From the Guidelines
Rhino Rocket is not recommended for controlling epistaxis due to its potential to cause significant adverse effects, including tissue necrosis, mucosal damage, and toxic shock syndrome, and instead, topical vasoconstrictors like oxymetazoline should be considered as a safer alternative. The use of Rhino Rocket can lead to serious complications, such as compromised blood supply to the nasal mucosa, permanent damage, and significant pain upon removal. In contrast, oxymetazoline has been shown to be effective in resolving nasal bleeding in 65% to 75% of patients, with a lower risk of serious complications 1.
When managing epistaxis, it is essential to address the underlying cause while providing effective and safe control of bleeding with minimal patient discomfort. Alternative approaches, such as traditional nasal packing with petroleum gauze or inflatable balloon catheters, may also be considered. However, topical vasoconstrictors like oxymetazoline are generally preferred due to their ease of use, minimal risk of complications, and effectiveness in controlling bleeding. Some key points to consider when using oxymetazoline include:
- Applying the agent as an intranasal spray or on a cotton pledget
- Using the agent in conjunction with humidification and intranasal emollients to help prevent additional bleeding
- Monitoring patients for potential cardiac or systemic complications, particularly in those with pre-existing hypertension or cardiovascular disease 1.
Overall, the potential risks and complications associated with Rhino Rocket make it a less desirable option for controlling epistaxis, and topical vasoconstrictors like oxymetazoline should be considered as a first-line treatment.
From the Research
Adverse Effects of Rhino Rocket for Controlling Epistaxis
- Hemolacria is a rare complication of epistaxis treated with nasal compression or tamponade, and it has been reported in a case where a "Rhino Rocket" nasal tamponade device was used to treat persistent epistaxis 2.
- The use of Rhino Rocket nasal tamponade devices can cause retrograde flow from the inferior nasal turbinates via an anatomic connection with the lacrimal system, leading to hemolacria 2.
- There is limited evidence on the efficacy and safety of Rhino Rocket devices for controlling epistaxis, and more research is needed to fully understand their effects 3.
Comparison with Other Treatments
- Oxymetazoline has been shown to be superior to tranexamic acid and epinephrine-lidocaine in achieving rapid hemostasis and reducing recurrence in epistaxis 4.
- Tranexamic acid has been found to be no more effective than placebo in controlling bleeding and reducing the need for anterior nasal packing in patients with epistaxis 5.
- Nasal packing, including the use of Rhino Rocket devices, is often associated with pain and a risk of aspiration if it is dislodged, and is usually reserved for cases where other treatments have failed 6, 3.
Recommendations for Treatment
- Compressive therapy is the first step to controlling anterior epistaxis, and oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1:1,000 may be useful adjuncts to compressive therapy 6.
- Directive nasal cautery, most commonly using silver nitrate, can be used to control localized continued bleeding or prominent vessels that are the suspected bleeding source 6.
- Topical therapy and nasal packing, including the use of Rhino Rocket devices, should be used with caution and only when other treatments have failed, due to the risk of adverse effects such as hemolacria 6, 3, 2.