Epistaxis In Children Research Articles

Awareness of First Aid Management of Epistaxis in Children Among Parents in Arar, Saudi Arabia.

Epistaxis is a relatively common condition, particularly among children, necessitating that parents be well informed about its effective management. This study aims to explore the current level of awareness among parents in the Arar region, Saudi Arabia, regarding the first aid management of epistaxis and to highlight the importance of education in empowering parents to handle such situations. A cross-sectional study was conducted using a survey distributed among the Arar population (aged >18 years) who had at least one child and were willing to participate. Data were collected between mid-July and the end of September 2023 using a self-administered questionnaire, which included a consent form, sociodemographic and background items, and epistaxis knowledge-related questions. A total of 342 participants (27.8% males) completed the questionnaire. It was observed that 47.4% of the participants' children had experienced epistaxis. Only around half of them (n=84; 51.9%) had received first aid management for epistaxis, and only 40.4% of the parents correctly identified all the necessary steps for managing it through first aid. There was inadequate knowledge regarding the causes/risk factors and appropriate first aid techniques for epistaxis. Certain sociodemographic factors were significantly associated with better knowledge of first aid management of epistaxis, such as female gender (p = 0.003), older participants (p = 0.002), and a higher educational level (p = 0.001). The study found low awareness of first aid management of epistaxis among parents residing in Arar, Saudi Arabia. Factors related to the demographic characteristics of the study participants were associated with this level of knowledge. These findings emphasize the need to improve awareness about first aid management of epistaxis, particularly among younger individuals, males, and those with limited education. Effective interventions should be developed to enhance first aid training, considering the specific risk factors associated with epistaxis.

Age Distribution of Epistaxis in Outpatient Pediatric Patients.

Objectives: Little is known about the prevalence of epistaxis in children. Existing reports focus on hospitalized children or those presenting to an emergency department. To better understand pediatric epistaxis in clinical practice, we sought out a searchable, representative outpatient database and examined the incidence of epistaxis in children of different ages. Methods: A cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2007 to 2011 was performed. The NHAMCS is a Centers for Disease Control and Prevention-curated national sample of data from visits to non-federally employed office-based physicians and health centers. We queried the NHAMCS to determine the cumulative incidence of epistaxis in children of different age groups. The International Classification of Diseases Ninth Revision code 784.7 was chosen to identify epistaxis. Comparisons of rates were performed using the chi-squared test. A P-value of <.05 was considered statistically significant. Results: In total, 55,435,691 children [27,816,237 (50.2%) males, 55,435,691 (77.2%) white] were included. The overall cumulative incidence rate of epistaxis was 2.4/1000 children. Children in the 3- to 5-year range had the highest cumulative incidence of epistaxis (5.0/1000), followed by those in the 6 to 8 (3.0/1000), 9 to 11 (2.0/1000), 0 to 2 (1.9/1000), 12 to 14 (1.6/1000), and 15 to 17 (0.5/1000) year ranges (P < .001). Conclusion: Pediatric epistaxis is common in the office setting (2.4 per 1000 children)-and well above emergency department estimates (1.7 per 1000 people). Children between the ages of 3 to 5 years have the highest cumulative incidence. Epistaxis is sufficiently unusual in infants and the late teens that alternative causes for nasal bleeding should be included in the differential diagnosis.

Environmental factors differentially affect epistaxis among preschool and school-aged children.

Environmental factors are closely associated with pediatric epistaxis. Whether this association differs according to age has not been previously reported. Therefore, we tried to evaluate the differences in associations between environmental factors and epistaxis in children of different ages. A total of 20,234 patients with epistaxis who visited the hospital between January 1, 2002, and December 31, 2015, were enrolled in this study. The patients were divided into two groups according to their ages: preschool-aged (<6 years) and school-aged children (6-18 years). Daily, monthly, and yearly data on environmental factors were collected. We performed a stepwise logistic regression to identify the potential environmental risk factors for epistaxis in each age group. The mean number of epistaxis cases per month in both groups was highest in September. The cases were lowest in February in preschool-aged children and in November in school-aged children. Temperature, humidity, maximum wind speed, and sunshine duration were associated with epistaxis in preschool-aged children. Average wind speed, particulate matter (>10 μm diameter), temperature, humidity, sunshine duration, and sulfur dioxide concentration were associated with epistaxis in school-aged children. This study indicates that the differences in environmental risk factors for epistaxis are associated with the patient's age.

Parents' knowledge regarding first-aid management of epistaxis in children in Taif, Saudi Arabia.

Epistaxis among children is considered a scary issue for both the child and the parents. In Saudi Arabia, one third of children suffer from epistaxis. In our study, we aimed to assess the level of knowledge among parents regarding first-aid management of epistaxis in Taif city, Saudi Arabia. We carried out a descriptive cross-sectional study among parents who visited Alhada Armed Forces Hospital and Prince Mansour Military Hospital between May 2022 and July 2022 in Taif, Saudi Arabia. A questionnaire with 17 questions was distributed among the participants. We excluded parents with children who were older than 18 years. A total of 502 parents were included in the study. About two thirds (67.5%) of parents had a moderate level of knowledge and around one third (30.9%) showed a good level of knowledge regarding epistaxis first aid. Furthermore, higher knowledge scores were found among parents who had epistaxis previously (P = 0.026), who attended a course on first aid (P = 0.002), and who were aged more than 35 years (P = 0.017). Our study demonstrated that most Saudi parents had a moderate level of knowledge regarding first-aid management of epistaxis. Additionally, several factors, such as the number of children, age, those attending first-aid courses, and experience treating others with epistaxis, were associated with the level of knowledge among parents. Further larger studies are required among Saudi parents to examine the knowledge, practice, and related factors regarding first-aid management of epistaxis.

Incidence, characteristics and laboratory parameters of epistaxis in children with β-Thalassemia major at a Tertiary Care Hospital of South Punjab, Pakistan.

Objective: To find out the incidence, characteristics and laboratory parameters of epistaxis in children with β-thalassemia major visiting a tertiary healthcare facility of South Punjab, Pakistan. Study Design: Retrospective study. Setting: Department of Hematological Disorder, Thalassemia and Bone Marrow Transplantation Centre, and Department of Biochemistry, Bahawal Victoria Hospital, Quaid e Azam Medical College, Bahawalpur, Pakistan. Period: January 2021 to November 2022. Material &amp; Methods: The hospital record of children of both genders aged from 2 to 18 years of age with blood transfusion dependent β-thalassemia was analyzed. Children reporting at least 1 episode of epistaxis in the preceding period were included in the final analysis to find out the incidence, characteristics and laboratory findings of children presenting with of epistaxis. Results: Out of 3772 children with β-thalassemia major, 85 reported at least 1 episode of epistaxis showing the incidence of epistaxis as 22.5/1,000 cases of β-thalassemia major. The mean age of the children at the time of enrollment and at the time of diagnosis of thalassemia was 9.93±3.48 years and 1.23±1.26 years respectively. The mean monthly frequency of blood transfusion was 1.71±0.75 blood transfusions per month. The mean monthly epistaxis frequency was reported to be 2.35±1.71 while 59 (69.4%) children had 2 or more than 2 monthly episodes of epistaxis. The mean serum ferritin level was noted to be 4058±2173 ng/ml. Ultrasonography findings revealed mean spleen size to be 9.25±5.80 cm. Conclusion: The incidence of epistaxis episodes among children with β-thalassemia was very high. Chronic iron-overload seemed to be common abnormality among children with β-thalassemia that should be addressed to potentially reduce the risk of epistaxis among these children.

IMPACTED BUTTON BATTERY MASQUERADING AS RECURRENT EPISTAXIS IN AN CHILD.

Epistaxis in children is one of the most common referral dealt by an ENT outpatient department . Here we report a case of a 2-year-old girl who presented with complaints of recurrent episodes of epistaxis and discharge from the right nasal cavity since 1 month duration. Endoscopic examination of the right side of nose revealed a button battery impacted between the inferior turbinate and the cartilaginous portion of nasal septum.

Low-intensity diode laser combined with nasal glucocorticoids in the treatment of recurrent epistaxis in children: a randomized controlled trail

Background A painless and effective treatment of childhood epistaxis is needed. Objective To observe the effectiveness of low-intensity diode (Lid) laser in treating epistaxis complicated with allergic rhinitis in children. Methods Our study is a prospective, randomized, controlled, registry trial (NO. 202001201) involving 44 recurrent epistaxis children (<14 years old) with or without Allergic Rhinitis (AR) in our hospital. They were divided randomly into the Laser and Control groups. The Laser group was treated with Lid laser (wavelength 635 nm, power 15mW) for 10 min after nasal mucosa was moistened with normal saline (NS). The Control group moistened their nasal cavities with NS only. Children in two groups complicated with AR were given nasal glucocorticoids for 2 weeks. The effectiveness of Lid laser in treating epistaxis and AR were compared between the two groups after treatment. Results After treatment, the effective rate of the Laser group in epistaxis (23/24, 95.8%) was higher than the Control group (16/20, 80%) (p < .05). The VAS scores of the children complicated with AR in the two groups both improved after treatment, however, the variation of VAS score (3.02 ± 1.50) in the Laser group was greater than the Control group (1.83 ± 1.56) (p < .05). Conclusion As a safe and efficient method, Lid laser treatment can effectively alleviate epistaxis and inhibit symptoms of AR in children.

Mean platellet volume and red cell distribution width values in children with recurrent epistaxis

Objective: This study aimed to evaluate the relationship between mean platelet volume and red blood cell distribution width, recurrent epistaxis in children. Material and Method:This study was conducted with 60 pediatric patients who applied to our clinic between complaint of epistaxis. The control group consisted of 60 pediatric patients with similar number of age and gender characteristics as the study group. mean platelet volume (MPV) and red cell distribution width (RDW) values measured routinely in the complete blood count (CBC) were investigated Results: Mean RDW value was founded 11.98±0.75% in patients with epistaxis and 12.44±0.78% in the control group. Since the p-value calculated according to these data was found to be 0.02, the difference was found to be statistically significant. The MPV value was 6.65±1.31 femtoliter in patients with epistaxis and 6.41±1.22 femtoliter in the control group. The difference was not statistically significant since the p-value was higher than 0.05. Conclusion: It is thought that the high values of RDW and MPV, which are among the parameters measured in complete blood count, may be associated with the increase in thrombotic activity. It is also observed that MPV and RDW values are high in cerebrovascular cases and coronary artery diseases. The low RDW value in patients who with recurrent epistaxis gives rise to thought that this value may not be a result of bleeding, but a cause.

Recurrent epistaxis in children.

A child came to my clinic complaining of recurrent epistaxis with several episodes occurring every year since he was a toddler. The nosebleeds affect both nostrils, often lasting for an extended period of time and occurring in no apparent seasonal pattern. What interventions are safe and effective for recurrent epistaxis in children, and which patients warrant hematologic testing? Epistaxis affects more than half of children by the time they are 10 years old, with 9% of children reported to have recurrent episodes. Most cases are of benign origin and will not require further workup. For those seeking intervention, nasal mucosal hydration, such as emollient application, or humidification resolves up to 65% of cases, and many novel interventions have shown promise in their respective initial studies. Standardized bleeding questionnaires have demonstrated usefulness in decision making for further coagulation studies, taking into account historical features including frequency, duration, bleeding site, seasonal correlation, and severity.

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.

Epistaxis among children in Usmanu Danfodiyo University Teaching Hospital Sokoto Nigeria

Background: Epistaxis is a life-threatening otorhinolaryngological emergency and presents as a symptom of varied clinical conditions. The study was designed to determine the frequency and forms of epistaxis among children in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, Nigeria. Materials and Methods: It was a prospective study of children ≤12 years with epistaxis presenting to UDUTH, Sokoto from January to December 2017. Information on age, gender, causes, nature, and laterality of epistaxis was collected and analyzed. Results: Of 1078 children who presented with otorhinolaryngological complaints during the study period, 39 (3.6 %) had epistaxis, with majority 14 (35.9 %) of children aged 7 – 8 years. Epistaxis was more prevalent in males than females in the ratio 1.6:1. Epistaxis digitorum was the most common cause 19 (48.7 %) of epistaxis in children in the study area. First episode epistaxis was more common 35 (89.7 %) than recurrent epistaxis 4 (10.3 %), while bilateral epistaxis was more 26 (66.7 %) than unilateral epistaxis 13 (33.3 %). There were more children with left unilateral epistaxis 10 (25.6%) than right epistaxis 3 (7.7 %).

Epistaxis

Key Points Anterior acute bleeding from the nostril or nasal cavity accounts for greater than 90% of epistaxis in children. Posterior bleeding into the nasopharynx and mouth is more difficult to assess and likelier to lead to hemodynamic instability. Up to one-third of children with recurrent bleeding have a coagulopathy. Direct pressure via pinching the nostrils for 5 to 10 minutes is the first-line treatment. Topical lidocaine, silver nitrate sticks, topical oxymetazoline, anterior packing, and other vasoconstrictive and hemostatic tactics may be used. Posterior epistaxes require referral to an otolaryngologist because they are more difficult to control.

A Case Report on Glanzmann’s Thrombasthenia: A Rare Platelet Function Disorder

Epistaxis in children is one of the important presenting symptoms for attending emergency department in paediatric patients. Recurrent epistaxis is common in children. Although epistaxis in children usually occurred due to different benign conditions, it may be one of the important presenting symptoms of some inherited bleeding disorder. Whereas most bleeding disorders can be diagnosed through different standard hematologic assessments, diagnosing rare platelet function disorders may be challenging. In this article we describe one case report of platelet function disorders on Glanzmann’s thrombasthenia (GT). Our patient was a 10-year old girl who presented to us with history of recurrent severe epistaxis. She had a bruise on her abdomen and many scattered petechiae in different parts of the body. Her previous investigations revealed no demonstrable haemostatic anomalies. After performing platelet aggregation test, she was diagnosed as GT.

A study of factors associated with epistaxis in children at a tertiary health care centre

A study of factors associated with epistaxis in children at a tertiary health care centre

Depression and anxiety levels in mothers of children with epistaxis: A controlled study

IntroductionPediatric epistaxis is very common. A child's illness can lead to depression and anxiety in the parents. The association between pediatric epistaxis and mothers’ anxiety has not been well documented. ObjectiveThe present study is aimed at measuring depression and anxiety levels in mothers of children with mild, recurrent epistaxis. MethodsThis prospective, clinical, questionnaire-based study examined 43 mothers of children with recurrent epistaxis and 42 mothers of healthy children. The depression and anxiety levels of the mothers in both the groups were assessed with the Beck Depression Inventory (BDI), the state-trait anxiety inventory–state (STAI-S), and the state-trait anxiety inventory–trait (STAI-T). ResultsNo statistically-significant differences were found between the two groups of mothers in terms of educational level, employment, age, or economic status. The mean STAI-S scores were higher in the mothers of children with epistaxis (p=.010). However, no statistically-significant differences were found between the two groups for the BDI and STAI-T scores. ConclusionsThe results of this comparative study suggest that mild, recurrent epistaxis in children can significantly increase their mothers’ state anxiety levels, but epistaxis has no significant effect on either depression or trait anxiety.

Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017.

Epistaxis is a common symptom in children. The effect of air pollution on epistaxis is not yet clear. To explore the characteristics of pediatric epistaxis in Beijing and its correlation with air pollutants. Data were collected from 2014 to 2017 in Otolaryngology Department of Capital Institute of Pediatrics. Children diagnosed with epistaxis with relevant information with the same period of municipal air pollutants' concentration were compared. The annual visits of epistaxis showed a bimodal trend. The incidence of epistaxis in infants was low, increased with age, reached the peak between the ages of 4 to 5, and then gradually decreased with age. In different age groups, male patients were more than females. From 2014 to 2017 in Beijing, particulate matter less than 2.5 μm in diameter (PM2.5), particulate matter less than 10 μm in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) showed a downtrend, lower in summer than in the other 3 seasons. Ozone (O3) was significantly higher in 2016 and 2017, showed an increase trend in summer. The incidence of epistaxis was negatively correlated with PM2.5, PM10, SO2, NO2 and CO, which was positively correlated with O3 (P < .05). Pediatric epistaxis in Beijing changes with age and has obvious seasonal variation. There are some correlations between air pollutants and the incidence of epistaxis in children.

A practical approach to recurrent epistaxis in children

Abstract Recurrent epistaxis (nose bleeds) are common in children. The vast majority of nose bleeds are self-resolving and do not require medical input. Clinicians get involved in cases where the nose bleeds are more severe, frequent and take a longer time to resolve. Emergency management involves basic resuscitation and first aid measures. A holistic approach is required, when dealing with non-emergency cases of frequent nose bleeds, including the exclusion of systemic illness. In this article we outline the basic history, examination, investigation and management aspects of evaluating a paediatric patient with epistaxis. We aim to provide a brief road map for clinicians dealing with cases of recurrent epistaxis in the pediatric population.

Safety and efficacy of sphenopalatine artery ligation in recalcitrant pediatric epistaxis

BackgroundEpistaxis is a common cause for emergency department visits for both children and adults. In particular, posterior bleeds can be difficult to identify and treat. In adults, endoscopic sphenopalatine artery (SPA) ligation has been shown to be safe, cost-effective, and curative. Conversely, very few studies have delved into the safety and efficacy of SPA ligation in children. This study aims to evaluate the feasibility of SPA ligation for treatment of recalcitrant epistaxis in children. MethodsA retrospective analysis of outcomes in pediatric patients who underwent SPA ligation at a tertiary academic center was performed. Patients with coagulopathies or other underlying conditions were excluded from the study. ResultsData obtained from 5 patients demonstrated 60% of the population were female, with ages ranging from 2 to 13 years. 7 SPA ligations were performed among the 5 patients, with 3 undergoing unilateral SPA ligation only. The remaining 4 underwent contralateral SPA ligation subsequently. No postoperative complications were observed, and all patients experienced resolution of significant epistaxis. ConclusionAlthough additional studies are necessary to further support our findings, SPA ligation in the pediatric population appears to be a safe and effective treatment to control persistent posterior bleeds.

Etiology, Management, and Outcome of Pediatric Epistaxis.

Epistaxis in children is one of the most common causes for seeking professional medical help. Patients may be treated by several disciplines with various approaches to pediatric epistaxis. We reviewed cases of pediatric epistaxis from an otorhinolaryngologist's point of view. A retrospective chart review was performed on all patients younger than 18 years presenting with epistaxis to the Department of Otorhinolaryngology at the University of Bonn, Germany. Sixty episodes of epistaxis in 58 patients were included in the study. Mean age was 10.1 ± 4.5 years. In terms of risk factors, 3 patients had a hemorrhagic diathesis, 3 had taken medication that interfered with hemostasis, and 8 had a history of previous trauma, most of which was digital manipulation. Twenty-six patients did not need invasive therapy. Twenty-six patients received cauterization to control the bleeding, and 4 patients needed surgery. The necessity for surgery was mainly noncooperation. Epistaxis in children is seldom serious. However, hemorrhagic diathesis needs to be kept in mind as a potential cause of epistaxis. In most cases, careful instruction of the patients and the relatives concerning nasal mucosal care is sufficient. If cauterization is necessary, silver nitrate coagulation should be preferred over electrocoagulation.