Prior therapeutic trial with local application of a vasoconstrictor (agent for vasoconstriction) and a local anesthetic (agent for local anesthesia).
Further procedure as follows:
- Easily visible bleeding from the anterior region of the nose can be treated with silver nitrate or electrocoagulation (cauterization).Note: In children, chemical cauterization should be preferred to electrical cauterization if the bleeding is persistent, as it is not painful and thus does not require general anesthesia.
- Unsuccessful cauterization: care of the epistaxis by means of a tamponade (if necessary, tamponade of both nasal cavities, as this provides a higher occlusion pressure (closing pressure) compared to a unilateral tamponade)The time to remove the tamponade varies from 12-24 hours to 3-5 days.
- Surgical procedure after renewed relevant bleeding after removal of the tamponade.
Operative therapy
2nd order for bleeding from the posterior inferior nasal cavity.
- Clipping (vascular ligation by means of a clip) or coagulation (e.g., electrocoagulation) of the sphenopalatine (sphenoid palatine) artery [method of choice].
- Clipping of the maxillary artery (maxillary artery) – for difficult to stop nosebleeds.
2nd order for bleeding from the posterior superior nasal cavity.
- Clipping or coagulation of the arteriae ethmoidales (ethmoidal arteries).
