor the endoscopical anatomical findings. It is also not clear whether their patients had continuous epistaxis at the moment of cauterization.
Second, the compared groups were too small to speak about superiority and effectiveness of nasendoscopic-assisted cauterization. As far as frail elderly patients with antiplatelet and/or anticoagulant treatment are concerned, experience shows that to make sure you avoid recurrent bleeding a regional haemostasis is always necessary.2
Third, physicians continue to use Foley’s catheters for posterior nasal packing despite possible complications. It is an important fact that the producers of these catheters neither recommend nor design them for posterior nasal packing.4
Finally, 33 patients were included in the study. In the results section, however, in the description of epistaxis causes, only 25 patients were presented. We did not understand what happened to the remaining 8 patients.
Alexander Asanau, MD, Andrei P. Timoshenko, MD, Jean-Michel Prades MD, PhD
Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, France
References
1. Ha JF, Hodge JC, Lewis R. Comparison of nasendoscopic-assisted cautery versus packing for the treatment of epistaxis. ANZ J Surg. 2011; 81: 336-339.
2. Asanau A, Timoshenko AP, Vercherin P, Martin C, Prades JM. Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol. 2009; 118: 639-644.
3. Neskey D, Eloy JA, Casiano RR. Nasal, septal, and turbinate anatomy and embryology. Otolaryngol Clin North Am. 2009; 42: 193-205.
4. Pellard S, Boyce J, Ingrams DR. Consent and the use of Foley catheters in epistaxis. J Laryngol Otol. 2005; 119: 822-824.
