Endoscopic detection of bleeding sites in patients with epistaxis

Objective: Epistaxis is a common, life-threatening, otorhinolaryngological condition. This study aimed to evaluate the use of nasal endoscopy for identifying bleeding sites in the nasal cavity and nasopharynx of patients with epistaxis. Methods: We enrolled 126 patients who underwent a rigid nasal endoscopic examination with 0° and 30° endoscopes and a routine anterior rhinoscopy. Findings were compared using Kappa statistics. Results: We found strong agreement (k=1.0) between the nasal endoscopy and anterior rhinoscopy methods in detecting bleeding sites in the anterior nasal cavity but no agreement (k=0.0) in detecting posterior nasal bleeds. At sites that extended through both the anterior and posterior nasal cavities, anterior rhinoscopy detected only 74.2% of the bleeding sites detected with rigid endoscopy. Nasal endoscopy revealed that right unilateral epistaxis (n=56 patients, 44.5%) occurred more frequently than left epistaxis (n=44, 34.9%) and bilateral epistaxis (n=26, 20.6%). Moreover, nasal endoscopy revealed that most bleeds occurred at anterior sites (n=95, 75.4%); however, a number of bleeds occurred at posterior sites (n=25, 19.8%) or in the nasopharynx (n=5, 4.0%). In one (0.5%) patient, the bleeding site was not visible; this patient was referred with nasal packing in situ. Conclusion: This study showed that the use of nasal endoscopy aided in identifying bleeding sites in the nasal cavity and nasopharynx, which could not be detected with routine anterior rhinoscopy. Hence, nasal endoscopy facilitated prompt treatment. This approach might obviate the need for blood transfusions and thus reduce hospital stays and costs.