Cases Of Epistaxis Research Articles

Post-transplant lymphoproliferative disorder presenting as epistaxis

An unusual case of epistaxis resulting from post-transplant lymphoproliferative disorder is described. A 30-year-old woman who had undergone renal transplantation 12 years previously presented with profuse, posterior, unilateral epistaxis. The initial findings, workup and treatment are presented. A post-nasal space (PNS) mass was detected and biopsy showed this to be an Epstein-Barr virus-positive polymorphous B-cell post-transplant lymphoproliferative disorder. Computed tomography findings showed a polypoid lesion protruding from the sphenoethmoidal recess and filling the left PNS. Post-transplant lymphoproliferative disorder is well known to involve tonsil tissue. Commonly, this is the first presentation of the disease in children. However, until now post-transplant lymphoproliferative disorder has not been described in the PNS or nasal cavity presenting as epistaxis. We conclude that all transplant patients presenting with epistaxis should be followed up for an accurate examination of the PNS and nasal cavity after the acute episode.

Epidemiology of epistaxis in us emergency department patients, 1992-2001

Study objectives: Epistaxis is a common emergency, but no emergency department (ED)–based epidemiology has been published. There is also significant controversy ns, such as the influence of age and weather. We study the demographics and trends in epistaxis visits to all US EDs for the 10-year period 1992 to 2001. Methods: ED visit data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to estimate the nationwide number of epistaxis visits for 1992 to 2001. Inclusion criteria were International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code 784.7 or chief complaint code 1405.1. Traumatic visits were identified as those with a supplementary classification of external injury and poisoning code (E-codes) or a reason-for-visit code related to an injury, poisoning, or adverse effect (codes 5001 to 5999). National estimates were obtained using NHAMCS patient visit weights. Rates were calculated using midyear population estimates from the US Census Bureau, by age, sex, race, and region (Northeast, Midwest, South, West). The standard error of the estimate was used to calculate 95% confidence intervals (CIs). Stata 7.0 software (StataCorp, College Station, TX) was used for analyses. Results: From 1992 to 2001, 4,503,000 visits for epistaxis occurred in US EDs (95% CI 3,993,000 to 5,013,000), accounting for 4.6 of every 1,000 ED visits (95% CI 4.1 to 5.1). On a population basis, there were 1.7 visits (95% CI 1.5 to 1.9) per 1,000 US residents. The sex-specific rates per 1,000 ED visits were 5.3 (95% CI 4.5 to 6.0) for men and 4.0 (95% CI 3.4 to 4.7) for women. Rates were similar among blacks and whites, Hispanics and non-Hispanics, and in metropolitan and nonmetropolitan areas. Rates did not change during the 10-year period of study. Arrival by ambulance was reported in 15% of visits (95% CI 12% to 18%). Most patients (94%) were discharged (95% CI 91% to 97%). Use of a medication for epistaxis was reported in 57% of visits (95% CI 52% to 62%). Cocaine was most common, followed by phenylephrine, silver nitrate, and oxymetazoline. Overall frequency of visits for epistaxis was strongly related to age, which was not because of a general trend toward more visits with increasing age: of 1,000 ED visits by those aged 70 to 79 years, epistaxis was present in 12.0 (95% CI 9.1 to 14.9) versus 2.3 (95% CI 1.2 to 3.3) for visits by those aged 20 to 39 years. The rate per 1,000 ED visits for children younger than 10 years was 4.0 (95% CI 3.0 to 5.1). Eighty-three percent of epistaxis cases were nontraumatic (95% CI 80% to 86%). Patients with nontraumatic epistaxis were older than those with traumatic epistaxis, with mean ages of 49.4 years (95% CI 47.2 to 51.6 years) and 30.8 years (95% CI 26.2 to 35.5 years), respectively. Nontraumatic epistaxis varied with the seasons, accounting for 50 of every 1,000 ED visits during the winter months of December to February (95% CI 40 to 60) and 34 per 1,000 ED visits during the rest of the year (95% CI 30 to 39). The seasonal variation of nontraumatic epistaxis was observed in all regions except the Western region. Traumatic epistaxis did not vary seasonally. Conclusion: Epistaxis is present in about one half of 1% of all ED visits. Among ED patients with epistaxis, the elderly predominate. The proportion of ED visits among those aged 70 to 79 years was nearly 6 times greater than among those aged 20 to 39 years. Even small children younger than 10 years had one third as high a proportion of all ED visits because of epistaxis compared with those aged 70 to 79 years. Nontraumatic epistaxis is significantly more common during the winter, possibly because of cold or low humidity. Though there was no seasonal variation in the Western region, the seasonal variation in the other regions was strong enough to cause significant variation in the nationwide sample. Our study was limited by the fact that NHAMCS records information about visits only, not individual patients. We were also unable to answer the much-debated question of the relationship between epistaxis and hypertension, because hypertension may not be recorded reliably in NHAMCS. Finally, the predominance of cocaine as a therapeutic choice could be due to reporting bias, given the close tracking of this controlled substance.

Combined open septorhinoplasty and functional endoscopic sinus surgery

Objectives: To compare perioperative and immediate postoperative complication rates of combined open septorhinoplasty and functional endoscopic sinus surgery to complication rates of the 2 procedures performed individually. Methods: A sample of 57 patients treated at an academic referral center who had undergone combined open septorhinoplasty and functional endoscopic sinus surgery was identified. Medical charts were reviewed to identify complications encountered during, or immediately after the combined procedures. These complication rates were compared to the complication rates of the 2 procedures performed alone as quoted in the general medical literature. Results: Patients ranged in age from 14 to 77 years (mean age, 42 years). Among the 57 cases, there were 7 (12%) minor complications and no major complications. Of the minor complications, there were 4 cases of mild cellulitis (7%) and 3 cases of postoperative epistaxis (5%). No other intraoperative or early postoperative complications were found. Conclusions: Open septorhinoplasty and functional endoscopic sinus surgery may be safely and effectively performed in combination without a significantly increased risk of complications when compared to either procedure performed individually. The slightly increased risk of cellulitis encountered in our study may warrant careful consideration of the use of postoperative antibiotic prophylaxis following combined open septorhinoplasty and functional endoscopic sinus surgery.

Efficacy of conservative treatment modalities used in epistaxis

To assess the efficacy of conservative modalities in the management of epistaxis. Prospective case studies. Rural medical college hospital. Indoor and outdoor patients with epistaxis. LNTERVENTION: Conservative(non surgical) management techniques in epistaxis. Chemical cauterization was successful in 72.07% cases, anterior nasal packing in 84.5% and posterior nasal packing in 95.6% cases. Out of 300 cases of epistaxis included in the study (except for one case that required internal maxillary artery ligation). all cases were treated successfully with conservative treatment alongwith treating the underlying pathology causing epistaxis.

Internal maxillary artery ligation for idiopathic intractable epistaxis

Epistaxis though common, is rarely life threatening. Routinely nose pinching, anterior find posterior nasal packing and endoscopic cauterization of bleeding points is sufficient to control epistaxis in 99% of the cases. It is mandatory to rule out local and systemic causes before labeling a case as idiopathic by using a battery of investigative modalities. Here are two interesting cases of epistaxis which did not respond to conventional therapeutic modalities in which transantral internal maxillary artery ligation was attempted leading to complete cure.

Multiple live leeches from nose in a single patient- a rare entity

Foreign bodies are a common cause of unilateral epistaxis in children. Both animate: and inanimate foreign bodies are commonly found but, leech as a cause of epistaxis is rare. Cases of leech infestation have been reported in the past but infrequently. Here we report an unusual case of bilateral epistaxis in a four years old child who had infestation with multiple live leeches.

A report of a case of intractable epistaxis

A report of a case of intractable epistaxis

Circadian variation in onset of epistaxis: analysis of hospital admissions

Circadian patterns have been shown in several acute cardiovascular events—for example, myocardial infarction and stroke—and such patterns could be related to blood pressure rhythms.1 We reviewed all cases of epistaxis...

Endoscopic sinus surgery in patients with cystic fibrosis: an analysis of complications.

The application of endoscopic sinus surgery (ESS) for the management of paranasal sinus disease in patients with cystic fibrosis (CF) has been well described. Due to underlying medical issues such as acquired coagulopathies and advanced pulmonary disease, perioperative morbidity is assumed to be higher in this group. The incidence and type of complications associated with CF patients undergoing ESS has not been previously described. We reviewed 52 consecutive endoscopic procedures in 41 patients with CF performed by a single surgeon over a 34-month period. This review focused on perioperative and postoperative complications. Additional clinical data gathered included estimated blood loss, length of procedure, coagulation laboratory studies, the presence of nasal polyposis, the use of nasal packing, pulmonary function status, and average hospitalization time. A total of six complications were identified--four immediate and two delayed. The perioperative or immediate complications included two cases of epistaxis, one case of periorbital ecchymosis, and one case of pulmonary hemorrhage. Delayed complications include one case of epistaxis and one case of intranasal scarring. In two of these six patients, length of hospitalization was prolonged for management of the associated complications. No study has specifically addressed complications of ESS in the CF patient. Our review demonstrates a complication rate of 11.5%, which compares favorably with the non-CF ESS complication rates of 0-17% reported in the literature. Critical to successful management of these patients is coordinated care delivered by the pediatrician or internist, the pulmonary specialist, the anesthesia team, and the otolaryngologist. In addition to a review of current literature, we discuss the overall management approach adopted at our institution and highlight elements thought to minimize morbidity.

Computer-aided surgery of the head and neck

Computer-aided surgery of the head and neck

VASCULAR EMBOLOTHERAPY-HOW MUCH HAS BEEN ACHIEVED?

Emergency and elective embolotherapy of various systemic arteries in 64 patients was carried out at a tertiary centre of Armed Forces. Specific indications were haemoptysis (n=43), preoperative (n=18), haematuria (n=1), epistaxis (n=1) and chemoembolization (n=1). The procedures were performed with gelfoam pellets (n=46), gelfoam pellets and absolute alcohol (n=1), polyvinyl alcohol particles (PVA) (n=14), steel coils (n=2) and Adriamycin-in-oil emulsion (n=1). Embolotherapy resulted in complete haemostasis in 37 (82.2%) out of 45 cases of haemorrhage. In eight cases (17.8%), it resulted in significant improvement. Complete haemostasis was achieved in both cases of haematuria and epistaxis. Pre-operative embolotherapy resulted in considerable reduction of peroperative blood loss in all the cases. Chemoembolization of Hepatocellular carcinoma resulted in partial regression of the tumour. The purpose of this study was to assess the efficacy, safety and reliability of vascular embolotherapy for control of life threatening haemorrhage and preoperative reduction of lesions.

A comparison of transnasal and transoral endoscopy with small-diameter endoscopes in unsedated patients

Background: The aim of this study was to compare use and tolerance of transnasal and transoral diagnostic endoscopy with small-diameter endoscopes in unsedated patients. Methods: Patients being seen for diagnostic endoscopy were randomly assigned to have an unsedated transnasal or transoral procedure. Two prototype narrow-diameter endoscopes (a 5.3 mm fiberoptic endoscope and a 5.9 mm videoendoscope) were used. Results: Of 170 patients (64 women and 106 men) enrolled, 86 underwent transoral and 84 underwent transnasal endoscopy. The procedure was successfully completed using the transoral route in 85 of 86 patients and using the transnasal route in 74 of 84 patients (p = 0.004). Sixteen patients experienced mild epistaxis after transnasal endoscopy. The larger videoendoscope, when compared with the fiberoptic endoscope, accounted for a significantly higher proportion of failures (8 of 41 vs. 2 of 43, p = 0.046) and cases of epistaxis (12 of 33 vs. 4 of 41, p = 0.007). The time taken for transoral endoscopy was shorter than the transnasal route (oral mean 13.7 ± 0.5 minutes, nasal mean 15.2 ± 0.6 minutes, p = 0.054). There was no difference between the 2 groups with respect to tolerance of the procedure. From the endoscopist's perspective, the only statistically significant difference between the 2 groups was that endoscope insertion was easier by the oral route (p = 0.007). Conclusions: Unsedated transnasal endoscopy with the videoendoscope was less successful compared with the transnasal fiberoptic instrument or when compared with either instrument passed transorally. Use of the larger diameter videoendoscope also resulted in significantly more epistaxis in the transnasal endoscopy group. Endoscopists find transoral introduction of the endoscope easier; this may reflect their relative unfamiliarity with the nasal route. Once intubation has been successfully achieved for either route, patient tolerance is the same. (Gastrointest Endosc 1999;49:292-6.)

鼻出血症例の臨床的検討

We examined 718 epistaxis cases who visited or were hospitalized in the Tokyo Women's Medical University Daini Hospital.1) Many of the epistaxis cases were men, and a relation to arteriosclerosis was strongly suggested.2) A relation to changes in the diastolic pressure was strongly suggested by the number of epistaxis patients with hypertension.3) The bleeding area, excluding the Kiesselbach area, increased with aging.

A microbiological study of anterior nasal packs in epistaxis.

Bleeding per nose is one of the comnonest ailment encountered by each and every otolaryngologvst Since hemostasis is immediate concern, anterior nasal pressure pack is put and is usually allowed to remain for 24-72 hours. Blood soaked pack and raw mucosal surface are good media for bacterial multiplication resulting in infection including sinusitis and sometimes toxic shock syndromes.Present study is conducted to work out bacterial flora of anterior nasal pack and effect of svstemic antibiotics in controlling it. Thirty cases of epistaxis of different etiology were included. Out of these 26 cases were positive on culture. These included Staphylococcus aureus 70%,. Pseudomonas aeruginosa twenty three percent. Klabsiella pneumonia and proteus mirabilis 3.3%, Streptococcus and Hemolyticus 3.3%. Details of type and duration of packing and its relation with organism cultured are discussed. It is concluded that the packing material should be soaked with antibiotics prior to use and should not be keep for more than 48 hours. And systemic antibiotics does not have any significant on this local infection due to packing.

Surgical bone wax causing epistaxis

A case of recurrent epistaxis caused by bone wax in the nasal cavity is reported. This is the first reported case of a nasal complication due to surgical bone wax.

Contamination with blood during management of epistaxis

The management of medical emergencies is known to expose medical staff to the risks of blood contamination,1 including infection with HIV and hepatitis B virus.2 Epistaxis is one of the commonest otolaryngological emergencies, requiring treatment that may range from simple chemical cautery to major arterial ligation. We assessed the risk of blood contamination to junior medical staff during the treatment of acute epistaxis and determined patient opinion regarding the junior doctors' use of protective clothing. Fifty consecutive cases of acute epistaxis treated by two junior medical staff were prospectively studied. Clean protective theatre clothing with gloves, mask, full face visor, hat, and apron was worn during …

Embolization as the Definitive Treatment of Epistaxis in the Pediatric Patient

Epistaxis occurs often in children, but these patients are seldom hospitalized. Two cases of intractable epistaxis, which were definitively treated with internal maxillary artery embolization, are presented with an algorithm for management of similar cases.

Posterior Epistaxis: Clinical Features and Acute Complications

Study objective: To describe the clinical features, evaluate the incidence of serious complications, and identify factors associated with rebleeding in adults with acute posterior epistaxis. Design: Retrospective chart review. Setting: University-affiliated community teaching hospital. Participants: We studied 88 episodes of posterior epistaxis in 81 patients (mean age, 64.3 years; range, 27 to 96 years) who were treated in the emergency department and hospitalized during a 6-year period. Inclusion criterion was active hemorrhage into the posterior pharynx without identifiable anterior bleeding or severe nasal hemorrhage refractory to anterior packing. Patients with anterior epistaxis were excluded. Results: Posterior epistaxis accounted for 5% of all cases of epistaxis. The most common factors associated with posterior epistaxis were a history of hypertension in 39 patients (48%) and previous epistaxis in 30 (37%). Of 57 patients who reported duration of epistaxis, 39 (68.4%) had nasal hemorrhage for less than 12 hours before ED presentation, and 13 patients (22.8%) had nasal bleeding that lasted more than 24 hours. Bleeding was recorded as moderate or severe for 88% of patients. All patients were treated with posterior nasal packing in the ED (73% with traditional gauze packing, 15% with balloon, and 12% with tampon). After admission, 16 patients (19.8%) required surgical intervention, 17 (21%) experienced acute sinusitis, 10 (12.3%) received blood transfusions, and 3 (3.7%) were intubated. Rebleeding occurred in 24 patients (29.6%), with 13 episodes (44.1%) occurring less than 24 hours after admission. Factors associated with rebleeding were posterior epistaxis described as "severe" (OR, 2.53; 95% CI, .88 to 7.39; χ 2=2.84, 1 df , P =.92) and pack removal within 48 hours after admission (OR, 3.07; 95% CI, .98 to 9.88; χ 2=3.66, 1 df , P =.056). Factors that failed to predict rebleeding included age, prior hypertension, anticoagulant use, vital signs, and type of posterior pack used (gauze or balloon). Conclusion: Although posterior epistaxis is an uncommon otolaryngologic emergency, many patients experience clinically significant complications. Rebleeding was associated with severe posterior epistaxis and pack removal within 48 hours after admission. [Viducich RA, Blanda MP, Gerson LW: Posterior epistaxis: Clinical features and acute complications. Ann Emerg Med May 1995;25:592-596.]

The intraorbital arrangement of the anterior and posterior ethmoidal foramina.

This study, instigated by surgical observations, and mainly carried out on the dry bone, attempts to analyse both the depth and variability of the anterior and posterior ethmoidal foramina through which pass the ethmoidal aa. The surgical implications of this study relate not only to ligation of the ethmoidal aa. in certain cases of epistaxis, their embolisation and the endonasal microsurgery of the ethmoid, but also to the surgery of the anterior cranial fossa. The study is based on 200 anatomic observations.

Nontraumatic Carotid-Ophthalmic Aneurysm Presenting as Recurrent Epistaxis

Recurrent epistaxis can be a rare presentation of ruptured internal carotid artery aneurysm. Although primarily a neurosurgical problem, these cases may be seen initially by the otolaryngologist, as the aneurysm erodes through the thin adjacent sphenoid sinus wall and ruptures, producing epistaxis. In most cases these aneurysms are traumatic in origin. We present the first cited case of a nontraumatic internal carotid aneurysm, arising from the origin of the ophthalmic artery, which presented as intermittent epistaxis from the sphenoid sinus. We suggest that aneurysmal rupture be considered in the differential diagnosis of all cases of epistaxis from the sphenoid sinus. Nasal endoscopy and CT scan of the paranasal sinuses in non-emergent cases is valuable in localizing the source of the bleed. Furthermore, preoperative angiography is essential in making the diagnosis of aneurysm and avoiding fatal torrential hemorrhage caused by nasal surgery. Once the diagnosis is made, the definitive treatment is surgical or intravascular trapping of the aneurysm.