Epistaxis Medication

  • Author: Quoc A Nguyen, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: May 24, 2011
 

Medication Summary

Most patients with epistaxis who seek medical attention are likely to be treated with cauterization, anterior packing, or both. Those with severe or recalcitrant bleeding may need posterior packing, arterial ligation, or embolization. Pharmacotherapy plays only a supportive role in treating the patient with epistaxis.

Next

Topical vasoconstrictors

Class Summary

Topical vasoconstrictors act on alpha-adrenergic receptors in the nasal mucosa, causing vessels to constrict.

View full drug information

Oxymetazoline 0.05% (Afrin)

 

Oxymetazoline is applied directly to mucous membranes, where it stimulates alpha-adrenergic receptors and causes vasoconstriction. Decongestion occurs without drastic changes in blood pressure, vascular redistribution, or cardiac stimulation.

Oxymetazoline can be used in combination with lidocaine 4% to provide effective nasal anesthesia and vasoconstriction.

Previous
Next

Anesthetics

Class Summary

When anesthetics are used concomitantly with vasoconstrictors, their anesthetic effect is prolonged and the pain threshold increased.

View full drug information

Lidocaine 4% (Xylocaine)

 

Lidocaine decreases permeability to sodium ions in neuronal membranes. This results in the inhibition of depolarization, blocking the transmission of nerve impulses.

Lidocaine can be used in combination with oxymetazoline 0.05% to provide effective nasal anesthesia and vasoconstriction.

Previous
Next

Antibiotic ointments

Class Summary

Antibiotic ointments help prevent local infection and provide local moisturization.

View full drug information

Mupirocin ointment 2% (Bactroban nasal)

 

Mupirocin ointment inhibits bacterial growth by inhibiting RNA and protein synthesis. It is a compounded medication.

Previous
Next

Cauterizing agents

Class Summary

Cauterizing agents coagulate cellular proteins, which can in turn reduce bleeding.

View full drug information

Silver nitrate

 

Silver nitrate coagulates cellular protein and removes granulation tissue. It also has antibacterial effects.

Previous
 
Contributor Information and Disclosures
Author

Quoc A Nguyen, MD  Associate Clinical Professor, Director, Sinus and Allergy Center, Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, Medical Center

Quoc A Nguyen, MD is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American Laryngological Rhinological and Otological Society, American Rhinologic Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Hassan H Ramadan, MD, MSc  Professor and Vice-Chair, Department of Otolaryngology-Head and Neck Surgery, Professor, Department of Pediatrics, West Virginia University School of Medicine

Hassan H Ramadan, MD, MSc is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Rhinologic Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Stephen G Batuello, MD  Consulting Staff, Colorado ENT Specialists

Stephen G Batuello, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American College of Physician Executives, American Medical Association, and Colorado Medical Society

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation Unrestricted gift Unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

  1. Moreau S, De Rugy MG, Babin E, Courtheoux P, Valdazo A. Supraselective embolization in intractable epistaxis: review of 45 cases. Laryngoscope. Jun 1998;108(6):887-8. [Medline].

  2. Abelson TI. Epistaxis. In: Schaefer SD. Rhinology and Sinus Disease 1st ed. New York: Mosby; 1998:43-50.

  3. Douglas R, Wormald PJ. Update on epistaxis. Curr Opin Otolaryngol Head Neck Surg. Jun 2007;15(3):180-3. [Medline].

  4. Emanuel JM. Epistaxis. In: Cummings CW. Otolaryngology-Head and Neck Surgery. 3rd ed. St. Louis: Mosby; 1998:852-865.

  5. Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J. May 2005;81(955):309-14. [Medline]. [Full Text].

  6. Cummings CW. Epistaxis. In: Cummings. Otolaryngology: Head and Neck Surgery. 4th ed. Philadelphia, Pa: Elsevier, Mosby; 2005:Chap 40.

  7. Padgham N. Epistaxis: anatomical and clinical correlates. J Laryngol Otol. Apr 1990;104(4):308-11. [Medline].

  8. Guarisco JL, Graham HD 3rd. Epistaxis in children: causes, diagnosis, and treatment. Ear Nose Throat J. Jul 1989;68(7):522, 528-30, 532 passim. [Medline].

  9. Jarjour IT, Jarjour LK. Migraine and recurrent epistaxis in children. Pediatr Neurol. Aug 2005;33(2):94-7. [Medline].

  10. Knight YE, Goadsby PJ. The periaqueductal grey matter modulates trigeminovascular input: a role in migraine?. Neuroscience. 2001;106(4):793-800. [Medline].

  11. Gifford TO, Orlandi RR. Epistaxis. Otolaryngol Clin North Am. Jun 2008;41(3):525-36, viii. [Medline].

  12. Schlosser RJ. Clinical practice. Epistaxis. N Engl J Med. Feb 19 2009;360(8):784-9. [Medline].

  13. Durr DG. Endoscopic electrosurgical management of posterior epistaxis: shifting paradigm. J Otolaryngol. Aug 2004;33(4):211-6. [Medline].

  14. García Callejo FJ, Muñoz Fernández N, Achiques Martínez MT, Frías Moya-Angeler S, Montoro Elena MJ, Algarra JM. [Nasal packing in posterior epistaxis. Comparison of two methods]. Acta Otorrinolaringol Esp. May-Jun 2010;61(3):196-201. [Medline].

  15. Abdelkader M, Leong SC, White PS. Endoscopic control of the sphenopalatine artery for epistaxis: long-term results. J Laryngol Otol. Aug 2007;121(8):759-62. [Medline].

  16. Wormald PJ, Wee DT, van Hasselt CA. Endoscopic ligation of the sphenopalatine artery for refractory posterior epistaxis. Am J Rhinol. 2000;Jul-Aug;14(4):261-264.

  17. Strong EB, Bell DA, Johnson LP, Jacobs JM. Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis. Otolaryngol Head Neck Surg. Dec 1995;113(6):674-8. [Medline].

 
Previous
Next
 
Posterior epistaxis from the left sphenopalatine artery.
Resolved posterior epistaxis after endoscopic cauterization of the left sphenopalatine artery.
Nasal speculum.
Vaseline gauze packing.
Expandable (Merocel) packing (dry).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.