Posterior epistaxis management: review of the literature and proposed guidelines of the hellenic rhinological-facial plastic surgery society

PurposePosterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible-even unethical-to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach.MethodsA review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above.ResultsInitial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions.ConclusionDespite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies.Graphical abstractSuggested treatment algorithm for posterior epistaxis. ABC Airway-Breathing-Circulation, ECA external carotid artery, AEA anterior ethmoidal artery, BT blood transfusion, FA facial artery, HB haemoglobin, IMA internal maxillary artery, SPA sphenopalatine artery