Bleeding is a main complication in ENT surgery especially in oral and nasal interventions. Based on good results in local application of tranexamic acid after dental extraction, the different possibilities of local application of tranexamic acid in ENT surgery are discussed and the current literature is presented. In our experience, the rate of secondary hemorrhage after oral and nasal interventions can be reduced considerably by local application of tranexamic acid, which means risk reduction and better compliance especially in an increasingly aging patient population. Based on our experience, the local use of tranexamic acid in ENT surgery should be the focus of future studies.