Modern management of bleeding disorders and haemorrhage in otorhinolaryngology

Abstract

Bleeding disorders and haemorrhages are recognized as common and serious problems in otorhinolaryngology. Over the past decade a number of innovative technologies and therapeutical options have been established to improve the management of them. The aim of this paper is to present diagnostical and therapeutical concepts proved to be medically effective and economically acceptable and to review the international literature. Bleeding disorders observed over a period of 10 years were analysed retrospectively to determine their prevalence and causes in otorhinolaryngology. Selected cases were used to illustrate both the efficacy and the limits of modern therapeutical options. A medico-economical evaluation of preoperative hemostaseological tests was carried out. Activated partial thromboplastin time (aPTT), Quick's prothrombin time combined with a detailed bleeding history were found to be optimal parameters to screen most of the haemostaseological defects. The incidence and severity of perioperative diffuse haemorrhages could significantly be reduced by routineous use of modern anesthesiological procedures, like controlled hypotension, total intravenous anesthesia (TIVA) and augmented ventilation techniques. Advances in interventional radiology reduced the risk of embolization of hypervascularized tumors and led to increasing application in recurrent epistaxis. A new generation of endoscopes combined with different laser techniques made the surgical treatment of hemorrhage more precise, increased the comfortability for the bleeding patient and were helpfull to decrease the length of stay and blood transfusion rates. Prevention and treatment of diffuse haemorrhages located within the craniocervical region can currently be optimized by an interdisciplinary dialog enrolling first of all the haemostaseologist and the anesthesiologist. Nowadays, close cooperation with the interventional radiologist is mandatory in the modern treatment of hypervascular lesions and vascular malformations. Moreover, it is necessary in emergency when otolaryngological measures faile to arrest bleedings from arterial site. Neither new techniques nor innovative strategies will be capable to compensate the experience and careful otolaryngologist.