• Jiro Iimura, Atsushi Hatano, Yuji Ando, Chiaki Arai, Satoshi Arai, Yasushi Shigeta, Hiromi Kojima, Nobuyoshi Otori, and Kota Wada.
• Department of Otorhinolaryngology, the Jikei University Daisan Hospital, Japan; Department of Otorhinolaryngology, the Jikei University Hospital, Japan. Electronic address: jiro.ii@icloud.com.
• Auris Nasus Larynx. 2016 Jun 1; 43 (3): 298-303.

ObjectiveHemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbach's area.MethodsThe subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis.ResultsThe bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures.ConclusionWe propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed.Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

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