Skip to main content
SpringerLink
Log in

Discomfort and costs in epistaxis treatment

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Epistaxis is a very common ENT event. Apart from the effectiveness of the different treatment options, the discomfort and the financial burden are of great importance. It has been the aim of this study to obtain data regarding the discomfort/pain of the epistaxis treatments and to calculate the financial burden. During the period between April 2010 and July 2011 epistaxis patients at our hospital had the opportunity to rate the discomfort/pain they experienced during their treatment on a 0–10 VAS scale. The costs of epistaxis treatments were calculated in an extended cohort. 84 VAS scores in 61 patients were acquired and the costs of treatment were calculated in 96 patients. The lowest VAS scores were found in chemical and electric coagulation with 1.5 and 2.0, respectively, followed by surgery (3.0), Rapid Rhino® packing (6.0) and balloon pack (7.5). The costs of treatments depended on whether the treatment was in an out- or inpatient setting. Surgery was not significantly more expensive than packing methods in the inpatient setting. Anterior epistaxis could be managed by local coagulation with an acceptable impact/cost ratio. At our institution, surgery was the most cost effective and the least troublesome procedure in posterior bleedings, preceded by Rapid Rhino® packing if required.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Viehweg TL, Roberson JB, Hudson JW (2006) Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg 64(3):511–518. doi:S0278-2391(05)01815-X

    Article  PubMed  Google Scholar 

  2. Small M, Murray JA, Maran AG (1982) A study of patients with epistaxis requiring admission to hospital. Health Bull (Edinb) 40(1):20–29

    CAS  Google Scholar 

  3. Toner JG, Walby AP (1990) Comparison of electro and chemical cautery in the treatment of anterior epistaxis. J Laryngol Otol 104(8):617–618

    Article  PubMed  CAS  Google Scholar 

  4. Badran K, Malik TH, Belloso A, Timms MS (2005) Randomized controlled trial comparing Merocel and Rapid Rhino packing in the management of anterior epistaxis. Clin Otolaryngol 30(4):333–337. doi:COA1019

    Article  PubMed  CAS  Google Scholar 

  5. Moumoulidis I, Draper MR, Patel H, Jani P, Price T (2006) A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. Eur Arch Otorhinolaryngol 263(8):719–722. doi:10.1007/s00405-006-0047-5

    Article  PubMed  Google Scholar 

  6. Chheda N, Katz AE, Gynizio L, Singer AJ (2009) The pain of nasal tampon removal after nasal surgery: a randomized control trial. Otolaryngol Head Neck Surg 140(2):215–217. doi:S0194-5998(08)01407-1

    Article  PubMed  Google Scholar 

  7. Singer AJ, Blanda M, Cronin K, LoGiudice-Khwaja M, Gulla J, Bradshaw J, Katz A (2005) Comparison of nasal tampons for the treatment of epistaxis in the emergency department: a randomized controlled trial. Ann Emerg Med 45(2):134–139. doi:S0196064404014957

    Article  PubMed  Google Scholar 

  8. Hirsh AT, Atchison JW, Berger JJ, Waxenberg LB, Lafayette-Lucey A, Bulcourf BB, Robinson ME (2005) Patient satisfaction with treatment for chronic pain: predictors and relationship to compliance. Clin J Pain 21(4):302–310. doi:00002508-200507000-00004

    Article  PubMed  Google Scholar 

  9. Woolhandler S, Himmelstein DU (1997) Costs of care and administration at for-profit and other hospitals in the United States. N Engl J Med 336(11):769–774. doi:10.1056/NEJM199703133361106

    Article  PubMed  CAS  Google Scholar 

  10. Altman SH, Shactman D (1997) Should we worry about hospitals’ high administrative costs? N Engl J Med 336(11):798–799. doi:10.1056/NEJM199703133361111

    Article  PubMed  CAS  Google Scholar 

  11. Himmelstein DU, Thorne D, Warren E, Woolhandler S (2009) Medical bankruptcy in the United States, 2007: results of a national study. Am J Med 122(8):741–746. doi:S0002-9343(09)00404-5

    Article  PubMed  Google Scholar 

  12. Soyka MB, Nikolaou G, Rufibach K, Holzmann D (2011) On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 49(4):474–478. doi:10.4193/Rhin

    PubMed  CAS  Google Scholar 

  13. Soyka MB, Rufibach K, Huber A, Holzmann D (2010) Is severe epistaxis associated with acetylsalicylic acid intake? Laryngoscope 120(1):200–207. doi:10.1002/lary.20695

    PubMed  Google Scholar 

  14. Van Wyk FC, Massey S, Worley G, Brady S (2007) Do all epistaxis patients with a nasal pack need admission? A retrospective study of 116 patients managed in accident and emergency according to a peer reviewed protocol. J Laryngol Otol 121(3):222–227. doi:10.1017/S0022215106003148

    PubMed  Google Scholar 

  15. Klotz DA, Winkle MR, Richmon J, Hengerer AS (2002) Surgical management of posterior epistaxis: a changing paradigm. Laryngoscope 112(9):1577–1582. doi:10.1097/00005537-200209000-00008

    Article  PubMed  Google Scholar 

  16. Kumar S, Shetty A, Rockey J, Nilssen E (2003) Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation? Clin Otolaryngol Allied Sci 28(4):360–363. doi:724

    Article  PubMed  CAS  Google Scholar 

  17. Wang L, Vogel DH (1981) Posterior epistaxis: comparison of treatment. Otolaryngol Head Neck Surg 89(6):1001–1006

    PubMed  CAS  Google Scholar 

  18. Goddard JC, Reiter ER (2005) Inpatient management of epistaxis: outcomes and cost. Otolaryngol Head Neck Surg 132(5):707–712. doi:S0194599805001518

    Article  PubMed  Google Scholar 

  19. Schaitkin B, Strauss M, Houck JR (1987) Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. Laryngoscope 97(12):1392–1396. doi:10.1288/00005537-198712000-00003

    Article  PubMed  CAS  Google Scholar 

  20. Moshaver A, Harris JR, Liu R, Diamond C, Seikaly H (2004) Early operative intervention versus conventional treatment in epistaxis: randomized prospective trial. J Otolaryngol 33(3):185–188

    Article  PubMed  Google Scholar 

  21. Rejas Ugena E, Trinidad Ruiz G, Alvarez Dominguez J, Carrasco Claver F, Pino Rivero V, Blasco Huelva A (2006) Utility of the surgical treatment for severe epistaxis by endoscopic approach of sphenopalatine and ethmoidal arteries. Acta Otorrinolaringol Esp 57(5):228–234

    Article  PubMed  CAS  Google Scholar 

  22. Christensen NP, Smith DS, Barnwell SL, Wax MK (2005) Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 133(5):748–753. doi:S0194-5998(05)01752-3

    Article  PubMed  Google Scholar 

  23. Miller TR, Stevens ES, Orlandi RR (2005) Economic analysis of the treatment of posterior epistaxis. Am J Rhinol 19(1):79–82

    PubMed  Google Scholar 

Download references

Conflict of interest

All authors state that there are no conflicts of interest to disclose. There are no financial disclosures.

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Frauenklinikstrasse 24, 8091, Zürich, Switzerland

    Georgios Nikolaou, David Holzmann & Michael B. Soyka

Authors
  1. Georgios Nikolaou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David Holzmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael B. Soyka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Georgios Nikolaou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nikolaou, G., Holzmann, D. & Soyka, M.B. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol 270, 2239–2244 (2013). https://doi.org/10.1007/s00405-012-2339-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-012-2339-2

Keywords

Search

Navigation