Epistaxis Group Research Articles

Influence of meteorological variables on the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate (Lorca, Spain).

Epistaxis is a common emergency for otorhinolaryngologists. Although the aetiological factors have been widely studied, they remain subject to debate. The role of meteorological variables has been discussed in recent years, but results have been inconsistent. Given a lack of prior data, the aim of our study was to identify the meteorological variables that influence the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate in Spain. Case-control study. patients who attended the accident and emergency department of a secondary level hospital for epistaxis over a 9-year period (2011-2019). Controls were established by simple random sampling among emergency rooms visits in general (patients who attended the same centre over the same period of time). Sociodemographic, clinical and meteorological variables were all taken into account. 2749 patients in the epistaxis group and 2764 in the control group. There were significant differences in the epistaxis group, with a higher proportion of male (62.85%) and older patients. Univariate and multivariate analysis revealed that the daily minimum temperature and maximum wind speed were factors significantly associated with the onset of epistaxis. In addition, logistic regression analysis showed that decreases in minimum temperature and increases in maximum wind speed were associated with an increase in epistaxis (p < 0.01). No association was found between hospital admission and the weather conditions. Our findings suggest that low minimum temperatures and high wind speeds are associated with the number of visits to hospital accident and emergency departments for epistaxis, but not with hospital admission.

Adenoid ve Nazal Patolojilerin Pediatrik Epistaksisteki Etkileri

Aim: The aim of this study was to investigate the effects of adenoid and nasal pathologies in paediatric patients with recurrent epistaxis.Methods: A total of 100 (61 boys, 39 girls) individuals aged 2–17 years (mean age: 8.9 ± 3.6 years) were included in this study. Anterior rhinoscopy and flexible nasal endoscopy were used to examine all the patients. The epistaxis duration, treatment in active epistaxis by parents, medical history, medical treatment and interventions were recorded. The location of the epistaxis site, nasal mucosa type, the presence of nasal vestibulitis, nasal septum deviation location and type, adenoid size and the degree of inferior turbinate hypertrophy were recorded.Results: The deviation was present in 31 (62%) patients with recurrent epistaxis and in 14 (28%) patients without epistaxis. The presence of deviation was significantly higher in the epistaxis group than in the control group (p &amp;lt; 0.05). The nasal mucosa type was friable mucosa in 37 (74%) patients, vascularised mucosa in 11 (22%) patients and friable-vascularised mucosa in 2 (4%) patients in recurrent epistaxis group. A significant relationship was detected between nasal mucosa type and age, the presence of the deviation, deviation location, the Mladina type in epistaxis group (p &amp;lt; 0.05, p &amp;lt; 0.05, p &amp;lt; 0.05, p &amp;lt; 0.05).Conclusion: Nasal septum deviation, inferior turbinate hypertrophy and nasal mucosa type are associated with paediatric recurrent epistaxis.

Simulation-based training in ear, nose and throat skills and emergencies

ObjectivesThe aim of the study was to compare lecture-based teaching and simulation-based hybrid training for ENT induction and objectively assess the performance of trainees in a simulated environment. MethodsThis is a prospective interventional study that included 60 interns in their rotatory internship with no prior exposure to ENT emergencies. The interns came in batches of 5‒6 for their 15-days ENT postings. On the first day, a pre-test questionnaire, lecture-based teaching on three scenarios and then allocation into one of the three simulation groups- Group A (Tracheostomy group), Group B (Nasogastric tube group), and Group C (Epistaxis group) was done. Hands-on simulation training was given only to the assigned group. At the end of 15-days, post-test questionnaire and an objective assessment of the three scenarios in a simulated environment was conducted. The same training was repeated for each batch of participants who attended the posting. ResultsThe participants had significant improvement in the post-test scores in all three scenarios (p < 0.05), and these improvements were marked in those who had received simulated training. On comparing simulation scores, the participants who received hands-on training on a particular scenario outperformed other (p < 0.05). ConclusionSimulation-based training improves cognition and overall confidence in managing ENT skills and emergencies. In simulation training, objective and standardized assessment is the key to achieve specific learning objectives to improve the psychomotor and cognitive skill. Level of evidenceII.

63 Topical Use of Tranexamic Acid in the Emergency Department

The usage of topical TXA has been shown in certain cases of epistaxis to reduced time to stop bleeding, rates of rebleeding, time spent in the emergency department and increased patient satisfaction. Local administration of topical TXA has since been described in various settings in emergency medicine journals. This study seeks to evaluate the use of tranexamic acid as a medication for the management of epistaxis and other superficial hemorrhages in the emergency department (ED) of local community hospitals. Retrospective review of adult ED patients from two community hospitals presenting with epistaxis or other superficial hemorrhage, treated with topical tranexamic acid (TXA) and discharged home between 2016 and 2019. Excluded from the study are traumatic nose injuries, major trauma patients, post-operative patients, and patients with incomplete data. Abstracted data included demographics, chief complaints, discharge diagnosis, history of anticoagulant use, outcome of TXA use, and 72 hours return to the ED with recurrent hemorrhage. Data analysis was performed on the index cases only. Demographics and outcomes are reported as descriptive statistics. Significance is set at 0.05 for comparison between anti-coagulation groups. There were 341 cases meeting inclusion criteria. Ten cases were excluded with four nasal trauma, three post-operative cases, and three with missing data. Nineteen case were patients returning within 72 hours, leaving 312 index cases. There were 192 cases of epistaxis and 120 cases of cutaneous (81) or mucosal (39) wounds. Overall, 48.4% of the patients were on outpatient anti-coagulants with 7.7% on two medications. The 72-hour return rate was 5.8% with 6.8% in the epistaxis group and 4.2% in the superficial wound group. Outpatient anti- coagulation did not affect 72 hours returns in epistaxis (6.5% versus 7.1%; p=0.856) but was significant in superficial wounds (11.6% return in anti-coagulant group versus 0%; p=0.002). In this four-year study of topical tranexamic acid use in two community emergency departments, 48.4% of the patients were on outpatient anti-coagulants. The 72-hour return rate for epistaxis was 6.8% and not affected by anti-coagulant use while the return rate for superficial wounds was 4.2% and impacted by anti-coagulant use. Epistaxis and superficial wound treated in the emergency department with topical tranexamic acid have a small return rate for hemorrhage control, despite outpatient anti-coagulant use.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Intraoperative variations of the sphenopalatine artery between epistaxis and non-epistaxis cases: a comparative endoscopic analysis

BackgroundSevere epistaxis is one of the most common emergencies in rhinology practices. The commonly used endoscopic cauterization of the sphenopalatine artery (SPA), alone or with the anterior ethmoidal artery (AEA), has a high success rate for controlling severe epistaxis. The current study was conducted to evaluate the endoscopic intra-operative variations of SPA between epistaxis and non-epistaxis cases. Forty consecutive patients who underwent exploration of SPA were included in the study. They were distributed into two groups depending upon the indication of SPA exploration; the epistaxis group (group A, n=25 patients, n=26 sides) and the non-epistaxis group (group B, n=15 patients, n=25 sides). Criteria of the main SPA in the two groups were compared regarding four parameters; arterial diameter, arterial adherence to the mucosa of the lower part of the basal lamella, sphenopalatine nerve bundle, and crista ethmoidalis erosion.ResultsA significant difference was found regarding the diameter of SPA between the two groups; a mean diameter of 4.2±0.64 mm was compared to 3.2±0.35 mm for group A and B, respectively (p=0.043). Moreover, a highly significant tendency was observed regarding the arterial adherence to the mucosa of the lower part of the basal lamella and sphenopalatine nerve bundle in the epistaxis group; (p≤0.01).ConclusionThese data clearly signify the importance of intraoperative identification of SPA criteria during surgical management of severe epistaxis. These criteria may help in altering the surgical decision between solely SPA and concomitant SPA/AEA cauterization.

Epistaxis as a marker for severe acute respiratory syndrome coronavirus-2 status - a prospective study.

To evaluate the prevalence of severe acute respiratory syndrome coronavirus-2 infection in patients presenting with epistaxis to a tertiary otolaryngology unit. A prospective study was conducted of 40 consecutive patients presenting with epistaxis referred to our tertiary otolaryngology unit. A group of 40 age-matched controls were also included. All patients underwent real-time reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus-2. Symptoms of fever, cough and anosmia were noted in the study group. The mean age was 66.5 ± 22.4 years in the study group. There were 22 males (55 per cent) and 18 females (45 per cent). The mean age in the control group was 66.3 ± 22.4 years (p = 0.935). There were six positive cases for severe acute respiratory syndrome coronavirus-2 (15 per cent) in the epistaxis group and one case (2.5 per cent) in the control group. The difference was statistically significant (p = 0.05). Epistaxis may represent a presenting symptom of severe acute respiratory syndrome coronavirus-2 infection. This may serve as a useful additional criterion for screening patients.

A Clinical Study on Etiological Factors and Management of Epistaxis at a Tertiary Level Hospital

Background: Epistaxis is a common otolaryngological emergency worldwide affecting up to 60% of the population in their lifetime. This study was conducted to describe the etiological profile and treatment outcome of epistaxis at Dhaka Medical College Hospital, a tertiary care hospital in BANGLADESH.&#x0D; Objective: The study is carried out with an objective to evaluate on etiological profile and management of epistaxis.&#x0D; Methods: This cross sectional study was conducted among the emergency and admitted patient with epistaxis at Dhaka Medical College Hospital from 1st November 2013 to 30th April 2014.&#x0D; Results: During the period under study, a total 104 patients were studied. The etiology of the cause of epistaxis was grouped into traumatic and non- traumatic. Among them 46 (44.23%) patient were in traumatic epistaxis and 58 (55.77%) patient were in non traumatic epistaxis. Male were affected more frequently than female in this study. There were 74 (71.15%) male and 30 (28.85%) females with a male female ratio of 2.47:1 Majority of the patients in this study were in 2nd decade (21.15%) followed by 6th decade (19.23%) and 3rd decade (17.31%). Among the 104 patients with epistaxis 78 (75%) were urban habitat and 26 (25%) were rural habitat. Significantly more patients were from urban resident. Regarding etiology and sex distribution there were no significant differences between urban and rural habitat. The present study shows that the most common cause of epistaxis was trauma (44.23%) followed by idiopathic (25%) and hypertension (17.31%). Local pain (41.31%), nasal obstruction (13.04%), nasal deformity (17.39%) associated other injury (13.04%) was more frequent in traumatic patient. Significant raise of blood pressure (Systoloic BP &gt;160 mm Hg and diastolic BP &gt; 100 mm Hg) were found in 58 (55.77%) non-traumatic patient. Severity of the nasal bleeding was mild to severe degree in both the groups. Significantly anterior epistaxis is common among the traumatic epistaxis group (69.57%) and posterior epistaxis in non-traumatic epistaxis group (46.55%). About 27.59% patient the exact site was not detected as there was diffuse bleeding. In case of nasal bleeding, bleeding from septum 42 (40.38%), from lateral wall 32 (30.76%) and from floor of the nose 23 (22.15%). Control of bleeding by the direct method was possible in 11 (10.57%) patients. Anterior nasal packing was given in 86 (82.69%) patients and post nasal packing was given in 3 (2.89%) patients.&#x0D; Conclusion: A high incidence in young adults was reported with preponderance of males over females. Occurrence of different types of epistaxis was strongly related with the certain demographic factors like age, sex and habitat of the patient. This study supports the credibility of conservative management procedure in the treatment of epistaxis. Simple nasal packing is the commonly practice conservative method with high success. Hence, this approach should be the preferred option in the management of epistaxis especially in developing countries.&#x0D; Bangladesh J Otorhinolaryngol; April 2020; 26(1): 45-54

Can We Estimate the Recurrence of Epistaxis with Simple Blood Tests?

Objective: Epistaxis is often treated in the emergency department (ED) and is one of the causes of bleeding that can be successfully managed by physicians. This study aimed to investigate whether there is a relationship between recurrent epistaxis and simple blood parameters (the values of mean platelet volume (MPV) and red cell distribution width (RDW)). Method: This retrospective case-control study was designed at a tier-three ED. The patients were chosen from among those who applied to the ED for epistaxis between 1 January 2018 and 31 December 2018. Demographic data, seasonal application frequency, complete blood count results and clinical findings were retrospectively reviewed on the hospital information record system. The patients were categorized into three groups of recurrent epistaxis, non-recurrent epistaxis and healthy control groups. Results: 143 epistaxis patients in total including recurrent (n=73) and non-recurrent (n=70) patients were enrolled in this study. The healthy control group was composed of 77 patients. The MPV value was significantly higher in the recurrent epistaxis group than in the non-recurrent epistaxis group (8.91±1.16, 8.48±1.06, P = 0.006, respectively). In addition, the mean platelet and platecrit values were significantly higher in the non-recurrent epistaxis group than in the recurrent epistaxis group (P = 0.034, P = 0.043, respectively). The high RDW level was found to be statistically significant both in the recurrent and non-recurrent epistaxis groups than in the control group (P < 0.001). The logistic regression analysis concluded that the high MPV value increased epistaxis 1.367 times [OR: 1.367 (0.952-1.963), P = 0.028]. Conclusion: High MPV levels caused an increase in the bleeding tendency in the patients with recurrent epistaxis.

Is epistaxis associated with high blood pressure and hypertension? Propensity score matching study

ObjectiveWe aimed to investigate whether high blood pressure and hypertension are associated with epistaxis. MethodsA retrospective study with a propensity score matching analysis was performed at the emergency departments (EDs) of a tertiary university hospital. The mean blood pressure (BP, systolic and diastolic) and proportion of subjects with elevated BP (systolic >120 and/or diastolic >80 mmHg) at presentation were compared between the epistaxis group and matched control group. The proportion of patients with newly diagnosed hypertension within six months between the two groups was also compared. ResultsA total of 1353 patients with epistaxis and the same number of those with simple lacerations were matched. The mean systolic and diastolic BPs of the epistaxis group were significantly higher than those of the matched control group (157.1 ± 26.4 and 91.4 ± 17.0 mmHg versus 144.9 ± 32.4 and 84.2 ± 13.5 mmHg) (P < 0.001). The proportion of patients with elevated BP at presentation was also significantly higher in the epistaxis group (91.4%) than in the matched control group (86.2%) (P < 0.001). Of the 724 (53.5%) patients without pre-existing hypertension in the epistaxis group, 660 patients were followed, of whom 107 (16.2%) were newly diagnosed with hypertension within 6 months, which was a significantly higher percentage than among the matched controls (4.9%, P < 0.001) ConclusionThe patients with epistaxis had elevated BP at presentation and a higher proportion of newly diagnosed hypertension within six months compared to the matched controls.

The effects of nasal closure on quality of life in patients with hereditary hemorrhagic telangiectasia.

IntroductionEpistaxis is the most common symptom of hereditary hemorrhagic telangiectasia (HHT). Complete nasal closure is one of the treatment options for patients with severe, intractable epistaxis. In our experience, this surgery can be life changing in a positive sense; but many patients as well as their physicians understandably fear that such a procedure will diminish certain aspects of quality of life (QOL).MethodsCase‐control study of HHT patients treated at the University of Utah HHT Center of Excellence with and without nasal closure from January 2005 to January 2016. Patients were matched according to epistaxis severity. Each included patient was issued three surveys: Epistaxis Severity Score (ESS), the Pittsburg Sleep Quality Index (PSQI), and the Nasal Obstruction Symptom Evaluation (NOSE).ResultsAfter treatment, the mean PSQI and NOSE scores were not significantly different between the two groups. However, the mean ESS score in the nasal closure group was significantly lower at 1.10 compared to the severe epistaxis group with a mean score of 3.99 (P = .027).ConclusionThe results of this study demonstrate that nasal closure significantly improves epistaxis severity without having a significant effect on sleep or nasal obstruction as they relate to QOL. These findings suggest that nasal closure should be considered for HHT patients with chronic severe epistaxis.Level of Evidence4.

Use of anticoagulant or antiplatelet agents is not related to epistaxis in patients undergoing transnasal endoscopy.

Background and study aims Unsedated transnasal endoscopy (uTNE) has become accepted as a safe and tolerable method for upper gastrointestinal tact examinations. Epistaxis is 1 of the major complications of TNE, though its risk factors have not been elucidated. Generally, patients administered an anticoagulant or antiplatelet drug are considered to have an increased risk of epistaxis during TNE. Here, we investigated risk factors of epistaxis in patients undergoing uTNE, with focus on those who received antithrombotic agents. Patients and methods We enrolled 6860 patients (average age 55.6 ± 12.97 years; 3405 males, 3455 females) who underwent uTNE and received the same preparations for the procedure. Epistaxis was evaluated using endoscopic images obtained while withdrawing the scope through the nostril. We also noted current use of medications including anticoagulant or antiplatelet agents prior to the endoscopic examination. Results Epistaxis occurred in 3.6 % of the enrolled patients (245/6860), and that rate was significantly higher in younger patients (average age 49.31 ± 11.8 years for epistaxis group vs. 55.83 ± 13.0 years for no epistaxis group, P < 0.01) as well as females (4.78 % vs. 2.35 %, P < 0.01). The odds ratio for occurrence of epistaxis was 2.31 (95 %CI: 1.746 – 3.167) in the younger patients and 2.02 (95 % CI: 1.542 – 2.659) in females. In contrast, there was no significant difference for rate of epistaxis between patients with and without treatment with an antithrombotic agent (3.0 % vs. 3.6 %). Conclusions The rate of epistaxis was higher in younger and female patients. Importantly, that rate was not significantly increased in patients who were administered an antithrombotic agent.

A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis

IntroductionEpistaxis and hypertension are frequent conditions in the adult population. Masked hypertension is defined as a clinical condition in which a patient's office blood pressure level is <140/90mmHg, but the ambulatory or home blood pressure readings are in the hypertensive range. Many studies have proved that hypertension is one of the most important causes of epistaxis. The prevalence of this condition in patients with epistaxis is not well defined. ObjectiveThis study aimed to evaluate the prevalence of masked hypertension using the results of office blood pressure measurement compared with the results of ambulatory blood pressure monitoring. MethodsSixty patients with epistaxis and 60 control subjects were enrolled in the study. All patients with epistaxis and controls without history of hypertension underwent physical examination, including office blood pressure measurement, ambulatory or home blood pressure, and measurement of anthropometric parameters. ResultsMean age was similar between the epistaxis group and the controls – 21–68 years (mean 42.9) for the epistaxis group and 18–71 years (mean 42.2) for the control group. A total of 20 patients (33.3%) in the epistaxis group and 7 patients (11.7%) in the control group (p=0.004) had masked hypertension. Night-time systolic blood pressure was significantly higher in patients with epistaxis than in the control group (p<0.005). However, no significant difference was found in daytime systolic blood pressure between the control group and the patients with epistaxis (p=0.517). ConclusionThis study demonstrates increased masked hypertension prevalence in patients with epistaxis. We suggest that all patients with epistaxis should undergo ambulatory or home blood pressure to detect masked hypertension, which could be a possible cause of epistaxis.

Nasal bacterial colonization in cases of idiopathic epistaxis in children

ObjectivesTo evaluate the role of nasal bacterial colonization in cases of idiopathic epistaxis in children. MethodsA descriptive, hospital based, observational study in our hospital was conducted on total 112 pediatric patients in the age group 4–16 years. Group A (control): 56 patients with no epistaxis; Group B (epistaxis): 56 patients with idiopathic epistaxis. A swab for microbiological evaluation was taken from the anterior nasal cavity of each child. ResultsA highly significant association between nasal colonization with pathological Staphylococcus aureus and idiopathic epistaxis was found. The presence of pathological S. aureus colonization in the anterior nasal cavity was also associated with statistically significant number of crusting and presence of dilated blood vessels on the anterior nasal septum of children in epistaxis group. ConclusionNasal bacterial colonization with S. aureus leads to a sequence of pathological events i.e. low grade inflammation, crusting and new vessel formation. This leads to irritation in nasal cavity resulting in digital trauma and subsequently epistaxis and thus it plays an important role in causing idiopathic epistaxis in children.

Incidence, risk factors and management of severe post-transsphenoidal epistaxis

Among the major complications of transsphenoidal surgery, less attention has been given to severe postoperative epistaxis, which can lead to devastating consequences. In this study, we reviewed 551 consecutive patients treated over a 4year period by the senior author to evaluate the incidence, risk factors, etiology and management of immediate and delayed post-transsphenoidal epistaxis. Eighteen patients (3.3%) developed significant postoperative epistaxis – six immediately and 12 delayed (mean postoperative day 10.8). Fourteen patients harbored macroadenomas (78%) and 11 of 18 (61.1%) had complex nasal/sphenoid anatomy. In the immediate epistaxis group, 33% had acute postoperative hypertension. In the delayed group, one had an anterior ethmoidal pseudoaneurysm, and one had restarted anticoagulation on postoperative day 3. We treated the immediate epistaxis group with bedside nasal packing followed by operative re-exploration if conservative measures were unsuccessful. The delayed group underwent bedside nasal hemostasis; if unsuccessful, angiographic embolization was performed. After definitive treatment, no patients had recurrent epistaxis.

Is There a Relationship between Epistaxis and Staphylococcus aureus Colonization in the Nasal Vestibule?

Objectives:Although epistaxis is still very common in children and adults, its cause in most non‐traumatic cases remains unknown. We aimed to find out if nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and new vessel formation and ends with epistaxis in association. We also wanted to investigate the relationship between positive cultures and seasons.Methods:One hundred twenty‐nine patients were recruited for the study group (86 had crusting in the nasal vestibule while 43 did not) and compared with 40 healthy control subjects. A microbial swab was taken from the anterior nasal cavity of each subject. The same procedure was repeated at each season.Results:S aureus was found to be more common in the epistaxis group when compared with the control group, with a percentage of 37% and 19% respectively. There was no difference in the prevalence of S aureus between crust and noncrust groups. When positive cultures were grouped and compared according to season, we observed that the positive culture with epistaxis was much higher (44.82 %) in autumn.Conclusions:A positive correlation between nasal colonization with S aureus with epistaxis highlights the importance of healthcare and preventive care. Further studies should be performed to decrease epistaxis by diminishing the colonization of S aureus. Special attention should be given in autumn.

Childhood epistaxis and nasal colonization with Staphylococcus aureus

Epistaxis is very common in children but its cause remains unknown. We postulate that nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and ultimately new vessel formation. A prospective case-control study. Sixty-seven children were recruited, 42 with epistaxis (22 had crusting in the nasal vestibule; 20 did not) and 25 control subjects. A microbiology swab was taken from the anterior nasal cavity of each child. All groups were equally likely to have a positive culture. S aureus was more common in the epistaxis group (P = 0.008) compared with the control group. There was no difference in the prevalence of S aureus between crust and noncrust groups. Epistaxis patients were much less likely to have isolates of respiratory pathogens or a skin commensal. Children with epistaxis are more likely to have nasal colonization with S aureus than controls. Our data would support the hypothesis that S aureus replaces existing nasal flora and causes inflammation and new vessel formation.

鼻出血患者における活性酸素種関連蛋白及び一酸化窒素合成酵素の遺伝子発現

PURPOSE and METHODS: Although many reports have been described a direct relation between reactive oxygen species (ROS) and nitric oxide (NO) and several disorders, the relationship between ROS/NO and epistaxis remains unclear. In this study, differences in the mRNA expression of Mn-SOD, CuZn-SOD, Catalase, iNOS, eNOS, COX-I, COX-II and p22phox (a subunit of NADPH oxidase) were studied in the epithelium of the nasal mucosa in patients with epistaxis (n=28) and healthy subjects (n=24).RESULTS: The expression of Mn-SOD, CuZn-SOD and catalase was significantly higher in the epistaxis group than in the healthy group. This finding suggests that O2- is related to epistaxis and that these mRNAs were expressed as part of a protective reaction against oxidative stress. The expression of iNOS, COX-I and COX-II was also significantly higher in the epistaxis group. The expression of iNOS produces NO, and NO activates COX-I and COX-II to produce more free radicals. In addition, p22phox expression in the epistaxis group was stronger than in the healthy group, indicating that NADPH oxidase may also cause epistaxis through the production of O2-.CONCLUSION: We demonstrated that ROS produced by COX-I, COX-II and NADPH oxidase and NO produced by iNOS may be involved in pathogenesis of epistaxis and that a protective reaciton involving SOD and catalase may be active.

Caspase 3 activation in nasal capillary in patients with epistaxis.

We investigated whether an apoptosis of nasal microvessels contributes to probable mechanism of the onset of epistaxis. Nasal septal mucosa of Little's areas taken from patients without (n = 19) and with (n = 26) epistaxis were examined. Active caspase-3 in the mucosa was detected according to the methods of immunohistochemistry and Western blotting. On Western blot analysis of the homogenates of the mucosa, we also sought probable signaling factors after caspase-3 activation. Marked activation of caspase-3 was detected in the capillaries and its neighboring muscle cells of Little's area from patients with epistaxis, and the activation was due to enhanced expression of procaspase-3 protein and progressive cleavage of the precursor. As a result of Western blotting of signaling factors, enhanced expressions of caspase-9 and Bax protein in the homogenates of Little's area in epistaxis group were found compared with those in control group. Increased levels of cytochrome c released into a cytosol were also detected in the capillaries in epistaxis group. In the present study, caspase-3 activation was found in the capillaries of Little's area from patients with epistaxis, suggesting that an apoptosis of capillaries may contribute to a mechanism of the onset of epistaxis. Moreover, alterations of some apoptotic factors such as caspase-9, Bax, and cytochrome c in the tissues demonstrated participation of mitochondrial disturbance in one of the apoptotic mechanisms. Further explorations of the pathobiologic mechanism of capillary apoptosis can lead not only to an identification of risk factors in the onset of epistaxis but also to the development of medical therapy of epistaxis.

Caspase 3 activation in nasal capillary in patients with epistaxis

We investigated whether an apoptosis of nasal microvessels contributes to probable mechanism of the onset of epistaxis. Nasal septal mucosa of Little's areas taken from patients without (n = 19) and with (n = 26) epistaxis were examined. Active caspase-3 in the mucosa was detected according to the methods of immunohistochemistry and Western blotting. On Western blot analysis of the homogenates of the mucosa, we also sought probable signaling factors after caspase-3 activation. Marked activation of caspase-3 was detected in the capillaries and its neighboring muscle cells of Little's area from patients with epistaxis, and the activation was due to enhanced expression of procaspase-3 protein and progressive cleavage of the precursor. As a result of Western blotting of signaling factors, enhanced expressions of caspase-9 and Bax protein in the homogenates of Little's area in epistaxis group were found compared with those in control group. Increased levels of cytochrome c released into a cytosol were also detected in the capillaries in epistaxis group. In the present study, caspase-3 activation was found in the capillaries of Little's area from patients with epistaxis, suggesting that an apoptosis of capillaries may contribute to a mechanism of the onset of epistaxis. Moreover, alterations of some apoptotic factors such as caspase-9, Bax, and cytochrome c in the tissues demonstrated participation of mitochondrial disturbance in one of the apoptotic mechanisms. Further explorations of the pathobiologic mechanism of capillary apoptosis can lead not only to an identification of risk factors in the onset of epistaxis but also to the development of medical therapy of epistaxis.

Recurrent epistaxis and nasal septal deviation in young adults

Epistaxis is common in young adults but the aetiology is unknown in many cases. To investigate the possibility that septal deviations are associated with epistaxis, 54 servicemen with recurrent epistaxis were compared with 46 controls. The epistaxis group were significantly more likely to have a history of nasal trauma (P = 0.008) and radiologically-proven nasal fracture (P = 0.002); on clinical examination, they were more likely to have a deviated septum (P < 0.00001), maxillary spur (P = 0.00004) and nasal obstruction (P = 0.011); they were also more likely to have radiological evidence of a deviated septum (P = 0.020). Those patients able to locate their epistaxis to one side tended to do so to the side of their septal deviation. This study supports the hypothesis that septal deviation is associated with epistaxis.