Introduction
Epistaxis occurs in approximately 60% of people worldwide at least once in their lifetime representing the second commonest cause of Otolaryngology emergency admissions1-5. On the other hand, COVID-19 pandemic has spawned an unprecedented crisis overwhelming most healthcare systems globally. Recommendations for epistaxis management during the COVID-19 pandemic suggest the use of absorbable nasal packing or cauterization in order to avoid hospital admissions and visits6. However, there are cases where non-absorbable nasal packing is needed and the patient has to be admitted, challenging the hospital capacity, increasing the burden on the health system and potentially exposing the patient to increased risk for COVID-19 infection.
Despite previously used protocol for the management of epistaxis in our department we selected the “Dundee epistaxis protocol”1 as our new “standard” in 2015. We modified our practice and scheduled an audit, which showed a great improvement in our practice; cautery became the main modality, nasal packings were reduced significantly while all patients with non-absorbable packings were admitted, and “Dundee protocol” was fully adapted in 2016 (unpublished data). During the second wave of COVID-19 pandemic in our area, a high patient influx was noted and the high need for hospitalization of COVID patients resulted in a dramatic reduction of available non-COVID hospital beds in all specialties including Otolaryngology. Thus, we re-reviewed our audit data in order to see if we can safely reduce epistaxis admissions during the pandemic by discharging patients with packing. Herein we present our experience with dealing with epistaxis with nasal packing on outpatient settings with main focus on the feasibility and safety of such management as well as on how such protocol could relieve the pressure on the inpatient service during the pandemic.