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Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review

Published online by Cambridge University Press:  27 December 2017

I Z Iqbal
Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
G H Jones
Department of Otolaryngology, Manchester Royal Infirmary, UK
N Dawe
Department of Otolaryngology, Freeman Hospital, Newcastle upon Tyne, UK
C Mamais
Department of Otolaryngology, Aberdeen Royal Infirmary, UK
M E Smith
Department of Otolaryngology, Addenbrooke's Hospital, Cambridge, UK
R J Williams
Institute of Naval Medicine, Gosport, UK
I Kuhn
University of Cambridge School of Clinical Medicine, UK
S Carrie
Newcastle University, Newcastle upon Tyne, UK
E-mail address:
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The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.


A systematic review of the literature was performed using standardised methodology.


Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.


Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.

Review Articles
Copyright © JLO (1984) Limited 2017 

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