TREATMENT OF EPISTAXIS: A NARRATIVE REVIEW OF CONSERVATIVE APPROACHES
DOI:
https://doi.org/10.31435/ijitss.3(51).2026.6503Keywords:
Epistaxis, Conservative Treatment, Tranexamic Acid, Nasal Packing, Topical Therapy, Hereditary Hemorrhagic TelangiectasiaAbstract
Background: Epistaxis is one of the most common emergencies in otolaryngology and can occur in patients of any age. Conservative management includes a variety of methods with differing effectiveness, such as topical agents, nasal tamponade, tranexamic acid (TXA), and hot water irrigation (HWI). The emergence of new studies evaluating the effectiveness of these methods requires a comprehensive analysis to update the current state of knowledge.
Aim:. The aim of this review is to present and critically analyze current information on the effectiveness of conservative methods for the treatment of epistaxis. This includes a comprehensive assessment of topical agents, nasal tamponade, TXA, HWI, as well as therapies used in patients with hereditary hemorrhagic telangiectasia (HHT).
Material and methods: A narrative review was conducted by searching PubMed and Google Scholar databases, while ResearchGate was used solely to obtain full-text publications. Studies published between 1999 and 2026 were included. The analysis considered RCTs, cohort studies, observational studies, and systematic reviews evaluating the effectiveness of conservative approaches to epistaxis management. Due to significant heterogeneity among studies, a qualitative synthesis of results was performed.
Results: Combination therapy based on topical agents and cauterization provided greater benefits than the use of topical preparations alone, particularly during longer follow-up. Nasal tamponade was effective in difficult cases, with the best results achieved when maintained for about 24 hours. HWI demonstrated similar efficacy to tamponade, but with less pain, shorter hospitalization, and less mucosal damage. TXA was associated with a shorter time to hemostasis, reduced risk of recurrence, limited the need for tamponade, and improved patient comfort, while maintaining a favorable safety profile. No clear advantage of timolol over placebo was demonstrated in the management of HHT.
Conclusions: Conservative treatment of epistaxis is effective, but the efficacy of individual methods depends on the type of intervention and patient characteristics. The strongest evidence supports the topical use of TXA, which is among the best-documented conservative treatments. Combination therapy with cauterization appears to be the most effective in preventing recurrences. HWI may be a beneficial alternative to nasal tamponade in selected patients. Large, multicenter RCTs with standardized endpoints and longer follow-up are needed to determine optimal treatment strategies.
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Copyright (c) 2026 Małgorzata Lubowiecka, Zuzanna Lecyk, Anna Szeszko, Martyna Płachta, Weronika Czernek, Magdalena Cichorzewska, Rafał Wojtan, Wiktor Rybicki
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