We were pleased at the inclusion of your recent 10 minute consultation paper on Epistaxis by Mulla et al [1] which covers a condition that whilst often simple, is potentially fatal.
Might we suggest an enhancement to the final paragraph where it is suggested that placing ice packs on the nose is a method of stopping further bleeding. Despite this method being widespread, the evidence available suggests that application of ice packs to the nose or indeed the neck (another commonly used method) has little effect on blood flow to the nasal mucosa [2].
Ice placed in the mouth however have been shown to produce a significant decrease in nasal mucosal flow up to 23% [3]. We suggest this is a more effective and evidence based method for stopping further bleeding and find it to be an effective adjunct with more posterior bleeds while definitive treatment is planned. Children can be encouraged to suck on flavoured ice-lollies.
[1] Mulla O, Prowse S, Sanders T, Nix P. Epistaxis (Ten-Minute Consultation).BMJ 2012; 344 doi: 10.1136/bmj.e1097
[2] Teymoortash A, Sesterhenn A, Kress R, Sapundzhiev N, Werner JA. Efficacy of ice packs in the management of Epistaxis. Clin Otolaryngol Allied Sci 2003; 28(6):545-547
[3] Porter M, Marais J, Tolley N. The effect of ice packs upon nasal mucosal blood flow. Acta Otolaryngol 1991; 111(6):1122-5
Competing interests:
No competing interests
29 March 2012
Joseph G Manjaly
CST2 ENT
Miss Kasia Konieczny (ST3 ENT), Mr N. Julian Holland (Consultant ENT Surgeon)
Rapid Response:
Re: Epistaxis
Dear Editor,
We were pleased at the inclusion of your recent 10 minute consultation paper on Epistaxis by Mulla et al [1] which covers a condition that whilst often simple, is potentially fatal.
Might we suggest an enhancement to the final paragraph where it is suggested that placing ice packs on the nose is a method of stopping further bleeding. Despite this method being widespread, the evidence available suggests that application of ice packs to the nose or indeed the neck (another commonly used method) has little effect on blood flow to the nasal mucosa [2].
Ice placed in the mouth however have been shown to produce a significant decrease in nasal mucosal flow up to 23% [3]. We suggest this is a more effective and evidence based method for stopping further bleeding and find it to be an effective adjunct with more posterior bleeds while definitive treatment is planned. Children can be encouraged to suck on flavoured ice-lollies.
[1] Mulla O, Prowse S, Sanders T, Nix P. Epistaxis (Ten-Minute Consultation).BMJ 2012; 344 doi: 10.1136/bmj.e1097
[2] Teymoortash A, Sesterhenn A, Kress R, Sapundzhiev N, Werner JA. Efficacy of ice packs in the management of Epistaxis. Clin Otolaryngol Allied Sci 2003; 28(6):545-547
[3] Porter M, Marais J, Tolley N. The effect of ice packs upon nasal mucosal blood flow. Acta Otolaryngol 1991; 111(6):1122-5
Competing interests: No competing interests