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Epistaxis is a common otorhinolaryngological emergency with complex etiological factors and varied clinical manifestations. The key to epistaxis treatment is accurate diagnosis and adequate hemostasis. Electrocoagulation is a reliable, safe and effective treatment for epistaxis. However, there are still several deficiencies in application of the commonly used electrocoagulation surgical products. This paper introduces a new type of radiofrequency head incorporating the dynamic circulatory functions of drip, irrigation, hemostasis and aspiration. We aim to achieve noninvasive, effective and accurate hemostasis in the treatment of epistaxis or nasal sinus surgery., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose.

Objective: To summarize the clinical features of epistaxis in the posterior fornix of inferior meatus and its comprehensive treatment measures., Method: We collected and retrospectively analyzed the clinical data of 212 cases of epistaxis hospitalized in our department, among which 23 cases were diagnosed as epistaxis in the posterior fornix of inferior meatus. They underwent nasal endoscopic exploration and coagulation surgery with one case under general anesthesia and the other 22 under local anesthesia. The bleeding from olfactory cleft, spheno-ethmoidal recess and the middle nasal meatus were excluded for all the patients during the surgery. After shifting the inferior turbinate inward by fracture, the active bleeding was found in the posterior fornix of inferior meatus, which was stopped immediately by bipolar coagulation. The areas of coagulation and nasal mucosa erosion were packed with nasopore after operation., Result: For all the patients, bleeding spots were definitely located during the operation and successfully coagulated. None of them suffered from recurrent-bleeding within 1 week postoperatively. Followed up for 6 to 12 months, there was no epstaxis recurrence or nasal cavity adhesion at the bled side in all patients., Conclusion: For intractable epistaxis patient, after excluding the bleeding in olfactory cleft, sphenoethmoidal recess and the middle nasal meatus, it should be considered that the bleeding might come from posterior fornix of inferior meatus. It is the key point to thoroughly expose the posterior fornix of inferior meatus by shifting the inferior turbinate inward by fracture and explore for the bleeding spot carefully.

Objective: To investigate the clinical characteristics of intractable epistaxis and the application of nasal endoscopic surgery as the treatment., Method: The clinical data of 163 patients with intractable epistaxis were retrospectively analyzed., Result: The bleeding points were found in the following different sites, superior wall of inferior nasal meatus (31.3%, 51/163), olfactory cleft area (21.5%, 35/163), postero-inferior wall of nasal septum (20.8%, 34/163), middle nasal meatus (10.4%, 17/163) and Little area (8.6%, 14/163). The results showed that the bleeding points had correlation with age. According to the frequency of nasal bleeding, patients under the age of forty in turn occurred in superior wall of inferior nasal meatus, olfactory cleft area, Little area, postero-inferior wall of nasal septum and middle nasal meatus; patients over the age of forty occurred in superior wall of inferior nasal meatus, postero-inferior wall of nasal septum, olfactory cleft area, middle nasal meatus and Little area. There was a significant difference between the two groups (P < 0.05). All cases stopped bleeding after 1 time of treatment, and there was no complication during a followed-up for 3 months after management. Seven cases reoccurred bleeding in half a year, but they were finally cured under nasal endoscopic surgery., Conclusion: The results indicate that we should pay attention to different bleeding points in different age groups. In addition, nasal endoscopic treatment is a reliable, convenient and effective method for intractable epistaxis and is the first choice after failed nasal packing.

Objective: To assess the efficacy and adverse reaction of nasal packing materials Rapid Rhino and Merocel., Method: We searched the database PubMed, EMBASE, Cochrane Library, CBM, CNKI, VIP and WANFANG database on line by computer, and traced the related references. Randomized controlled trials(RCTs) of rapid rhino and merocel as nasal packing materials were included. The quality of the included documents was evaluated by the criterion of Cochrane handbook 5.1. The cochrane collaboration's Revman 5.1 software was used for data analysis., Result: Four RCTs involving 115 patients were identified. Meta-analyses showed that Rapid Rhino produced significantly lower pain and discomfort during insert of pack [MD = 1.37, 95% CI (0.13, 2.60), P < 0.05], whereas less pain and discomfort during removal of pack [MD = 2.88, 95% CI (2.34, 3.41), P < 0.01]. Rapid Rhino associated with a significantly slighter degree of fullness raised after insertion [MD = 1.15, 95% CI (0.75, 1.55), P < 0.01, and the same situation happened after 6 hours [MD = 1.15, 95% CI (0.75, 1.55), P < 0.01]. Rapid rhino caused to less reactionary bleeding when pack removal [MD = 0.26, 95% CI (0.12, 0.39), P < 0.01], rapid rhino was easier for the healthcare worker during insert and removal. There was no significant difference between two packs on the efficiency of hemostatic [OR = 1.00, 95% CI (0.38, 2.61), P > 0.05]., Conclusion: The application of Rapid Rhino caused less pain and fullness, leaded to slighter bleed than Merocel when insertion and removal. There was no significant difference between two packs on the efficiency of hemostatic when used for epistaxis or after routine nasal surgery.

Clinical manifestation bipolar coagulation treatment for nosebleed. The patient was affected by nasal obstruction, fever and headache three weeks after operation. Clinical and laboratory examination nasal septum's bilateralism knuckle, soft quality, puncture with purulent secretion. Diagnose: abscess of nasal septum.

Objective: To investigate the methodology and efficacy of endoscopic sphenopalatine artery diathermy in management of refractory epistaxis., Method: Twenty patients with severe intractable posterior epistaxis, who had underwent various procedures like nasal packing, electro- or chemical cautery or others and still exacerbated, were subjected to this study. Under general anesthesia, according to the endoscopic anatomy of the sphenopalatine foramen, the sphenopalatine artery was identified under the posterior tip of the middle turbinate. After the pedicle of the artery was delineated, a bipolar cauterized the artery and transected it., Result: Twenty patients have been followed up for 5 to 20 months with an average of 10 months. No patients suffered recurrent epistaxis during the period. Only 1 patients in this series reported minor nasal adhesion., Conclusion: Diathermy of sphenopalatine artery, as a purely endonasal procedure, is an effective and microinvasive means of achieving long-term control of refractory epistaxis. It has few complications associated with other forms of arterial ligation.

Objective: To evaluate the effect of partial inferior turbinectomy in treating inferior nasal meatus epistaxis., Method: Twenty one case of inferior nasal meatus epistaxis were subjected to submucoperiosteous partial inferior turbinectomy and nasal cavity plugging under nasal endoscopy Its effect were analyzed., Result: All patients cured and discharged after 3-7 days. After 2 months to 3 years of follow up, no recurrence were seen., Conclusion: Submucoperiosteous partial inferior turbinectomy under nasal endoscopy is an effective and reliable method in treating inferior nasal meatus epistaxis.

Objective: To investigate the clinical treatment consideration and the therapic procedure., Method: We analyze the clinical data of 171 cases of obstinate epistaxis in recent years, mainly the pathogeny, treatment consideration and therapic procedure., Result: Were two steps were selected to the therapeutics according to different causations: step one, using the methods including nasal septum rectification, nasal cavity microwave cauterization, the curative ratio were 87.20%, 91.25% respectively; step two, using the methods including DSA (digital subtraction angiography), ligation of the external carotid artery, arteria ethmoidalis clipping, the curative ratio were 90%, 100%, 100% respectively., Conclusion: The thought of taking two steps methods to treat the obstinate epistaxis is very clear, and the curative effect is satisfactory as well.

Objective: To investigate the indication for diagnosis and treatment of epistaxis under nasal endoscope., Method: The data of 226 epistaxis cases were analized. Under nasal endoscope: 126 cases were packed, 78 cases were treated with microwave, laser cautery, 42 cases were operated., Result: An outstanding visutization was afforded by nasal endoscope and operation conveniencly, diagnosis correctively., Conclusion: We think it is an excellent method to examine and treat epistaxis and worthy to be recommented.

Objective: To evaluate the therapeutic effect of radiofrequency on epistaxis., Method: Three hundred and ten patients with epistaxis were treated with radiofrequency and Nd:YAG laser, respectively., Result: The effective rate of radiofrequency was 88.8%, Nd:YAG laser 90.5%., Conclusion: The therapeutic effects of epistaxis by radiofrequency and ND:YAG laser are similar, but radiofrequency is simpleier, easy to perform, more and useful than Nd:YAG laser.

In this study, we assessed the value of the clinical application of YAG laser in 32 cases of nasal endoscopic surgery. It was found that the operation performed under the nasal endoscope with YAG laser has several advantages including less bleeding, clear observation, simplified performance, thorough excision and less postoperative pain. But it also has some disadvantages, such as laser-induced lesion in the surrounding normal tissues, easy pollution and damage of the opto-guide fiber.