Endoscopically guided chitosan nasal packing for intractable epistaxis.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the effectiveness and safety of endoscopically guided chitosan packing in controlling intractable epistaxis. A prospective case series was performed.

METHODS:

This is a prospective clinical study conducted in a tertiary rhinology fellowship training hospital between January 2009 and November 2009. The study population consisted of patients with intractable epistaxis that failed to respond to traditional anterior-posterior nasal packing using either a 10-cm Pope PVA Merocel or a Rapid-Rhino. The bleeding site was identified using a nasal endoscope and controlled using a pack made of a ChitoFlex chitosan dressing wrapped around a polyvinyl acetal nasal sponge.

RESULTS:

The intent-to-treat population consisted of 20 severe epistaxis subjects (8 men and 12 women) who continued to bleed despite traditional anterior-posterior nasal packing. The mean age was 67 years (±19 years). Sixteen subjects were on antiplatelets and/or anticoagulants. Eleven subjects (55%) presented with anterior epistaxis, and 7 subjects (35%) presented with posterior epistaxis. Chitosan nasal packing was performed on an outpatient basis and resulted in effective and immediate hemostasis in 19/20 subjects (95%). One subject had persistent bleeding after the first packing attempt and was successfully repacked within 30 minutes. Time to complete cessation of bleeding was 3.6 ± 2.2 minutes in the 19 subjects; the pack was removed after 48 hours, without any evidence of rebleeding or any serious side effects.

CONCLUSION:

Endoscopically guided chitosan packing is a safe, effective, and well-tolerated outpatient treatment for the management of intractable epistaxis.

• Authors: Alan H Shikani, Karim A Chahine, Mohannad A Alqudah
• Journal: American journal of rhinology & allergy (Am J Rhinol Allergy) 2011 Jan-Feb Vol. 25 Issue 1 Pg. 61-3 ISSN: 1945-8932 [Electronic] United States
• PMID: 21711982 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Hemostatics
• Hydrogel, Polyethylene Glycol Dimethacrylate
• Chitosan

Topics

• Aged
• Aged, 80 and over
• Chitosan (administration & dosage, adverse effects)
• Endoscopes (statistics & numerical data)
• Epistaxis (pathology, physiopathology, prevention & control)
• Feasibility Studies
• Female
• Hemostatics (administration & dosage, adverse effects)
• Humans
• Hydrogel, Polyethylene Glycol Dimethacrylate (administration & dosage, adverse effects)
• Male
• Middle Aged
• Nasal Mucosa (metabolism)
• Nose (drug effects, pathology)
• Prospective Studies
• Treatment Outcome