• Mehdi Torabi Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
  • Ava Roughani Esfahani Department of Emergency Medicine, Kerman University of Medical Sciences, Kerman, Iran.
  • Shiva Moeinaddini Department of Emergency Medicine, Rafsanjan University of Medical Sciences, Kerman, Iran.
  • Mohammad Reza Baneshi Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.


 Objective: Epistaxis is one of the common causes of patients’ referral to the emergency departments. In the majority of cases, epistaxis is managed by traditional methods. We investigated the efficacy of nasal gel (NG) in comparison to anterior nasal packing (ANP) to stop mild-to-moderate anterior nasal bleeding.

Methods: In this prospective, randomized clinical trial, patients were divided into two groups of ANP (n=60) and NG (n=40). We determined and compared the efficacy of treatment (bleeding stop time and recurrence), patients’ satisfaction at discharge (length of stay in the hospital, pain during the procedure, and procedural time), and safety (less side effects) in both groups.

Results: The procedural time ≤2 min was observed in 90% and 58.33 % of NG group and ANP group, respectively (p<0.001). Pain score during procedure ≤4 and patients’ satisfaction ≥7 were, respectively, seen in 87.5% and 65% of NG group, but it was 43.33% and 41.7% in ANP group, respectively (p<0.001, p=0.02). The side effects in ANP group were 35%; however, no side effects were observed in NG group.

Conclusion: In the management of mild-to-moderate anterior nasal bleeding although NG efficacy is equivalent to ANP, using NG may be more convenient and satisfactory for patients. In addition, the use of this gel may result in more safety and fewer side effects.

Keywords: Epistaxis, Patient satisfaction, Visual analog scale.


1. Spielmann PM, Barnes ML, White PS. Controversies in the specialist management of adult epistaxis: An evidence-based review. Clin Otolaryngol 2012;37:382-9.
2. Zahed R, Moharamzadeh P, Alizadeharasi S, Ghasemi A, Saeedi M. A new and rapid method for epistaxis treatment using injectable form of tranexamic acid topically: A randomized controlled trial. Am J Emerg Med 2013;31:1389-92.
3. Strand M, Meyers J, Boyer H. Epistaxis in a patient on antiplatelet therapy: Not always benign. Am J Otolaryngol 2014;35:411-3.
4. Singer AJ, Blanda M, Cronin K, LoGiudice-Khwaja M, Gulla J, Bradshaw J, et al. Comparison of nasal tampons for the treatment of epistaxis in the emergency department: A randomized controlled trial. Ann Emerg Med 2005;45:134-9.
5. Barnes ML, Spielmann PM, White PS. Epistaxis: A contemporary evidence based approach. Otolaryngol Clin North Am 2012;45:1005-17.
6. Chhapola S, Matta I, Marker P. Comparison of blind nasal packing vs endoscopic Control of epistaxis in an emergency setting. Int J Head Neck Surg 2012;2:79-82.
7. Cohn B. Are prophylactic antibiotics necessary for anterior nasal packing in epistaxis? Ann Emerg Med 2015;65:109-11.
8. Kashyap S. Influence of topical retapamulin (1%) ointment, sofinox-rd cream, sofinox cream (2%), zinc fusidate cream (2%) and zinc fusidate ointment (2%) on nasal mucosal surface safety in new zealand albino rabbits. Int J Pharm Pharm Sci 2015;7:183-6.
9. Wadhwa R, Sharma Y, Upadhyay RP, Bala K. Nosocomial infection by non-fermenting gram negative bacilli in tertiary care hospital: Screening and cure. Int J Pharm Pharm Sci 2016;8:274-7.
10. Murthy P, Nilssen EL, Rao S, McClymont LG. A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis. Clin Otolaryngol Allied Sci 1999;24:228-31.
11. Mudunuri RK, Murthy MA. The treatment of spontaneous epistaxis: Conservative vs cautery. J Clin Diagn Res 2012;6:1523.
12. Mathiasen RA, Cruz RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899-902.
13. Meric Teker A, Korkut AY, Kahya V, Gedikli O. Prospective, randomized, controlled clinical trial of ankaferd blood stopper in patients with acute anterior epistaxis. Eur Arch Otorhinolaryngol 2010;267:1377-81.
14. Stieler M, Weber J, Hils M, Kolb P, Heine A, Büchold C, et al. Structure of active coagulation factor XIII triggered by calcium binding: Basis for the design of next-generation anticoagulants. Angew Chem Int Ed Engl 2013;52:11930-4.
15. Heemskerk JW, Mattheij NJ, Cosemans JM. Platelet-based coagulation: Different populations, different functions. J Thromb Haemost 2013;11:2-16.
16. Xu X, Teng X. Effect of fibrinogen on blood coagulation detected by optical coherence tomography. Phys Med Biol 2015;60:4185-95.
17. Foley JH, Butenas S, Mann KG, Brummel-Ziedins KE. Measuring the mechanical properties of blood clots formed via the tissue factor pathway of coagulation. Anal Biochem 2012;422:46-51.
18. Milojevic K, Cantineau JP, Simon L, Bataille S, Ruiz R, Coudert B, et al. Acute severe pain in emergencies. The key for efficient analgesia. Ann Fr Anesth Reanim 2001;20:745-51.
19. Walker TW, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: An investigation of Scottish hospital admissions 1995-2004. Clin Otolaryngol 2007;32:361-5.
20. Singer AJ, Thode HC Jr. Determination of the minimal clinically significant difference on a patient visual analog satisfaction scale. Acad Emerg Med 1998;5:1007-11.
21. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: What is moderate pain in millimeters? Pain 1997;72:95-7.
22. Daly LE, Bourke GJ. Interpretation and Uses of Medical Statistics. 5th ed. Oxford: Blackwell Science Ltd.; 2000.
23. Tibbelin A, Aust R, Bende M, Holgersson M, Petruson B, Rundcrantz H, et al. Effect of local tranexamic acid gel in the treatment of epistaxis. ORL J Otorhinolaryngol Relat Spec 1995;57:207-9.
24. Kilty SJ, Al-Hajry M, Al-Mutairi D, Bonaparte JP, Duval M, Hwang E, et al. Prospective clinical trial of gelatin-thrombin matrix as first line treatment of posterior epistaxis. Laryngoscope 2014;124:38-42.
25. Binder JE. Inventor; Binyarco, Llc, Assignee. Composition and Method for Treating Nosebleeds. 2016. United States Patent Application No. 9, 248,186.
26. Corbridge RJ, Djazaeri B, Hellier WP, Hadley J. A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis. Clin Otolaryngol Allied Sci 1995;20:305-7.
27. Soyka MB, Nikolaou G, Rufibach K, Holzmann D. On the effectiveness of treatment options in epistaxis: An analysis of 678 interventions. Rhinology 2011;49:474-8.
28. Klossek JM, Dufour X, de Montreuil CB, Fontanel JP, Peynègre R, Reyt E, et al. Epistaxis and its management: An observational pilot study carried out in 23 hospital centres in France. Rhinology 2006;44:151-5.
29. Al-Deen S, Bachmann-Harildstad G. A grading scale for epistaxis in hereditary haemorrhagic teleangectasia. Rhinology 2008;46:281-4.
30. Bhakta HC, Marco CA. Pain management: Association with patient satisfaction among emergency department patients. J Emerg Med 2014;46:456-64.
31. Tekwani KL, Kerem Y, Mistry CD, Sayger BM, Kulstad EB. Emergency department crowding is associated with reduced satisfaction scores in patients discharged from the emergency department. West J Emerg Med 2013;14:11-5.
32. Boudreaux ED, O’Hea EL. Patient satisfaction in the emergency department: A review of the literature and implications for practice. J Emerg Med 2004;26:13-26.
33. Badran K, Malik TH, Belloso A, Timms MS. Randomized controlled trial comparing Merocel® and RapidRhino® packing in the management of anterior epistaxis. Clin Otolaryngol 2005;30:333-7.
34. Santos E, Cardoso D, Queirós P, Cunha M, Rodrigues M, Apóstolo J, et al. The effects of emergency department overcrowding on admitted patient outcomes: A systematic review protocol. JBI Database System Rev Implement Rep 2016;14:96-102.
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How to Cite
Torabi, M., A. Roughani Esfahani, S. Moeinaddini, and M. R. Baneshi. “A NEW METHOD OF EPISTAXIS MANAGEMENT USING NASAL GEL: A SINGLE CENTER, RANDOMIZED CLINICAL TRIAL”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 11, no. 3, Mar. 2018, pp. 104-8, doi:10.22159/ajpcr.2018.v11i3.22462.
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