Moderate Epistaxis Research Articles

Risk Factors and Management Outcomes in Pediatric Epistaxis at an Emergency Department

BackgroundMost cases of pediatric epistaxis are spontaneous and self-resolve. However, a subset of children may experience significant bleeding and require procedural or medical intervention. ObjectiveWe aim to identify risk factors associated with moderate and severe epistaxis in the emergency department (ED) and explore management outcomes. MethodsWe retrospectively reviewed all patients under 22 years old with epistaxis who presented to our ED between 2013 and 2022. Epistaxis severity was defined as mild (required nasal compression or intranasal medications), moderate (required cautery or packing), or severe (required factor replacement, transfusion, hospital admission, or surgery). We performed univariable and multinomial regression analyses, with risk factors and outcomes analyzed according to severity. ResultsOf 858 visits, 41 (5%) patients had moderate and 67 (8%) had severe epistaxis. Patients with moderate epistaxis were older than those with mild and severe epistaxis (median 15.6 vs. 8.3 vs. 10.7 years, p < 0.001). In regression analysis, moderate epistaxis was associated with older age, prior ED visit within 72 h, and antiplatelet medication use (p < 0.01). Severe epistaxis was associated with bleeding disorders, nasal procedures within 30 days, and anticoagulation medication use (p ≤ 0.001). Bleeding over 30 min prior to arrival was associated with both moderate and severe epistaxis (p < 0.05). Of the 67 patients with severe epistaxis, 10 (15%) required factor replacement, 28 (42%) required transfusion, 52 (77%) required hospital admission, and 5 (7%) underwent surgery. ConclusionEpistaxis severity is associated with certain risk factors. However, most cases of pediatric epistaxis are mild and do not require intervention or ED evaluation.

A comparison between the Disposcope endoscope and fibreoptic bronchoscope for nasotracheal intubation: a randomized controlled trial

BackgroundNasotracheal intubation (NTI) is frequently performed for oral and maxillofacial surgeries. This study evaluated whether NTI is easier when guided by Disposcope endoscopy or fibreoptic bronchoscopy.MethodsSixty patients (30 per group) requiring NTI were randomly assigned to undergo fibreoptic bronchoscopy-guided (fibreoptic group) or Disposcope endoscope-guided (Disposcope group) NTI. The NTI time, which was defined as the time from when the fibreoptic bronchoscope or aseptic suction catheter was inserted into the nasal cavity to the time at which the tracheal tube was correctly inserted through the glottis, was recorded. Epistaxis was evaluated by direct laryngoscopy five minutes after completing NTI and was scored as one of four grades according to the following modified criteria: no epistaxis, mild epistaxis, moderate epistaxis, and severe epistaxis.ResultsThe time to complete NTI was significantly longer in the fibreoptic group than in the Disposcope group (38.4 s vs 24.1 s; mean difference, 14.2 s; 95% confidence interval (CI), 10.4 to 18.1). Mild epistaxis was observed in 8 patients in the fibreoptic group and in 7 patients in the Disposcope group (26.7% vs 23.3%, respectively; relative risk, 1.2; 95% CI, 0.4 to 3.9), though no moderate or severe epistaxis occurred in either group. Furthermore, no obvious nasal pain was reported by any of the patients at any time point after extubation (P = 0.74).ConclusionNTI can be completed successfully using either fibreoptic bronchoscopy or Disposcope endoscope as a guide without any severe complications. However, compared to fibreoptic bronchoscopy, Disposcope endoscope requires less execution time (the NTI time).Trial registrationThis clinical research was registered at the Chinese Clinical Trial Registry (www.chictr.org.cn, ChiCTR-IPR-17011462, date of registration, May 2017).

Thermophysical Properties of Thermosoftening Nasotracheal Tubes.

Thermosoftening treatment of polyvinyl chloride (PVC) nasotracheal tubes (NTTs) can reduce the incidence and amount of epistaxis during nasotracheal intubation. The optimal thermal setting for thermosoftening treatment of NTTs without burn injury was investigated. Two composite types of PVC NTTs were used. Following withdrawal of the PVC NTTs from a bottle of water at 45 or 60°C, the changes in the surface temperature of the NTTs were measured by infrared thermography. Hardness of the NTTs at 25, 30, 35, and 40°C was measured. The incidence of epistaxis during nasotracheal intubation using thermosoftened NTTs was evaluated retrospectively. The surface temperature of both PVC NTTs dipped in 45 and 60°C water decreased to below body temperature 30 seconds after withdrawing them from the bottles. Although thermosoftening treatment proportionally decreased the hardness of both types of NTTs, the degrees differed according to their composition. When avoiding impingement of the NTT on the posterior wall of the nasopharynx, the incidence of mild and moderate epistaxis was 2.3%. Flexibility of PVC NTTs could be obtained by thermosoftening treatment at 60°C without burn injury. Thermosoftening treatment of PVC NTTs may be useful to avoid epistaxis during nasotracheal intubation.

CHANGES IN THE OXYGEN TRANSPORT FUNCTION AND ENERGY BALANCE IN RED BLOOD CELLS IN EPISTAXIS PATIENTS

Aim. To study the oxygen transport function in red blood cells and energy balance in patients suffering from epistaxis of various progress severities. In case of epistaxis a single blood loss is insignificant, yet in case of recurrent epistaxis there is a threat of a tissue hypoxia development. However no indicator blood values demanding transfusion therapy exist these days. This is a study of the blood oxygen transport function and energy balance in the red blood cells in those suffering from single epistaxis, recurrent moderate epistaxis and recurrent severe epistaxis. Materials and methods. In patients’ red blood cells a contents of 2.3-diphosphoglyceric acid (2.3-DFG) and hemoglobin oxygen affinity (Р50) were estimated; energy balance was assessed by the activity of glucose-6-phosphate-dehydrogenase (G-6-FDG), lactate-dehydrogenase (LDG), as well as by the lactate and pyruvate contents in the red blood cells and plasma. Tissue hypoxia severity was assessed by the lactate/pyruvate ratio in blood plasma. Results. It has been determined that in case of single epistaxis the studied parameters do not differ from normal ranges. In case of recurrent epistaxis the level of hemoglobin and P50 goes down, plasma LDG activity goes up, the pyruvate content goes down, while plasma lactate retains within the normal ranges. Conclusion. The stated changes in the carbohydrate metabolism in the red blood cells and blood plasma of patients suffering from severe recurrent epistaxis suggest a breakdown of compensatory mechanisms, which manifests itself in the reduced cell energy reserve and disturbed red blood cell membranes. The obtained data testify that the severity of the state of patients suffering from epistaxis is not only defined by a quantitative loss of red blood cells and hemoglobin, but also by the adaptive capacities of the body, which determine its resistance to hypoxia. The guide link in the pathogenesis of disturbed gas transport function of blood in patients suffering from epistaxis is metabolic acidosis developing as a consequence of tissue hypoxia.

The effects of epistaxis on health‐related quality of life in patients with hereditary hemorrhagic telangiectasia

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease mainly characterized by epistaxis in more than 96% of patients. Recently, a validated questionnaire known as the HHT Epistaxis Severity Score (ESS) was developed. However, little is known about the relationship between epistaxis and quality of life. We hypothesize that epistaxis severity is a major factor predicting health-related quality of life (HR-QoL) in HHT patients. This is a cross-sectional study. The ESS questionnaire and Medical Outcomes Study 36-item short form (SF-36) were administered to subjects through an Internet survey. All participants had a definitive diagnosis of HHT through Curaçao criteria or genetic testing. Demographic information, genetics, and extensive histories were also collected. Descriptive analyses were performed with calculations of means and standard deviations (SDs) for continuous variables and proportions for categorical variables. Linear regressions were then performed to assess the association between HR-QoL and ESS. A total of 604 subjects participated between April and August 2008. All patients reported epistaxis, 285 (47.2%) had telangiectasias, and 545 (90.2%) had a family history of HHT; 167 (27.6%) patients had mild epistaxis (ESS <4), 285 (47.2%) reported moderate epistaxis (≥4 ESS <7), and 152 (25.2%) reported severe epistaxis (ESS ≥7). Patients with severe epistaxis had lower scores for both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of HR-QoL when compared to those with mild epistaxis (p < 0.001, p < 0.001). The ESS is a major determinant of HR-QoL and should be considered as a measurement of treatment efficacy in HHT-related epistaxis.

Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia

Objective: To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis. Methodology: We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure. Results: RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding. Conclusion: Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

TWO RARE CASES OF NEOPLASMS OF THE NOSE AND PARANASAL SINUSES

Purpose: To present the diagnostic approach and treatment of two rare neoplasms, hemangiopericytoma and hemangioleiomyoma, treated in the ENT Dept. of Chania General Hospital. description of the cases: A female, 65 years old, with severe nasal congestion, diplopia and exophthalmos and an 82 years old male with unilateral, recurrent, moderate epistaxis were admitted in the ENT Dept. In both cases assessment included full ENT examination, laboratory tests and imaging with CT and MRI scans. For the first patient, due to extension of the lesion in the right maxillary sinus and orbit, excision biopsy with combined Caldwell-Luc and endoscopic approach was decided. Five months after initial intervention she had local recurrence and distance metastasis and underwent adjuvant chemotherapy. She is on follow up without any indication of expansion of the preexisting disease. For the second patient, specimen from the lesion in the left nostril was sent for histology and he denied any further intervention. The patient is on regular follow up without any change from the initial diagnosis. Conclusion: While clinical examination raises the suspicion, diagnosis is confirmed by histology, and extent of disease is evaluated with CT-MRI scans. Imaging should precede biopsy because of high vascularity of these tumors. Appropriate treatment is extensive removal of the lesion. keywords: hemangiopericytoma, hemangioleiomyoma, nose-paranasal sinuses.

Coblation for epistaxis management in patients with hereditary haemorrhagic telangiectasia: a multicentre case series

To propose radiofrequency coblation as a potential treatment modality for mild to moderate epistaxis in patients with hereditary haemorrhagic telangiectasia. Case reports and review of the world literature concerning coblation and other treatment modalities for epistaxis in patients with hereditary haemorrhagic telangiectasia. Effective epistaxis control was achieved in four out of five cases of hereditary haemorrhagic telangiectasia. In the fifth case, we struggled to achieve haemostasis due to disease severity. Radiofrequency coblation is a novel technique, which was found to be a safe, effective, quick and well tolerated treatment option for epistaxis management in patients with hereditary haemorrhagic telangiectasia.

Efficiency of laser treatment in patients with hereditary hemorrhagic telangiectasia

Earlier studies have shown the effect of laser treatment on epistaxis in patients with hereditary hemorrhagic telangiectasia (HHT). At the present time, only very few prospective trials have been performed, and many studies are based on patients' subjective assessment of the severity of epistaxis. This prospective study measures the objective effect of laser treatment in HHT patients with mild to moderate epistaxis. We introduce an objective measure to assess the severity of epistaxis: the bleeding time (BT). Before and after treatment, the quality of life, as measured by the patient, was assessed and compared to normative data. In 30 patients, we measured the BT before laser treatment 1.5 and 6.5months after treatment. The Short form 36 (SF-36), a validated health questionnaire, was completed before and 6.5months after treatment. Compared to preoperative value, BT was significantly reduced 1.5 and 6.5months after laser treatment (p<0.05) in both cases. No significant difference in quality of life, before and after treatment, was found. The quality of life of the HHT patients was reduced in five out of eight dimensions when compared with the Danish background population. Laser treatment reduces epistaxis in HHT patients with mild to moderate epistaxis for at least 6months; this group of patients have reduced quality of life compared to the background population.

Management of equine skull fractures using fixation with polydioxanone sutures

Ten horses presented with severe distortion of the facial contour, crepitus on palpation and mild to moderate epistaxis. Individual horses also showed ocular damage, ptosis, severe dyspnoea and movement of the facial bones concurrent with respiration. The fracture fragments were exposed using a large curvilinear incision and elevated using a retractor, periosteal elevator, chisel or Steinmann pin. The fracture fragments were unstable following reduction and fixation was necessary. Stabilisation was achieved with polydioxanone sutures placed through holes drilled in opposing sides of the fracture lines. Polydioxanone sutures provided good stability and had better handling properties than wire. There was good apposition of fracture edges and minimal complications. Use of polydioxanone sutures can also avoid the expense and complexity of plate fixation in selected cases, and should be considered as an alternative to fixation with stainless steel wire in any facial fracture that adjoins stable bone.

Percutaneous Lung Biopsy in the Horse: Comparison of Two Instruments and Repeated Biopsy in Horses with Induced Acute Interstitial Pneumopathy

The aim of the study reported here was to compare complications of lung biopsy in horses and the quality of the lung specimens after biopsy using the manual Tru‐Cut biopsy needle (TC) and an automated biopsy needle (ABN). For experiment 1, lung biopsy was performed in 50 horses with one instrument on one side of the thorax, and then with the other instrument on the other side. Postmortem examination was performed in 20 of the 50 horses. Coughing was detected in 10 of 50 horses and epistaxis was observed in 6 of the 50 horses. Endoscopy revealed bleeding into the airways in 16 of 49 horses and in 5 of 49 horses after biopsy with the TC or the ABN, respectively. Use of the ABN induced a significantly smaller amount of bleeding. Pneumothorax was detected by radiography in 1 of 50 horses. Hematoma diameter determined in 7 of 20 horses at postmortem examination, was significantly larger after biopsy with the TC than with the ABN. The quality of the lung specimen was good. In experiment 2, complications after repeated and multiple lung biopsies in 6 horses were evaluated. Moderate epistaxis was observed on 13 of 104 occasions. Bleeding into the airways was detected at endoscopy on 41 of 104 occasions, and pneumothorax was detected during 4 of 104 occasions. Complications such as hematoma at the biopsy site and bleeding into the airways were greater after biopsy with the TC than after use of the ABN. Lung biopsy specimens obtained with the ABN were fairly safe for the animal.

Percutaneous Lung Biopsy in the Horse: Comparison of Two Instruments and Repeated Biopsy in Horses with Induced Acute Interstitial Pneumopathy

The aim of the study reported here was to compare complications of lung biopsy in horses and the quality of the lung specimens after biopsy using the manual Tru-Cut biopsy needle (TC) and an automated biopsy needle (ABN). For experiment 1, lung biopsy was performed in 50 horses with one instrument on one side of the thorax, and then with the other instrument on the other side. Postmortem examination was performed in 20 of the 50 horses. Coughing was detected in 10 of 50 horses and epistaxis was observed in 6 of the 50 horses. Endoscopy revealed bleeding into the airways in 16 of 49 horses and in 5 of 49 horses after biopsy with the TC or the ABN, respectively. Use of the ABN induced a significantly smaller amount of bleeding. Pneumothorax was detected by radiography in 1 of 50 horses. Hematoma diameter determined in 7 of 20 horses at postmortem examination, was significantly larger after biopsy with the TC than with the ABN. The quality of the lung specimen was good. In experiment 2, complications after repeated and multiple lung biopsies in 6 horses were evaluated. Moderate epistaxis was observed on 13 of 104 occasions. Bleeding into the airways was detected at endoscopy on 41 of 104 occasions, and pneumothorax was detected during 4 of 104 occasions. Complications such as hematoma at the biopsy site and bleeding into the airways were greater after biopsy with the TC than after use of the ABN. Lung biopsy specimens obtained with the ABN were fairly safe for the animal.

Adding intranasal fluticasone to cefuroxime resolved acute rhinosinusitis

(2001) JAMA 286, 3097; Dolor RJ, Witsell DL, Helkamp AS, et al, for the Ceftin and Flonase for Sinusitis (CAFFS) Investigators. . Comparison of cefuroxime with or without intranasal fluticasone...

Treatment of complete and partial obstruction of the nasolacrimal system with polyurethane stents: initial experience.

To present our experience in the treatment of nasolacrimal occlusion by means of polyurethane stents. Forty polyurethane stents were placed under fluoroscopic guidance in 35 consecutive patients with epiphora due to total or partial obstruction of the nasolacrimal system. The set designed by Song was used in all patients. The procedure was performed by introducing a guidewire through the superior punctum into the canaliculus and advancing it across the obstruction into the inferior meatus of the nasal cavity. After pulling out the guidewire, the stent was advanced in retrograde fashion and released into the sac and the nasolacrimal duct. The technical success rate was 100%. The average time for the procedure was 25 min (range 10-60 min). Immediate complications were: mild pain (n = 5), severe pain (n = 1), minimal epistaxis (n = 7), and moderate epistaxis (n = 1). No major complications occurred. The last clinical control revealed complete resolution of epiphora in 35 eyes and partial resolution in four; one patient did not improve. This technique for treatment of obstruction of the nasolacrimal system is simple and safe, and may obviate the use of more invasive procedures.