الفهرس 
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Abstract
Epistaxis is one of the most common clinical entities responsible for admittance of patients to the ENT-ED and has an important impact in healthcare costs. It occurs in up to 60%. Bleeding point identification is the key to efficient epistaxis management because it allows for control by cauterization and reduces the need for more complex procedures, which can prolong hospital stay, increase patient morbidity, and place demands on hospital resources. Although 10% of episodes of epistaxis are posterior bleeds. It may lead to life-threatening complications. So many studies were done to get options for management of posterior epistaxis. One of these options is hot water irrigation. We conducted this study in 45 patients with posterior epistaxis above 10 years old. We found 46.7% of patients in this study were above 40 years old and 71.1% were males. These support that posterior epistaxis more common in elderly and males. 27 (60%) were smoking and among these patients 3 (50%) of failed patients were smoking. This supports that smoking may be important factor affecting the posterior epistaxis and the efficacy of the HWI. Other comorbidities also affect the posterior epistaxis and the efficacy of the procedure as we found 20% were cardiac, 8.9% were hypertensive and 8.9% had malignant diseases other than nasal causes, and 3 (50%) of failed patients had malignancy. 20% were on antiplatelet, 15.6% on anticoagulants, and 8.9% on chemotherapy. Among the failed patients 1(16%.7) were on antiplatelet and 3 (50%) were on chemotherapy. The severity of epistaxis may be an important factors affecting the failure rate of the procedure as we found 36 (80%) had severe epistaxis and the procedure failed in 5 (83.3%).The mean duration (±SD) of whole procedure was 19.11 (± 8.61). The irrigation was repeated in 17.8 %. 68.9 % had hurts little bit according to VAS. This supports that the procedure is less pain than other options in controlling of posterior epistaxis. The HWI was successful in 86.7 % of patients with posterior epistaxis and 4.4% had complication in form of minimal adhesions which resolved within 2 weeks. The recurrence of epistaxis occurred in 8.9 % and other options were used to control the recurrence in the form of anterior nasal packs in two, posterior nasal pack in one patient, and surgical intervention in the last one. 53.3 % among successful cases did not need hospital admission and 22.2 % had admitted for one day only. This supports that HWI may be as outpatient procedure The procedure failed in 13.3% of patients. We used anterior nasal packs in the form of merocel in two patients, and remaining two had posterior nasal pack in the form of Foley’s catheter To be concluded hot water irrigation constitutes a safe, efficient, and cost-effective treatment method for posterior epistaxis. This method has the additional benefits of less patient discomfort, less morbidity, less need for surgical intervention, and fewer days of hospitalization. Hot water irrigation should be considered as the first line of treatment for posterior epistaxis, and medical trainees should be repeatedly instructed in its use in outpatient and emergency settings. We also recommend new researches to be done using hot saline irrigation (HSI) as isotonic saline for controlling posterior epistaxis and not only in epistaxis but also in other nasal surgeries to control bleeding intraoperative. As recent studies observed that cells exposed to pure water or hypotonic saline suffered from cellular damage. However, cells exposed to isotonic saline appeared healthy with no evidence of damage.