Outcome of Hyaluronic Acid Gel Versus Petroleum Jelly in Treatment of Epistaxis

* Epistaxis is one of the most common otorhinolaryngologic emergencies. It affects up to 60% of the population during their lifetime, with 6% requiring medical attention. The greatest peaks in the overall incidence occur in individuals under 10 years of age and over 40 years of age.
* In 1879, James Little identified an arterial plexus on the anterior septum as a frequent site of bleeding and the same plexus was described one year later by Kiesselbach. As a result of these descriptions, the area most frequently implicated in epistaxis is known as Little's area or Kiesselbach plexus which is anatomically formed by the anastomosis between the terminal branches of the external and internal carotid arteries (Anterior ethmoidal artery, Septal branch of Superior labial artery, Septal branch of Sphenopalatine artery, Septal branch of Greater palatine artery) .
* The most common etiology of epistaxis is idiopathic in 80%-90% of cases, no precipitating causes can be identified. Of the other identifiable local causes of epistaxis, the most frequent are trauma, nasal neoplasm, iatrogenic or due to systemic factors (hypertension, coagulopathy, inflammatory conditions, infectious diseases, vessel wall fibrosis in associated with ageing), use of drugs (anticoagulant, antiplatelet, nonsteroidal anti-inflammatory nasal sprays) and congenital nasal septal abnormalities .
* Management of recurrent anterior epistaxis can be done by cautery (chemical or electrical), anterior nasal packing or Surgical therapy if the other methods failed .
* This protocol outlines standardized guidelines for the use of Hyaluronic Acid (HA) in epistaxis management for nasal mucosal hydration, healing, and recurrence prevention. It is suitable for use in ENT clinics, emergency departments, and hospital wards.
* Mechanism of action of Hyaluronic acid:

1. Hydration: Binds large amounts of water, maintaining skin moisture and elasticity.
2. Wound healing: Promotes keratinocyte and fibroblast proliferation, enhancing tissue repair and regeneration.
3. Anti-inflammatory effect: Reduces inflammatory cytokines and modulates immune response.
4. Barrier protection: Forms a protective layer that prevents water loss and protects against irritants and microbes.
5. Collagen stimulation: Supports collagen synthesis and improves skin structure.
6. Antioxidant action: Scavenges free radicals, reducing oxidative damage.

• Hyaluronic Acid Gel (Drug): "Topical hyaluronic acid gel will be applied to the nasal mucosa of participants for the treatment of epistaxis. The gel will be administered according to the study protocol and frequency, and outcomes will be assessed throughout the study period."
• Petroleum jelly (Drug): "Topical petroleum jelly will be applied to the nasal mucosa of participants for the treatment of epistaxis. The application will follow the study protocol, and outcomes will be monitored and recorded over the study period."

Primary outcomes

• To compare the recurrence rate of epistaxis between the two groups [14 days]: "Proportion of participants whose epistaxis stops completely within 7 days of treatment application."

Secondary outcomes

• To assess time to symptom resolution [Within 24 hours]: "Time in minutes or hours from first application to complete cessation of nasal bleeding."
• To evaluate mucosal healing (endoscopic findings) [7-14 days]: "Assessment of nasal mucosa healing using endoscopic examination after application of hyaluronic acid gel or petroleum jelly, scored according to a standardized mucosal healing scale."
• To assess patient comfort and compliance [7 days]: "Measured using a standardized questionnaire or visual analog scale during the treatment period."
• To record adverse effects [14 days]: "Incidence of local irritation, allergic reactions, or other side effects related to the topical intervention."

Sex: All

Inclusion Criteria:

* Patients with anterior localized idiopathic epistaxis

Exclusion Criteria:

* Patients wit secondary epistaxis (posttraumatic, postoperative, tumoral).
* During pregnancy.
* Patients wit major systemic disease (Blood Disease, Hypertension).

• Ahmed AbdelAleem AbdelWahab, Prof, Study director