To explore the effect of diluting tranexamic acid as 1000 mg versus epinephrine as 1 mg in a volume of 200 mL of normal saline used for local washing and rinsing of the used gauze at the surgical bleeding sites during microscopic ear surgeries.

In a randomised, double-blind trial, sixty patients scheduled for elective microscopic exploratory tympanotomy consented to participate after meeting the inclusion criteria. Patients assigned using the balanced block randomisation method into two similar groups; one received tranexamic acid (TXA), and the other received epinephrine. The outcome of the study focused on blood pressure, heart rate, quality of surgical field assessed via Boezaart score, the volume of bleeding, and the incidence of complications.

The more prominent findings were the statistically significant and favourable surgical field assessment according to the Boezaart score, and lower estimates of bleeding demonstrated in the TXA group compared to the epinephrine group, along the time of the study P-value was < 0.05. The haemodynamic monitoring showed promising changes in the TXA group compared with the epinephrine group in terms of lower mean blood pressure and lower heart rate that reached the level of statistical significance during the time of the study.

the use of topical tranexamic acid during microscopic ear surgeries is associated with a better surgical field, less bleeding, and favourable haemodynamic parameters compared to epinephrine.