Diagnosis Of Epistaxis Research Articles

Can we determine recurrent epistaxis by hemogram parameters in children?

ObjectiveEpistaxis in children is a common reason for admission at otolaryngology outpatient clinics. Patients are diagnosed by clinical examination and laboratory tests. We aimed to evaluate epistaxis using simple blood parameters useful for diagnosis. Material and methodsThis study includes a retrospective analysis of 240 patients, including 120 study group and 120 healthy pediatric patients, who applied to the ENT outpatient clinic with the diagnosis of epistaxis between 2018 and 2020. This study is designed to analyze the predictive values of neutrophil-lymphocyte ratio (NLR), eosinophil-LR (ELR), platelet-LR (PLR), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) in pediatric epistaxis. ResultsSerological factors were assessed and no statistical associations in MPV, PDW, PLR, and ELR values were found. However, significant changes were found for PCT and NLR within the patient and control groups. The average PCT was lower in the study group in comparison to the controls (p = 0.022). The average NLR was higher in the study group in comparison to the controls (p = 0.004). ConclusionThe examination of children with epistaxis, as well as their management, following admission to the outpatient clinic continues to evolve. Although many studies have investigated the hemogram parameters and platelet indices, the PCT value has never been investigated in epistaxis. To our knowledge, our study is the first to demonstrate a relationship to PCT values and epistaxis.

Treating epistaxis \u2013 who cares for a bleeding nose? A secondary data analysis of primary and secondary care

BackgroundThe primary objective was to describe outpatient treatment of epistaxis among different physicians based on a large patient population over a period of 10 years. The secondary objective was to evaluate the value of the practice fee as an instrument of allocation in patients with epistaxis.MethodsAnonymized statutory health insurance data (AOK Lower Saxony) of patients with a diagnosis of epistaxis treated between 2007 and 2016 were examined. Demographic data, accompanying diagnoses, medication and involved medical groups (general practitioners (GP), pediatricians, ear, nose and throat (ENT) specialists or other) were analyzed. Furthermore, we assessed whether the use of specialist groups changed after abolition of the practice fee in 2013.ResultsEpistaxis was responsible for 302,782 cases (160,963 patients). The distribution of cases was slightly in favor of ENT specialists vs. GP (119,170 vs. 110,352). The cases seen by GP and ENT specialists were comparable with regard to age and sex distribution. Hypertension, atrial fibrillation/flutter and an antithrombotic therapy were slightly more common among cases consulting a GP. The GP recorded more co-diagnoses than the ENT. The use of outpatient care and the proportions of the involved physicians scarcely fluctuated during the study period. Overall, 23,118 patients (14.4%) were diagnosed by both, GP and ENT during a relatively short time period. The practice fee remuneration had no impact on the consultation of the physician groups.ConclusionThe outpatient treatment of epistaxis constitutes a considerable medical and economic burden in Germany. Strengthening the primary medical sector (GP-centered care) is necessary to reach the goal of initially directing patients to primary care, providing specialists more time for severe cases and reducing the impact on public health balance sheets.

The Impact of Traditional Anticoagulants, Novel Anticoagulants, and Antiplatelets on Epistaxis.

Anticoagulant and antiplatelet medications (ACAP) are known to be associated with an increased risk for epistaxis. There are conflicting results regarding the impact of Novel Oral Anticoagulants (NOAC) on epistaxis and its severity. Retrospective chart review of patients who were admitted to the ED in our tertiary level hospital with a diagnosis of epistaxis during the years 2012 to 2018. Retrospective analysis of patients presenting to tertiary level emergency otolaryngological care during the years 2012 to 2018. The impact of various ACAP medications on epistaxis severity, hospital admission, and recurrence was analyzed. A total of 470 patients were identified. Two hundred and twenty-nine patients (49%), were not on any anticoagulant/antiplatelet (ACAP) medications (controls) and 241 patients (51%) were taking at least one ACAP medication (ACAP group). Patients in the ACAP group were at a higher risk for severe epistaxis (OR=1.8, P < .05) and were more likely to be hospitalized (OR=2.17, P < .05). Surprisingly, the risk for recurrence was similar in the ACAP and control groups (15%, P > .05). Compared to controls, Warfarin and Enoxaparin increased the overall risk for severe epistaxis (OR=4.4, P < .05) and for hospital admission (OR=2.1, P < .05). Specifically, an increased risk for posterior tamponade (OR=19, P < .001), significant blood loss (OR=4.4, P=.032), and blood transfusion (OR=4.7, P=.007) were identified as well. Interestingly, NOACs were not associated with increased risk for severe epistaxis, hospital admission, tamponade, and significant blood loss or blood transfusion compared to controls. Compared to older generation anticoagulants and antiplatelet medications, NOACs demonstrated an improved safety profile, in terms of epistaxis severity, need for hospital admission and outcomes. These results may suggest a more conservative approach and less hospitalization when treating epistaxis in patients receiving NOACs. 4 Laryngoscope, 131:1946-1951, 2021.

Examining seasonal variation in epistaxis in a maritime climate

BackgroundEpistaxis is a common reason patients present to the emergency department. There is significant variation in climate across Canada. Our study aimed to determine if epistaxis is related to season, temperature and humidity in a Maritime climate.MethodsEthics approval was obtained. A retrospective chart review was performed. Patients who presented to the Saint John Regional Hospital Emergency Room between July 2015 and December 2017 with a diagnosis of epistaxis were identified. Weather data was collected from Environment Canada. We performed multiple univariate analyses examining confounding variables.ResultsIn total, 476 cases of epistaxis were identified. There was a significant seasonal variation; the highest number of epistaxis cases occurred in the winter (p < 0.001). A negative correlation was seen between mean daily humidity and epistaxis (R2 = 0.7794).ConclusionThe highest number of cases presented in the winter and a negative correlation was found between epistaxis and mean daily humidity.

Factors influencing recurrent emergency department visits for epistaxis in the elderly

ObjectiveOur objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly. MethodsWe used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities. ResultsOut of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities. ConclusionAdditional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department

ObjectiveInvestigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting. Study designCross-sectional study using national databases. MethodsChildren (age <18 years) presenting with a diagnosis of epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined. ResultsThere were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p < 0.001). Children from the lowest income quartile comprised a higher proportion of epistaxis presentations (38.8%, p < 0.001), yet were least likely to have an epistaxis control procedure performed (p < 0.001). Most patients had either Medicaid (43.8%) or private insurance (41.3%). Patients with Medicaid and those without healthcare coverage were least likely to undergo an epistaxis control procedure (p < 0.001). White children were more likely to undergo an epistaxis control procedure compared to those of minority backgrounds (p < 0.001). ConclusionsMost emergency department presentations of pediatric epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities.

Epistaxis in Children: Aetiology, Management and Outcome

Background: Although epistaxis is a common problem in preschool and school children, it is often considered as trivial and overlooked. As a result recurrent epistaxis sometimes may occur which, in some cases, may even be fatal.Objective: The present study was, undertaken to determine the etiological profile and outcome of treatment of epistaxis in children.Methods: This cross sectional study was conducted in Dhaka Shishu Hospital, Dhaka from January 2012 to December 2013. In cases of mild bleeding and stable patient, detailed history was noted along with management of the bleeding. In case of severe bleeding, history was taken after the bleeding was controlled. The diagnosis of epistaxis was based on clinical history, physical findings, laboratory investigations with examination of the nose and nasopharynx. All patients were treated conservatively initially and chemical cauterization of the specific area was considered only when conservative means failed to control the epistaxis.Results: Total 50 cases of epistoxis were enrolled. Nearly half (46%) of the patients were 3-4 years old and the rest 54% 5-6 years old with mean age being 4.6±0.9 years. Majority (68%) of the patients was male with male to female ratio being 2:1. Over twothirds (68%) of the patients were from lower middle class. All patients’ had anterior nasal bleeding. Seventy percent had acute epistaxis and the rest (30%) had recurrent epistaxis. Nearly half (46%) of the patients had inflammatory diseases, 28% had upper respiratory tract infections (URI), 16% had history of nasal trauma, 12% allergic rhinitis and very few patients (2%) had idiopathic causes. Eight percent patients developed shock and were resuscitated along with management of bleeding. Over one-quarter (28%) of the patients developed recurrent epistaxis and only 6% had facial oedema. All patients recovered uneventfully.Conclusion: The study concluded that the common causes of epistaxis in children in our country is inflammatory and infectious diseases of nose and upper respiratory tract and most of the epistaxis could be managed with conservative treatment alone.Bangladesh J Child Health 2015; VOL 39 (2) :73-76

Nasal and Ocular Forms of Transmissible Venereal Tumor in Dogs

The present report describes the clinical presentation, radiographic features, cytological findings, treatment and follows up of 5 cases of CTVT involving the nasal cavity, oral cavity, eyes, skin and genitalia. The cases had the common finding of bleeding from the nearest cavity. Epistaxis was observed in dogs having nasal form of CTVT. Two cases had primary and three had secondary nasal and/or ocular involvement. All cases were treated with weekly injections of Vincristine sulphate @0.025mg/kg, intravenously, along with surgery and supportive medication. This report highlights the need for considering CTVT for the differential diagnosis of epistaxis or any ulcerated lesion.

A multi-centre audit of epistaxis management in England: is there a case for a national review of practice?

The ENT-UK Clinical Audit and Practice Advisory Group initiated a pilot audit to investigate variance in epistaxis management between six units nationwide. All patients with a diagnosis of epistaxis who were admitted for in-patient care at six ENT departments between November 2011 and February 2012 were prospectively enrolled. A total of 166 patients were included in the study. Variance was demonstrated between the six units in a number of the key outcome areas. Twenty-eight per cent of patients were identified as eligible for operative intervention for epistaxis in one unit, compared with only 12.5 per cent in another. There are measurable, patient-relevant outcomes to assess epistaxis management and these can highlight areas of potential improvement. This pilot audit gives a snapshot of modern practice, which shows variance between the six units assessed. A national audit may allow us to improve patient experience and maximise efficiency in delivering emergency care in our most common patient encounter.

Patterns of hospital admission with epistaxis for 26,725 patients over an 18-year period in Wales, UK

INTRODUCTIONEpistaxis is the one of the most common otorhinolaryngology emergencies. This study examined the age and sex distribution of all patients admitted with epistaxis to National Health Service (NHS) hospitals in Wales, UK, over a period of 18 years and 9 months.METHODSThe Patient Episode Database for Wales was examined for all patient admissions with a diagnosis of epistaxis between April 1991 and December 2009. The age and sex of these patients was recorded and the proportion of the underlying population affected was calculated by comparing admission rates to the population data derived from the 1991 and 2001 national population censuses for Wales.RESULTSA total of 26,725 patients were admitted to NHS hospitals in Wales with epistaxis over the period studied. The proportion of the population admitted with epistaxis increased from the age of 40 onwards. For all ages except patients in the 10–14 years group, a higher proportion of the male population was admitted with epistaxis than the comparable female population. This discrepancy was most pronounced between the ages of 15 and 49 years, with the female-to-male ratio of hospital admissions with epistaxis being 0.55. These ages (15 and 49 years) approximate the average age of menarche and menopause respectively in the UK.CONCLUSIONSWomen of menstrual age have fewer hospital admissions with epistaxis. This may be due to oestrogens providing protection to the nasal vasculature (as they do to other areas of the vascular tree).

Epistaxis in Port Harcourt

Epistaxis often causes significant anxiety in both patients and clinicians. Various methods of treatment have been advocated. The aim of this paper is to document the pattern of epistaxis in Port Harcourt, determine the etiologies and advocate the best treatment option. This is a 6-year retrospective study of patients that were managed for epistaxis in the department of Otorhinolaryngology of the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 2000 to December, 2005. The material resources were the records of the Otorhinolaryngology outpatient clinic and Accident & Emergency department of the hospital. These were updated with records from the ward admissions and theatre. The diagnosis of epistaxis was based on clinical history, physical findings, laboratory and radiological investigations with examination under anaestheasia of the nose, nasopharynx and biopsy. There were 30 patients, 16 males and 14 females with a mean age of 30.48 years +/- 15.14 [range 1-70 years]. The most commonly affected age group was 31-40 years. Idiopathic causes accounted for 66.67%, trauma 13.33%, nasopharyngeal carcinoma 10%, chronic maxillary sinusitis 6.67%, and vicarious menstruation 3.33%. The right nasal cavity was more affected than the left. The most commonly used method of treatment was anterior nasal packing (50%). Posterior nasal packing accounted for 26.67% while chemical cauterization was done in 13.3% of cases. The pattern of epistaxis in our study agrees with the pattern found elsewhere. Anterior and posterior nasal packing were cost effective methods of treatment.

Use of Oxymetazoline in the Management of Epistaxis

The purpose of this study was to determine if use of an intranasal vasoconstrictor (oxymetazoline) could be used to effectively treat epistaxis, avoiding nasal packing. The charts of 60 patients who presented to the emergency room with the diagnosis of epistaxis and who required medical management were reviewed. Sixty-five percent of these patients were successfully managed with oxymetazoline as their sole therapy. An additional 18% were managed successfully with silver nitrate cautery in combination with oxymetazoline. In only 17% of patients was it necessary to use nasal packing as treatment for epistaxis after an initial attempt with oxymetazoline alone or in combination with silver nitrate failed. These data suggest that pharmacologic management may be adequate in the majority of patients with epistaxis, thus avoiding the need for nasal packing with its associated complications.

Control of Epistaxis in Patients with Hereditary Hemorrhagic Telangiectasia

Twenty-nine patients were admitted to Pennsylvania Hospital between March 1984 and July 1990 with a diagnosis of epistaxis and hereditary hemorrhagic telangiectasia. Data were obtained through a retrospective review of the charts of these patients. Patients were treated for epistaxis with the CO2 laser, neodymium:aluminum garnet laser with a wavelength of 1064 nm (Nd-Yag), Nd-Yag laser with a wavelength of 532 nm (KTP), septodermoplasty, or any combination of these procedures. Patients underwent an average of 2.5 procedures each. Overall, 25 of 29 patients reported their symptoms had greatly improved with therapy. The average length of time without the need for further surgical intervention was 16.3 months for the Nd-Yag laser and 11.7 months for the KTP laser. Septodermoplasty using buccal mucosal grafts allowed, patients to avoid additional procedures for 24.4 months, which was twice as long as for standard septodermoplasty using split-thickness skin grafts. Although no therapy completely resolves the epistaxis, laser therapy combined with septodermoplasty enables the patients to gain excellent control of the epistaxis for several years.