Minimally Invasive Control of Epistaxis (MICE) (MICE)

Epistaxis is a common disorder with 60% of the population suffering from one episode and 10% of these cases requiring medical attention. Between March 2006 and March 2007, in Calgary, Alberta, there were 1500 presentations of epistaxis to adult emergency rooms with 7% of these (105 patients) requiring packing with admission. Common methods to control epistaxis include, nasal packing (88%), operative arterial ligation (10%), and arterial embolization (2%). A cost analysis demonstrated that nasal packing had a lower cost compared to embolization and arterial ligation, and all modalities had similar lengths of stay (Goddard, Otolaryng Head Neck Surg. 2006). Arterial ligation is the current recommended therapy for recurrent or refractory epistaxis, with a success rate of 98%. With the advancement of endoscopic techniques, emergency room Minimally Invasive Control of Epistaxis (M.I.C.E.) allows for selective packing and cauterization, which provides the patient with retained function of their nasal cavity and prevents a hospital admission, resulting in significant cost savings. Hypothesis: Does the M.I.C.E. procedure provide significant cost savings compared to operative sphenopalatine artery ligation? Null hypothesis is that there is no difference in hospital admission rates between M.I.C.E. and operative sphenopalatine artery ligation.

Inclusion criteria: Age ≥ 18 years old, Presenting to Rockyview General Hospital Emergency room No coagulopathy (must have INR reversed before inclusion) Available for follow-up at 1 week and 1 month in Calgary, Alberta Refractory or Recurrent Epistaxis defined as: Refractory = unable to control epistaxis with bilateral Merocel™ Nasal Tampons fully inserted into nasal cavity Recurrent = epistaxis after removal of Merocel™ Nasal Tampons following outpatient packing for 48 hours Exclusion Criteria: Uncorrectable coagulopathy Unable to comply with procedure Pregnancy Non-Calgary emergency room presentation Severe posterior epistaxis requiring intubation for airway protection