The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) Foundation recently published a multidisciplinary clinical practice guideline on best practices in the diagnosis and treatment of nosebleeds.
Nosebleeds affect up to 60% of people in the United States, accounting for o.5% of all ED visits and up to one-third of all otolaryngology-related ED visits, the guidelines note. The Clinical Practice Guideline: Nosebleed (Epistaxis) (Otolaryngol Head Neck Surg. 2020;162 [1_suppl]:S1-S38) is intended for all clinicians who evaluate and treat nosebleeds, according to the document.
“While nosebleeds are a very common reason for otolaryngology referral, most are treated by primary care providers and emergency department personnel, so a multidisciplinary guideline is ideal to present recommendations for treatment that are actionable by any clinician that treats a patient with a nosebleed,” said the guideline’s lead author, David Tunkel, MD, director of pediatric otolaryngology at Johns Hopkins University School of Medicine in Baltimore.
The practice guideline addresses patients ages three or older with nosebleeds that are severe, persistent, or recurrent and impact a person’s quality of life. It summarizes the evidence behind a broad range of interventions, including educating patients on self-treatment and home remedies, as well as treatments delivered in EDs, medical offices, hospitals, and operating rooms.
Dr. Tunkel encourages clinicians to become familiar with some of the best practices addressed in the guidance, such as the appropriate way to administer first-line treatment using nasal compression. Although he said that nasal compression may be widely used in clinical practice, the panel found that it is often not done effectively or is combined with other ineffective measures.
Dr. Tunkel said the guidance discusses a number of issues clinicians may not be up to date on, including the lack of evidence on a direct causal link between hypertension and nosebleeds. He also underscored the fact that evidence supports administering first-line treatment with compression, packing, and cautery, even in patients on anti-clotting and anti-platelet medications.
The AAO-HNS also published a Plain Language Summary: Nosebleeds (Epistaxis) (Otolaryngol Head Neck Surg. 2020;162:26-32), which is accessible by patients and can be used by clinicians to help educate patients.
—Mary Beth Nierengarten