New modification of hot-water irrigation in the treatment of posterior epistaxis

Background: Tamponade treatment for epistaxis is painful and traumatic to t he nasal mucosa, and may necessitate hospitalization for several days. Hot- water irrigation (HWI) was introduced as a treatment of epistaxis more than 100 years ago. In a previous study the treatment proved to be effective, l ess painful, and less traumatic, and required a shorter hospital stay than tamponade treatment. However, HWI has the risk of aspiration during treatme nt. To minimize this risk, a special catheter has been designed. Objectives: To evaluate the modified HWI and to compare the results with ta mponade treatment, with respect to patient compliance, effectiveness, recur rence of bleeding, pain, complications, and length of hospital stay. Patients: A total of 122 patients, hospitalized far posterior epistaxis, we re randomized to receive either HWI or tamponade treatment. Results: In the HWI group, 31 (55%) of the patients could be discharged fro m the hospital after the initial treatment only, compared with 29 (44%) of the patients treated with tamponade. Using a 10-cm visual analog scale, the mean pain score during treatment was 4.7 in the HWI group compared with 7. 5 in the tamponade group. The mean hospital stay was 2.9 days for the HWI g roup vs 4.0 days for the tamponade group. After discharge from the hospital , necrosis or synechia was found on rhinoscopy in 12 patients (40%) in the tamponade group compared with none in the HWI group. Conclusions: Compared with tamponade treatment, HWI is as effective, requir es a significantly shorter hospital stay, is less traumatic to the nose, an d is significantly less painful.