Epistaxis In Children Research Articles

Hemostasis of idiopathic recurrent epistaxis in children with microwave ablation: a prospective pilot case series

ObjectiveWe evaluated microwave ablation (MWA) for treatment of idiopathic recurrent anterior epistaxis (RAE) in children, in terms of technical feasibility, efficacy, and safety.Study designA prospective pilot case series.SettingTertiary university hospital.MethodsChildren with idiopathic RAE were treated with endoscopic MWA and reevaluated at 1 and 4 weeks and at 6 months thereafter. The primary outcome was successful hemostasis on the day of the procedure. Secondary outcomes were the rebleeding rates after 1 and 4 weeks, and 6 months, and any complications.ResultsOf the 92 children with idiopathic RAE who met the inclusion criteria, the operation was interrupted in 7 children due to intraoperative noncooperation, and silver nitrate cautery was performed instead. All procedures were completed, and hemostasis was achieved within 10–20 s by MWA in 85 children. Two to four ablations were conducted. No recurrent epistaxis occurred and no severe MWA -related complications, such as septal perforation or synechiae formation, were observed at the 6-month follow-up.ConclusionsEndoscopic MWA is a feasible and safe technique for the treatment of idiopathic pediatric RAE in the clinical setting, especially those cases that do not respond to in-office chemical cautery.

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.

The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis.

Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 μm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.

Epistaxis in children: a clinical study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Epistaxis is a common condition among children. Most cases are due to vascular fragility in the nasal vestibule aggravated by digital trauma. Epistaxis is rare below 2 years. 30% of children of all children between 0-5 years, 56% aged between 6-10 years, 64% of those aged between 11-15 years have had at least 1 episode of epistaxis in their lifetime.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective analysis was done on 56 patients of nasal bleed, at Institute of child health and Hospital for children / Madras Medical College, Chennai, between June 2015 - June 2016. The records of children were analysed. All the patients under went blood investigation. The statistical analysis was done for the age group. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There were 56 cases of nasal bleed enrolled in our study, out of which 35 were boys and 21 girls. The most common age group was between 6-10 years accounting for 27 cases. In laterality of nasal bleed right side was common. The most common site in nostril noted was from little’s area of nasal septum in 27 cases. The most common cause was idiopathic in 15 cases. Most of the cases were managed conservatively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Epistaxis is a common clinical condition among the paediatric age group. In all cases, ENT examination should be done to rule out nasal pathology or foreign body in nasal cavity and haematology workup is necessary. Majority of nasal bleed stops with digital pressure.&lt;/p&gt;

Epistaxis in Children: Evaluation and Management

To review treatment options for patients with both ongoing acute epistaxis and chronic recurring epistaxis. While a common occurrence, epistaxis can successfully be treated with adequate first aid, without a medical provider in most cases. Despite its common nature, widespread knowledge of appropriate first aid is lacking. Recurrent episodes may require further testing depending on the severity. Although a minority of patients referred to specialists have significant underlying pathology, there is little guidance in the literature to help inform practitioners regarding which patients warrant referral. While treatment options for idiopathic pediatric recurrent epistaxis is not currently an active area of research, investigators are actively pursuing novel treatments for hereditary hemorrhagic telangiectasia and endoscopic surgery for juvenile nasal angiofibroma (two rare causes of recurrent epistaxis). Epistaxis is a common problem in the pediatric population which can lead to patient and family distress. Knowledge of appropriate treatment pathways is lacking and an area for improvement. Epistaxis that persists despite conventional treatment, or epistaxis in the context of a family history of excessive bleeding or a personal history of other sources of recurrent bleeding, may warrant additional evaluation.

Glanzmann’s Thrombasthenia: Epistaxis Treatment and Outcomes in Children

Background: Glanzmann’s Thrombasthenia (GT) is a rare inherited blood clotting (coagulation) disorder characterized by the impaired function of specialized cells (platelets) which are essential for proper blood clotting. Objectives: The present study aimed to assess the management steps of epistaxis in children with GM disease and assess the clinical outcome and the success rate or field of management. Methods: Data was taken via scanning all the patients’ files in ENT clinic and 4 children with GM were identified as receiving therapy. Furthermore, data collected from each file were primary complaint needing a duration of hospitalization, intensive care unit (ICU) admission, coagulation management, hematologic results, medical therapy administration, blood products transfusion and the surgical intervention performed. Results: With a total of 25 hospital presentations, the highest percentage of the present symptoms was for epistaxis with 68% (17), then 16% (4) for gingival bleeding and 8% for each of menorrhagia and hematemesis. Conclusion and recommendation: Our study carried out the most effective technique that control epistaxis is Fresh Frozen (FFP) Plasma. The epistaxis in GT should be concern as sever threating life condition and should be managed with effective treatment.

Causes and prognostic Factors of epistaxis in children

Causes and prognostic Factors of epistaxis in children

Severity and Features of Epistaxis in Children with a Mucocutaneous Bleeding Disorder

To use standardized bleeding questionnaires to compare the severity and patterns of epistaxis in children with a mucocutaneous bleeding disorder and control children. The epistaxis sections of the Pediatric Bleeding Questionnaire (PBQ) administered to pediatric patients with von Willebrand disease or a platelet function disorder and healthy control children were reviewed. Scores and features of epistaxis (frequency, duration, onset, site, seasonal correlation, and need for medical/surgical intervention) were recorded. A PBQ epistaxis score ≥2 was defined as clinically significant. The Katsanis epistaxis scoring system was administered to eligible patients, ie, with ≥5 episodes of epistaxis per year. PBQ epistaxis scores were obtained for 66 patients, median age 12 years (range 0.6-18.3 years), and 56 control children. The median PBQ epistaxis score in patients was 2 vs 0 in control children (P <.0001). All of the features of epistaxis, except spontaneous onset, occurred in a significantly greater proportion of patients than control children with epistaxis. A total of 50% of the patients were graded as having severe epistaxis by the Katsanis epistaxis scoring system, and 30 of these (91%) had a clinically significant PBQ epistaxis score. Standardized bleeding questionnaires are useful in the assessment of epistaxis severity and pattern and may help to distinguish children with and without a mucocutaneous bleeding disorder.

Epistaxis in children and adolescents with hereditary hemorrhagic telangiectasia.

Our objective was to describe epistaxis onset and severity in pediatric hereditary hemorrhagic telangiectasia (HHT) patients and study the cumulative incidence of epistaxis by age of onset within each genetic subtype. Retrospective cohort chart review. Charts were reviewed of patients age 0 to 18 years with a clinical or genetic diagnosis of HHT who were evaluated at a tertiary multidisciplinary HHT clinic from January 2010 to June 2016. The epistaxis severity score (ESS), a validated tool for assessing epistaxis severity, was used to assess epistaxis. Statistical analyses were conducted on the full HHT cohort as well as subgroups stratified by the HHT causative gene (HHT1 = ENG and HHT2 = ACVRL1). Sixty-nine pediatric subjects were identified; 60 had HHT confirmed by genetic testing, and nine (from families with known mutations) met published clinical diagnostic criteria alone. Fifty-nine (85%) had onset of epistaxis. The median age of onset of epistaxis was 5 years (interquartile range [IQR]: 2-9 years). The median ESS for the entire cohort was 1.6 (IQR: 0-2.6). The median ESS was higher in HHT1 versus HHT2 (2.3 vs. 1.1, P = .002), and age of epistaxis onset was earlier in HHT1 (3 vs. 5 years, P = .03). Sex and age were not associated with ESS. Epistaxis may present early in HHT, but is typically mild in the pediatric period. Severity in the pediatric population is worse in patients with HHT1. By recognizing the significance of even mild, infrequent epistaxis in a child with a family history of HHT, and understanding that not all HHT patients have epistaxis during childhood, community providers and otolaryngologist can assist in the early detection of HHT. 4 Laryngoscope, 128:1714-1719, 2018.

The frequency and severity of epistaxis in children with sickle cell anaemia in eastern Uganda: a case-control study

BackgroundThere are a paucity of data on epistaxis as it pertains to sickle cell anaemia. Some case studies suggest epistaxis to be a significant complication in patients with sickle cell anaemia in sub-Saharan Africa; however, no robust studies have sought to establish the epidemiology or pathophysiology of this phenomenon.MethodsWe conducted a case-control study with the aim of investigating the importance of epistaxis among children presenting with sickle cell anaemia at the Mbale Regional Referral Hospital in eastern Uganda. Cases were children aged 2–15 years with an existing diagnosis of laboratory confirmed sickle cell anaemia, while controls were children without sickle cell anaemia who were frequency matched to cases on the basis of age group and gender. The frequency and severity of epistaxis was assessed using a structured questionnaire developed specifically for this study. Odds ratios controlled for age group and gender were calculated using unconditional logistic regression.ResultsA total of 150 children were included, 73 children with sickle cell anaemia and 77 children without sickle cell anaemia. The overall prevalence of epistaxis among children with sickle cell anaemia and children without sickle cell anaemia was 32.9 and 23.4% respectively. The case-control odds ratios for epistaxis, recurrent epistaxis and severe epistaxis were, 1.6 (95%CI 0.8–3.4; p = 0.2), 7.4 (1.6–34.5; 0.01), and 8.3 (1.0–69.8; 0.05) respectively.ConclusionsOur results suggest that in eastern Uganda, children with sickle cell anaemia experience epistaxis more frequently and with greater severity than children without sickle cell anaemia. Further studies are indicated to confirm this conclusion and investigate aetiology.

Epistaxis in Children: Aetiology, Management and Outcome

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

Assessment of red blood cell distribution width and mean platelet volume in children with epistaxis

ObjectiveThis study aimed to investigate whether there is a relationship between red blood cell distribution width, mean platelet volume and epistaxis in children. MethodsBetween January 2015 and July 2016, 105 children who were referred to our clinic with epistaxis and 100 sex- and age-matched controls were retrospectively analyzed. Red blood cell distribution width (RDW) and mean platelet volume (MPV) values were determined in both groups. ResultsRDW values were found significantly (P < 0.05) lower in the group with epistaxis than in the control group (11.95 ± 1.31 vs. 12.74 ± 1.21). MPV was 7.49 ± 1.33 in the group with epistaxis and 7.23 ± 1.06 in the control group, and there was no significant difference between the groups (p > 0.05). ConclusionWe found no difference between MPV values of both groups and significantly lower RDW values in children with epistaxis. Decreased RDW values were considered as an accompanying marker rather than a result of epistaxis. In addition, it may be thought that low RDW values may increase the bleeding tendency by disrupting the thrombotic activities. Further studies are needed to validate the relation of these parameters with epistaxis and its mechanisms.

Outcomes of recalcitrant idiopathic epistaxis in children: Septoplasty as a surgical treatment

4 Laryngoscope, 126:2833-2837, 2016.

Prophylaxis in congenital coagulation disorders: past, present and future.

Prophylaxis in congenital coagulation disorders: past, present and future.

Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment.

Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that low-grade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children. This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients. Retrospective cross-sectional study. Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group. Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments. Despite the high colonization rates, topical antibacterial treatment was not found superior to non-antibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.

Fusidic Acid Ointment in Treatment of Recurrent Epistaxis in Children

ABSTRACT Aim To establish fusidic acid ointment in the treatment of recurrent epistaxis in children as a local antiseptic. Materials and methods It was a retrospective study and a total of 184 pediatric patients’ data were analyzed. Ninety-seven patients were found to be fitting in selection criteria. The time of presentation, number of episodes, treatment received, and follow-ups were noted. Results were confirmed over the phone. Results Ninety-five patients had simple bleed and were managed on outpatient treatment with fusidic acid ointment and saline nasal drops, while two required admission and underwent electrocautery of offending vessel. Out of the 95 patients, 10 had initial failure of treatment in the 1st month, but with continued treatment were subsequently treated. Fifteen of these 95 had episodes in the next season. The incidence of bleeding was more in summers than winters in children. Conclusion Fusidic acid ointments are safe and effective in the treatment of recurrent epistaxis in children. Clinical significance: The effectivity of fusidic acid in epistaxis has never been studied. This study can establish it as an antiseptic ointment in the treatment of recurrent epistaxis. How to cite this article Khandelwal G, Pathak S, Sharma M. Fusidic Acid Ointment in Treatment of Recurrent Epistaxis in Children. J Postgrad Med Edu Res 2016;50(4):194-196.

Attention deficit hyperactivity disorder and other disruptive behavior disorders are risk factors for recurrent epistaxis in children: A prospective case-controlled study.

The aim of this study was to investigate the frequency of attention deficit hyperactivity disorder (ADHD) and other disruptive behavior disorders in children with recurrent epistaxis (RE). Children aged between 6-11 years were enrolled according to presence (n=34) and absence (n=103) of RE. Turgay DSM-IV-Based Child and Adolescent Disruptive Behavior Disorders Screening and Rating Scale was applied to parents. Moreover, Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime Version was performed. Oppositional defiant disorder (ODD) and ADHD were determined in 17.6% and 32.4% of patients, respectively. When psychiatric diagnoses between both groups were compared, statistically significant differences were found in terms of ADHD and ODD (p=0.028 and p=0.003). In children with RE, the frequency of ADHD and ODD are higher than children without RE. A referral to a child psychiatrist should be considered, if a child with RE also has symptoms of increased activity, inattention and/or body-injurious behaviors.

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.

A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children

BackgroundEpistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management.ObjectiveTo compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery.Study design and methodologyThis is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children’s Hospital. One hundred children aged 6–12 years who presented with epistaxis to Qena University Hospital and Assiut University Children’s Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5–2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis.ResultsBoth groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization.ConclusionTreatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification of the effectiveness of such treatment option.

Recurrent epistaxis in children: When should we suspect coagulopathy?

Abstract The objective of this study was to evaluate children and adolescents with recurrent epistaxis and to spot variables that may predict underlying bleeding disorder. This was a prospective study. Thirty-six children with recurrent epistaxis were recruited from ENT outpatient clinic as well as emergency room of Cairo University children hospital. Patients with systemic causes for epistaxis were not included. All patients were subjected to basic workup to differentiate between ENT and hematological causes of epistaxis. Accordingly, extended ENT investigations or coagulation studies were performed. Results showed 47.6% incidence for bleeding disorders, 39.7% incidence for ENT causes, and 12.7% incidence for idiopathic causes. Reported coagulopathies included idiopathic thrombocytopenic purpura with an incidence of 26.7%, platelet functions disorders such as Glanzmann’s thrombasthenia (13.3%) and Bernard-Soulier syndrome (10%), aplastic anemia (3.3%), hemophilia A (3.3%), Von Willebrand disease (3.3%), and unclassified (40%). Reported local ENT causes included bacterial rhinitis (88%) (lodged foreign body was found in 1/3 of these patients, digital trauma by habitual nose picking was detected in another 1/3, and the remaining 1/3 represented cases of complicated previous viral rhinitis), nasal allergy (8%), and adenoid (4%). The study recommended some statistically significant predictors for bleeding disorders such as positive consanguinity, high epistaxis bleeding score, presence of other bleeding sites, low hemoglobin level and platelet count, and elevated activated partial thromboplastin time.