Overview
Posterior epistaxis involves bleeding originating from the posterior nasal cavity, often challenging to diagnose and manage due to its deep location and potential severity. 1Diagnosis
Use of rod lens endoscopes for accurate identification of bleeding sites 1.
Difficulty in identifying and accessing bleeding points may necessitate advanced endoscopic techniques 1.Management
First-line: Selective packing of the bleeding site with Surgicel (oxidized cellulose) to target hemorrhage without extensive nasal packing 1.
Adjunctive: Consider electrocautery for precise hemostasis; however, approach with caution due to potential pain and need for anesthesia 1.Special Populations
No specific guidance provided for pregnancy, pediatrics, elderly, or comorbidities in the given abstracts 12.Key Recommendations
Employ selective Surgicel packing at the identified bleeding site to manage posterior epistaxis, aiming to minimize patient morbidity and hospital stay 1 (Evidence: Moderate).
Utilize endoscopic techniques for accurate localization of bleeding prior to intervention 1 (Evidence: Moderate).
Approach electrocautery cautiously due to associated risks and potential need for general anesthesia 1 (Evidence: Expert opinion).References
1 Bhatnagar RK, Berry S. Selective surgicel packing for the treatment of posterior epistaxis. Ear, nose, & throat journal 2004. link
2 Vivian AJ, Lloyd C, Russell-Eggitt I, Taylor D. Familial posterior lenticonus. Eye (London, England) 1995. link