Packing to control posterior epistaxis

Prior to the availability of balloon catheters, tamponade was achieved by means of cotton packing. This process involves: (A) feeding a small caliber rubber hose through the nose, retrieving it from the oropharynx, and attaching a cotton pack; (B) the hose is then retracted through the nose, while digitally guiding the pack posteriorly, until it lodges against the posterior choana; (C) a second cotton pack or gauze roll is secured against the nares to secure the hose. Balloon catheters are preferable. A foley catheter may be used (D).