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ORIGINAL ARTICLE
KEYWORDS Abstract Objectives: To evaluate the efficacy of radiofrequency coagulation and to compare it
Radiofrequency; with that of liquid paraffin plus antiseptic cream in the management of recurrent anterior epistaxis.
Antiseptic; Design: Prospective clinical trial. Between February 2011 and July 2012, one hundred consecu-
Cream; tive patients with histories of recurrent anterior epistaxis were randomly assigned to receive treat-
Recurrent; ment consisting of either a combination of liquid paraffin plus antiseptic cream (group 1) or
Epistaxis radiofrequency coagulation (group 2).
Setting: Benha University Hospital.
Main outcome measures: The Epistaxis Severity Score; before treatment, at 4, 12 weeks, 6 and
12 months after treatment, participant’s perception of discomfort during the management and com-
plications.
Results: The severity score of the 94 patients who had full data at 4 weeks after treatment shows
no statistically significant differences between the two groups. However, at 12 weeks; 85% of the
radiofrequency group versus 40% of paraffin-antiseptic group patients had reported no bleeding.
At 6 months; 74% of the radiofrequency group versus 25% of the paraffin-antiseptic group patients
reported no bleeding. At 12 months, 70% of the radiofrequency group versus 23% of the paraffin-
antiseptic group patients reported no bleeding. Both groups had no complications. The level of pain
associated with the procedure was tolerable. Mean duration of the radiofrequency procedure was
14.2 min.
2090-0740 ª 2013 Egyptian Society of Ear, Nose, Throat and Allied Sciences. Production and hosting by Elsevier B.V. All rights reserved.
http://dx.doi.org/10.1016/j.ejenta.2013.02.002
68 A.M. Abdelghany
Conclusions: It can be concluded that radiofrequency coagulation is a safe, convenient rapid and
simple procedure that is associated with a significant improvement in epistaxis severity in cases of
recurrent anterior epistaxis. This therapy could be performed in office settings.
ª 2013 Egyptian Society of Ear, Nose, Throat and Allied Sciences.
Production and hosting by Elsevier B.V. All rights reserved.
1. Introduction 2. Methods
minutes to stop the bleeding and the radiofrequency power The patients returned to the clinic in 2, 4, and 12 weeks then
was then increased. When no further telangiectasias or bleed- 6 and 12 months after the treatment.
ing was visualised, the process was discontinued. No packing
of the nose was planned. 2.4. Statistics
2.3. Data collection and follow-up Data were analysed using the SPSS 16 software programme
(IBM, New York, USA). Demographic data were collected,
All of the participants completed questionnaires before and and they are presented as the mean ± sd and mean rank.
after treatment. The data that were collected and recorded in- The paired-samples t-test was used for means, the Mann–
cluded demographic parameters, severity of bleeding (accord- Whitney U test for mean rank, and the chi-square test was used
ing to the Epistaxis Severity Score), the number of for gender percentages. A 95% confidence interval was used,
applications of liquid paraffin and cream or radiofrequency, and P-values <0.05 were considered significant.
pain experienced during the procedure, and complications.
The Epistaxis Severity Score (ESS), developed by Hoag et 3. Results
al.,11 was applied as a standard measurement for pre and post-
operative epistaxis severity. The score includes the assessment A total of 100 consecutive patients (59 males, 41 females), aged
of six factors reflecting severity. These factors are: frequency of 18–61 years, with recurrent anterior epistaxis were included in
bleeding episodes, average bleeding duration, intensity of aver- the study. The data for six patients (two from group 1 and four
age bleeding episodes, seeking medical attention for nose from group 2) were lost, while the remainder of the patients
bleeding, the presence of anaemia, and the need for blood (94; 55 males, 39 females) completed the trial. Of the 94 pa-
transfusion specifically related to epistaxis. The score was orig- tients, 48 were included in group 1, and the remaining 46 were
inally made for assessing hereditary haemorrhagic telangiecta- included in group 2. The mean ages were 35.4 for group 1 and
sia – related epistaxis, but it can be applied to any case of 39.1 years for group 2 (Table 1). The baseline characteristics of
epistaxis. It gives a ‘raw’ score that is converted mathemati- each group are shown in table 1, which demonstrates that the
cally to a ‘normalised’ score ranging from 1 to 10 and this groups were well matched. There are no statistically significant
score is further categorised into 4 grades; None (0–1), Mild differences in the characteristics between the two groups.
(2–4), Moderate (>4–7), and Severe (>7–10). For group 2, the pain associated with the procedure, the
With the use of a 10-point visual analogue scale (VAS), the length of time required and the bleeding situation during the
patients estimated the pain experienced during the procedure procedure are shown in Table 2. The median and mean ± sd
(0 = no discomfort, 10 = unbearable).
Table 2 Intra-operative pain, procedure duration and bleeding situation (for group 2).
No. of patients (%) Median Mean ± SD
Procedure duration (minutes) 46 12.5 14.2 ± 8.7
VAS of pain/discomfort 46 4.8.0 5.2 ± 2.3
Intra-operative bleeding 13 (28.3)
No bleeding 33 (71.7)
70 A.M. Abdelghany
Table 3 Outcome scores at 4 weeks, 12 weeks, 6 and 12 months for the studied groups.
Outcome measure Group Epistaxis severity score p value
None (0–1) Mild (>l–4) Moderate (>4–7) Severe(>7–10)
Before treatment Group 1 0 18 25 5 0.2
Group 2 0 14 29 3
4 weeks after Group 1 45 (94%) 2 1 0 0.15
Group 2 42 (91%) 3 1 0
12 weeks after Group 1 19 (40%) 20 8 1 0.00
Group 2 39 (85%) 6 1 0
6 months after treatment Group 1 12 (25%) 24 9 3 0.00
Group 2 34 (74%) 11 0 1
12 months after treatment Group 1 11 (23%) 22 10 5 0.00
Group 2 32 (70%) 11 2 1
pain levels experienced during the coagulation operation were ities in a short period of time (the second day). There were no
4.8 and 5.2 ± 2.3, which are levels that can be tolerated. The recorded complications.
duration of the radiofrequency coagulation ranged from Antiseptic cream has been used in a number of studies and
5 min to 27 min, with median and mean ± sd values of has been shown to be as effective as chemical cautery and even
12.5 min and 14.2 ± 8.7 min. more effective,9,14 but does not have long lasting results and its
In group 2, all of the patients were able to go home on the effect is temporary.15 Petroleum jelly (Vaseline) and liquid par-
day of surgery and resume their daily activities. There was no affin have also been used by otolaryngologists for many years
retained material in the nasal cavity of most patients, with the as a safe, cost-effective treatment for epistaxis. The evidence
exception of three patients who required a piece of merocele base for the efficacy of liquid paraffin is limited. Although sev-
sponge in their nasal cavity to prevent bleeding. It was re- eral case reports show a link between liquid paraffin and par-
moved on the 2nd day. Thus, in general, the patients did not affinoma,16 the topical application of paraffin only has
feel any discomfort after treatment, and the therapy did not af- negligible epidermal penetration and has not been shown to
fect their activities. have any adverse effects in multiple species.17
The severity score of the 94 patients at 4 weeks after treat- The combination of liquid paraffin and antiseptic cream is
ment shows no statistically significant differences between the also a safe and easy intervention for recurrent epistaxis. This
two groups. At 12 weeks; 85% of radiofrequency group versus treatment causes no pain and little discomfort. However, this
40% of paraffin-antiseptic group patients had reported no treatment requires long-term application, which requires pa-
bleeding. At 6 months; 74% of the radiofrequency group versus tient compliance. Lack of compliance can, therefore, result in
25% of paraffin-antiseptic group patients reported no bleeding. a lack of efficacy. Bleeding recurred in most patients after a
At 12 months, 70% of radiofrequency group versus 23% of par- short period of stoppage of treatment.
affin-antiseptic group patients reported no bleeding (Table 3). In our study, 66% of the patients had idiopathic epistaxis,
Five patients from group 1 had worsening outcomes and which did not match the prevalence of 80–90% noted in the lit-
underwent radiofrequency coagulation after the conclusion erature. This difference may be due to the smaller sample size
of the study. Additionally, two patients from group 2 whose in our study. The most common source of bleeding was the na-
original symptoms persisted underwent radiofrequency coagu- sal septum; 90% of the patients exhibited bleeding from this
lation for a second time after the conclusion of the trial. Both site, a prevalence similar to that described in the literature.
groups had no complications, such as visible nasal scars, nasal Although there are some weaknesses in the study regarding
adhesions, nasal septum perforation, blood transfusion or sample size and follow up duration, we proved that the efficacy
hospitalisation. of radiofrequency coagulation is superior to that of simple li-
quid paraffin plus antiseptic cream in the treatment of recur-
4. Discussion rent epistaxis, especially with regard to long-term.
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