Epistaxis In Adults Research Articles

What is the best treatment of epistaxis in adults?

Magnusson, Leif DO; Raja, Danash MD; Stafki, Shawn MD; Washburn, Mark DO; Hamblin, Joan MD Author Information

Clinico-Aetiological Profile of Adult Epistaxis-Three Years’ Experience at a Tertiary Care Centre

Introduction Epistaxis is the commonest otorhinolaryngological emergency affecting upto 60% of population. The aetiology of epistaxis can be local or systemic. Often it may be difficult to categorize the epistaxis and no clear cause is found; then it is labelled as idiopathic. Materials and Methods It was a prospective observational study. All the patients of both gender, age ≥18 years with epistaxis without obvious cause coming to the ENT OPD/ Emergency were included in the study. The patient's vitals were recorded and hemodynamical stability was established first. All patients of epistaxis underwent thorough clinical examination and proper history was taken. Measures to stop bleeding included nasal packing, electro/chemical cautery of local area or ligation of sphenopalatine vessels etc. Efforts were made to establish a primal relationship of adult epistaxis with various factors. Results There were 97 patients in the study. Male to female ratio was 5.7:1. Majority were above 40 years. The commonest factor associated with epistaxis was Hypertension(38%) followed by idiopathic(21%). Anterior nasal bleeding was present in 71% patients whereas posterior nasal bleeding was there in 29% patients. Non-surgical measures like nasal packing and cauterization were the main intervention methods. Duration of hospital stay was more than 3 days in 73% patients. Conclusion Hypertension, blood thinners and trauma were the most common risk factors among the patients in whom aetiology was found although in 21% of the patients, aetiology could not be found. Most cases were successfully managed with conservative (non-surgical) treatment.

Efficacy of topical tranexamic acid in epistaxis: A systematic review and meta-analysis.

Epistaxis is a very common presentation in the emergency department (ED), accounting for approximately 1 in 200 ED visits in the United States. Currently, standard practice includes the initial use of topical anesthetics and vasoconstrictors, followed by more invasive treatments such as nasal packing, cauterization or surgical ligation for refractory cases. Over the years several studies have investigated the potential use of topical Tranexamic Acid (TXA) in the management of epistaxis. We have conducted a meta-analysis to assess the efficacy of topical TXA versus other standard practices or placebo in the management of epistaxis. PubMed and Scopus databases were searched from inception to April 2021. We included randomized controlled trials and observational studies investigating the efficacy of TXA in bleeding cessation in epistaxis in adults. The primary outcome measured was the prevalence of bleeding cessation after treatment at first assessment. Other outcomes were bleeding reoccurrence between 24 and 72h and at 7-8days. A random-effects model was used to estimate odds ratio (OR) for outcomes. A total of eight studies were included in the analysis, including seven randomized trials and one retrospective study. We included a total of 1299 patients, 596 (46%) received TXA while 703 (54%) received control treatment (placebo, lidocaine plus vasoconstrictors or local anesthetics). Patients who were treated with TXA were 3.5 times (OR 3.5, 95% CI 1.3-9.7) more likely to achieve bleeding cessation at the first assessment. Patients treated with TXA had 63% (OR 0.37, 95% CI 0.20-0.66) less likelihood of returning due to rebleeding at 24-72h. Topical TXA is associated with better bleeding cessation rates after treatment compared to the standard practices.

Management of non-traumatic epistaxis in adults in the emergency department.

Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019-20. The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing. The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.

Particulate Matter 10 (PM10) Is Associated with Epistaxis in Children and Adults.

The impact of atmospheric concentration of particulate matter ≤10 μm in diameter (PM10) continues to attract research attention. This study aimed to evaluate the effects of meteorological factors, including PM10 concentration, on epistaxis presentation in children and adults. We reviewed the data from 1557 days and 2273 cases of epistaxis between January 2015 and December 2019. Eligible patients were stratified by age into the children (age ≤17 years) and adult groups. The main outcome was the incidence and cumulative number of epistaxis presentations in hospital per day and month. Meteorological factors and PM10 concentration data were obtained from the Korea Meteorological Administration. Several meteorological factors were associated with epistaxis presentation in hospital; however, these associations differed between children and adults. Only PM10 concentration was consistently associated with daily epistaxis presentation in hospital among both children and adults. Additionally, PM10 concentration was associated with the daily cumulative number of epistaxis presentations in hospital in children and adults. Furthermore, the monthly mean PM10 concentration was significantly associated with the total number of epistaxis presentations in the corresponding month. PM10 concentration should be regarded as an important environmental factor that may affect epistaxis in both children and adults.

A clinical study of etiopathogenesis of epistaxis

Introduction: It is a common clinical condition-encountered by the otorhinolaryngologist. Key clinical areas of epistaxis are the Little’s area and the ‘Woodruff’s plexus. Little’s area lies in the anteroinferior part of septum; a common site of anterior epistaxis in children and young adults [2]. Woodruff s plexus lies just inferior to the posterior end of inferior turbinate; gives rise to posterior, epistaxis in adults [3]. The causes of epistaxis are numerous which can be divided into local and general causes. Common local causes are Trauma, Infections, Foreign bodies, Deviated nasal septum, Neoplasms. General causes are Hypertension, Blood dyscrasias, Chronic liver disorders, Chronic kidney diseases, Overuse of salicylates and anticoagulants.Aim: To study the etiopathogenesis, age and sex distribution of epistaxis.Materials and Methods: This study was conducted in the ENT department of Sree Mookambika Institute of Medical Sciences, Kulasekharam, Kanyakumari district in a time period from January 2020 to September 2020. Fifty patients of both sexes and all age groups presenting with epistaxis are included in this study. The study was conducted after obtaining the clearance from Institutional Human Ethical Committee.Study design: Prospective descriptive study.Results and Analysis: The incidence of epistaxis was 1.2%. It was more common in males. The age incidence was more in the first and second decades and then increased from the fifth decade onwards with almost 48% cases belonging to this category. The seasonal incidence was more during cold, dry, winter months (64%). The commonest etiological factor was trauma (48%), followed by the hypertension (22%). The causes for epistaxis in the first and second decades were trauma, infection and septal abnormalities. Hypertension, trauma and neoplasms accounted for the cases from fourth decade onwards.Conclusion: The conclusions drawn from this study are as follows: Epistaxis is a common clinical condition encountered by the otorhino-laryngologist. It is prevalent in the 1st and 2nd decade and once again the age incidence increases from the 5th decade onwards. It is found to be more common in males than females. It occurs frequently in cold and dry climate. The common causes epistaxis are trauma and hypertention.

Local sclerotherapy with lauromacrogol versus chemical cautery with chromic acid in treatment of idiopathic recurrent anterior epistaxis

Introduction: Epistaxis is a very common medical problem affecting up to 60% of population at a point of their life. The classic lines of treatment of significant epistaxis include, vessel compression by packing or similar maneuvers, cauterization using various types of chemicals or heat and ligation or embolization of the bleeding vessel(s). Lauromacrogol is a relatively new compound that has been recently used as a sclerosing material in some vessel-related diseases like varicose veins and Hereditary Hemorrhagic Telengectasia. Objectives: This study compared the efficacy of local sclerotherapy with Lauromacrogol and chemical cautery with chromic acid as treatments for recurrent idiopathic anterior epistaxis in adults. Patients and Methods: Patients were grouped into 2 groups. In group A Lauromacrogol was injected in the submucosa. In group B Chromic acid was applied locally to the surface over the bleeding vessel(s). The primary outcome measure was bleeding control / recurrence during 3-months follow up. Secondary outcome measures were morbidity or complications and cost of both materials. Results: The overall epistaxis control was significantly higher in group A (Lauromacrogol group) than in group B (Chromic acid group). Less morbidity was also reported in group A. Lauromacrogol was relatively more expensive. Conclusion: Local sclerotherapy with Lauromacrogol is an effective mean for controlling recurrent idiopathic anterior epistaxis in adults. Better bleeding control with less morbidity were reported during 3-months follow up than Chromic acid cautery.

A Study on Causes of Epistaxis in Adults: A Series of Total 100 Cases

A Study on Causes of Epistaxis in Adults: A Series of Total 100 Cases

Rapid hemostasis: a novel and effective outpatient procedure using microwave ablation to control epistaxis of isolated mucosal bulge lesions

IntroductionRecurrent epistaxis is commonly encountered in the rhinology outpatient clinic. Under endoscopic guidance, both bipolar cautery and monopolar forceps (combined with suction) have been employed to control the bleeding. However, the use of monopolar forceps requires the placement of grounding pads. Most procedures are currently performed in operating rooms. ObjectiveWe investigated outcomes after the use of Microwave Ablation (MWA) to control epistaxis in adults with isolated mucosal bulge lesions. All procedures were performed with patients under local anesthesia in our outpatient clinic. MethodsThis is a retrospective cohort study. We included 83 adults with epistaxis of isolated mucosal bulge lesions. Microwave ablation was performed in the outpatient clinic to control bleeding, after induction of local anesthesia. The primary outcome was successful hemostasis. The secondary outcomes were the rebleeding rates at weeks 1 and 4 and month 6, and complications (crust or synechiae formation, septal perforation, and/or orbit or brain complications). ResultsAll bleeding points were successfully ablated; hemostasis was achieved within 1–2min. The mean pain score was 1.83 intra-operatively and 0.95 1h postoperatively. No patient re-bled, and no severe MWA-related complication (septal perforation, synechiae formation, or orbit or brain complication) was recorded to 6 months of follow-up. ConclusionsEndoscopic microwave ablation with patients under local anesthesia is a novel, safe, effective, rapid, well-tolerated, outpatient treatment for adults with epistaxis of isolated mucosal bulge lesions, especially those for whom general anesthesia might be risky, those with electrical implants, and those exhibiting contraindications for arterial embolization.

Management of idiopathic epistaxis in adults: what's new?

SUMMARYEpistaxis is one of the most common complaints presenting to emergency departments. The aim of this study is to systematically review and critically evaluate the evidence relating to treatment of idiopathic epistaxis for guiding best practice. A comprehensive review of the English language literature was performed using PubMed, Embase, Cochrane Library and Central electronic databases. The inclusion criteria were: retrospective or prospective or randomised controlled clinical trials which included outcomes in the management of idiopathic epistaxis. Twenty-three articles met inclusion criteria and were reviewed. Nasal packing still represents the first-line approach to epistaxis, although, at present, it appears that there is clear evidence in the literature to suggest that it is less effective and associated with more admissions and longer hospital stays than endoscopic electrocoagulation-based management of epistaxis. In conclusion, cauterisation should be the first-line approach for its high cost-effectiveness rate and low risk of complications. Further research is urgently needed to assess the efficacy of new biomaterials.

Tranexamic acid for patients with nasal haemorrhage (epistaxis).

Tranexamic acid for patients with nasal haemorrhage (epistaxis).

Haematological factors in the management of adult epistaxis: systematic review.

The management of epistaxis requires an understanding of haematological factors that may complicate its treatment. This systematic review includes six distinct reviews examining the evidence supporting epistaxis-specific management strategies relating to warfarin, direct oral anticoagulants, heparin, antiplatelet agents, tranexamic acid and transfusion. A systematic review of the literature was performed using a standardised methodology and search strategy. Limited numbers of articles were identified in each systematic review, with level 1 evidence only regarding the use of tranexamic acid. No studies met the inclusion criteria within the heparin, direct oral anticoagulants or transfusion systematic reviews. Many studies were limited by small sample sizes and significant risk of bias. The management of major bleeding and transfusion practice is well documented in national guidance from multiple sources. The guidelines include advice on anticoagulants, antiplatelet agents and tranexamic acid. In the absence of more specific evidence, these guidelines should be applied in the management of epistaxis.

Initial assessment in the management of adult epistaxis: systematic review.

The initial assessment of epistaxis patients commonly includes: first aid measures, observations, focused history taking, and clinical examinations and investigations. This systematic review aimed to identify evidence that informs how the initial assessment of these patients should be conducted. A systematic review of the literature was performed using a standardised methodology and search strategy. Seventeen articles were included. Factors identified were: co-morbidity, intrinsic patient factors, coagulation screening and ice pack use. Hypertension and anticoagulant use were demonstrated to adversely affect outcomes. Coagulation screening is useful in patients on anticoagulant medication. Four studies could not be accessed. Retrospective methodology and insufficient statistical analysis limit several studies. Sustained ambulatory hypertension, anticoagulant therapy and posterior bleeding may be associated with recurrent epistaxis, and should be recorded. Oral ice pack use may decrease severity and can be considered as first aid. Coagulation studies are appropriate for patients with a history of anticoagulant use or bleeding diatheses.

A study on epistaxis in adults: a series of 120 cases

<p class="abstract" style="display: inline !important;"><strong>Background:</strong> <span lang="EN-IN">Epistaxis is a symptom of many diverse conditions. This study on epistaxis of 120 cases in adults, is to find out the most common causes for epistaxis, prevalence of epistaxis in either sex, age groups and for early identification of cause and management. Results were analysed. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">Prospective study of series 120 cases<strong> </strong>in adults. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Results were analysed and idiopathic was most common cause of epistaxis, males were more affected than females, and the most common age group affected is 13 to 30 years. Most cases are treated by conservative measures. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Idiopathic is the most common cause of epistaxis in this present study. Other causes are trauma, DNS with spurs, sinusitis and JNA in adolescent males. Males are commonly affected than females .The most common age group affected is 13 to 30 years and 41 to 60 years. Most cases are treated by conservative measures.</span></p>

English

English

An Aetiopathological Study on Epistaxis in Adults and its Management


 IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.

Managing epistaxis

An estimated 60% of the population will have a nosebleed in their lifetime, and 6% will require medical intervention. Uncontrolled nasal bleeding can lead to hypovolemia and airway compromise. Understanding prevention and management of epistaxis is especially important to clinicians who manage patients on anticoagulants, supplemental oxygen therapy, or who have other risk factors for epistaxis. This article reviews stepwise management for epistaxis and newer treatment options in adults.

The use of bipolar electrocautery in adult epistaxis management: Using audit of one hundred and twenty‐four cases to define a standardised protocol

Clinical OtolaryngologyVolume 38, Issue 6 p. 554-558 Correspondence: Our Experience The use of bipolar electrocautery in adult epistaxis management: Using audit of one hundred and twenty-four cases to define a standardised protocol A.H. Henderson, Corresponding Author A.H. Henderson Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKCorrespondence: A.H. Henderson, Department of ENT, Queen Alexandra Hospital, Cosham, Portsmouth P06 3LY, UK. Tel.: +44 02392 286000; Fax: +44 02392 286708; e-mail: [email protected]Search for more papers by this authorA. Larkins, A. Larkins Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this author A.H. Henderson, Corresponding Author A.H. Henderson Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKCorrespondence: A.H. Henderson, Department of ENT, Queen Alexandra Hospital, Cosham, Portsmouth P06 3LY, UK. Tel.: +44 02392 286000; Fax: +44 02392 286708; e-mail: [email protected]Search for more papers by this authorA. Larkins, A. Larkins Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this authorC. Repanos, C. Repanos Department of ENT, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UKSearch for more papers by this author First published: 18 October 2013 https://doi.org/10.1111/coa.12191Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume38, Issue6December 2013Pages 554-558 RelatedInformation

Vascular Anatomy of Little?s Area in Children with Epistaxis

Epistaxis in children in more than 90% of the cases from the anterior nasal cavity. In the majority of the paediatric population Epistaxis is due to trauma (accidents, manipulation, secondary hemorrhages after surgery), bleeding disorders (v.-Willebrand´s disease, side-effects of medication), dry climate (low humidity, heating period), rhinitis, vascular abnormities and rarely it is due to hereditary syndromes. In contrast to Epistaxis in adults, blood pressure changes play no essential role in paediatric nosebleeds. The present publication analyses the vascular anatomy of the anterior nasal septum (Little´s area) based on video endoscopic findings in affected children. Video endoscopies of 16 children could be analysed for the study. Twelve of 16 children had a prominent vessel shining through the mucosa at the anterior or lower edge of the nasal septum and teleangiectic vessels appeared in 4/16 cases. The endoscopic examinations showed that the dominant vessels for the anterior septum were emerging from the floor of the nose, making a 90° cranial direction turn towards Little’s area. In contrast to most descriptions in literature, anastomoses with vessels coming from the cranial parts of the nose, deriving from the anterior ethmoidal artery, could not be found. According to the findings of the present analysis, Little’s area therefore is predominantely supplied by the septal branch of the superior labial artery and inferior septal branches of the sphenopalatine artery. Results in Epistaxis therapy might be improved, if the respective terminal branches of these vessels can be obliterated succesfully.

Controversies in the specialist management of adult epistaxis: an evidence‐based review

Clinical OtolaryngologyVolume 37, Issue 5 p. 382-389 Emergency ORL: Controversies in Management Controversies in the specialist management of adult epistaxis: an evidence-based review P.M. Spielmann, P.M. Spielmann Ninewells Hospital & Medical School, Dundee, UKSearch for more papers by this authorM.L. Barnes, M.L. Barnes Ninewells Hospital & Medical School, Dundee, UKSearch for more papers by this authorP.S. White, Corresponding Author P.S. White [email protected] Ninewells Hospital & Medical School, Dundee, UKCorrespondence: P.S. White, Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. Fax: +44 1382 632816; e-mail: [email protected]Search for more papers by this author P.M. Spielmann, P.M. Spielmann Ninewells Hospital & Medical School, Dundee, UKSearch for more papers by this authorM.L. Barnes, M.L. Barnes Ninewells Hospital & Medical School, Dundee, UKSearch for more papers by this authorP.S. White, Corresponding Author P.S. White [email protected] Ninewells Hospital & Medical School, Dundee, UKCorrespondence: P.S. White, Department of Otolaryngology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. Fax: +44 1382 632816; e-mail: [email protected]Search for more papers by this author First published: 19 November 2012 https://doi.org/10.1111/coa.12024Citations: 29Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume37, Issue5October 2012Pages 382-389 RelatedInformation