Nasal Trauma Research Articles

Environmental impact on pediatric epistaxis and the utility of diagnostic studies: A single-institutional review

ObjectivesPediatric epistaxis is a multifactorial disease entity. The objective of this study is to determine the socioeconomic and air-quality contributions to pediatric epistaxis. The study also evaluates the utility of diagnostic lab work as a predictor of bleeding rates and need for operative intervention. MethodsA case series of pediatric patients treated in an outpatient Otolaryngology clinic at a tertiary care children's hospital in 2021 for epistaxis was performed. Patients with nasal bone trauma (n = 8), consult while inpatient (n = 7), and those with nasal masses (n = 2) were excluded; 181 patients met inclusion criteria. Demographic, clinical, socioeconomic, and air quality (tropospheric ozone, particulate matter) data were recorded. Associations with persistent bleeding and operative interventions were evaluated using logistic regression, Wilcoxon rank-sum, and Spearman rank correlation. ResultsOf the 181 patients, 75 (41.4%) were female. Forty-six of 181 (25.4%) had associated allergic symptoms. Twenty-six patients had allergy testing; 14/26 (53.8%) of these had positive results. Re-bleeding was more common in those with allergic symptoms (OR: 2.42, 95% CI: 1.22–4.78, p = 0.01). Patients with re-bleeding lived in counties with more days with ozone over the US standard (median 5 days, range 0–32 days) compared with those with no re-bleeding (median 3 days, range 0–32 days, p = 0.007). There was also an association between the number of visits for re-bleed and percent below poverty level (ρ = 0.259, p = 0.03) as well as the number of days with particulate matter levels over the US standard (ρ = 0.343, p = 0.01). Coagulopathy was present in 9/54 (16.7%) patients, with the majority being Von Willebrand disease (5/54, 9.3%). Easy bruising was not significantly associated with positive lab results. ConclusionsEnvironmental pollution, living in a zip code with more residents below the poverty level, and allergic rhinitis were positively associated with recurrent epistaxis. Understanding the geographic background of presenting patients may help direct workup and treatment options.

Ultrasound for management of pediatric nasal fractures.

Nasal bone fractures are common in children but can be challenging to diagnose accurately in the first days due to swelling and tenderness. While X-rays and computed tomography have limitations, ultrasound may be a radiation-free and cost-effective alternative for diagnosing and treating nasal fractures. A prospective cohort study at a tertiary referral hospital between 2021-2023. Children who had sustained nasal trauma were included. A radiologist and a non-radiologist blindly reviewed ultrasound scans, and the results were compared to the physical examination performed by a senior otolaryngologist. If closed reduction was necessary, ultrasound was employed during the procedure. The primary outcome was the assessment of nasal fractures in children using ultrasound; Secondary outcomes included success rates for closed reduction and test reliability. Of the 50 children (mean age: 11 years, interquartile range: 6-15 years, 36 [72%] males), 22 (44%) were clinically diagnosed with a nasal fracture. Interobserver reliability for nasal fracture by ultrasound was 92%, with a Cohen's kappa coefficient of k=0.91. The sensitivity and specificity of ultrasound in detecting nasal fractures were 90% and 89%, respectively, with positive and negative predictive values of 86% and 93%, respectively. Closed reduction was performed on 18 children, with (n=11) or without (n=7) ultrasound, with the former showing better alignment results (82% vs. 71%). Ultrasound has a high negative predictive value in identifying nasal fractures in children with swollen noses during presentation. This enables to avoid further unnecessary referrals and interventions. Ultrasound-guided closed reduction of nasal fractures demonstrates improved outcomes; however, further large-scale randomized studies are required to validate our findings.

Comparing recurrence between cautery techniques in pediatric epistaxis

ObjectiveTo compare the risk of recurrent epistaxis between children treated with silver nitrate (SN) in the office or electrocautery (EC) in the operating room (OR). MethodsPatients aged 2–18 diagnosed with epistaxis (ICD R04.0) in 2018 and treated with SN or EC were retrospectively reviewed. Epistaxis laterality, history of nasal trauma, and personal or family history of a bleeding disorder were recorded. Patients with prior cautery or epistaxis secondary to a procedure were excluded. Recurrence was defined as initial encounter after cautery with documented epistaxis. Patients were followed up into 2022 to track onset of recurrence. Time to recurrence between SN and EC was compared with hazard curves with predictors for recurrence analyzed via Cox's proportional hazard regression. ResultsAmong 291 patients cauterized for epistaxis, 62 % (n = 181) received SN compared to 38 % (n = 110) who underwent EC. There was significantly higher risk of recurrence when treated with SN compared to EC (Hazard ratio 2.45, 95 % CI: 1.57–3.82, P < 0.0001). Median time to recurrence was not statistically different between techniques (6.39 months (SN) (IQR: 2.33, 14.82) vs. 4.11 months (EC) (IQR: 1.18, 20.86), P = 0.4154). Complication rates were low for both groups (1.16 % (SN) vs. 0 % (EC), P > 0.05). ConclusionAmong patients with epistaxis, risk of recurrence is significantly higher in those cauterized with SN compared to EC. Time to recurrence is not significantly different between cautery techniques.

Clinical outcomes of endoscopic dacryocystorhinostomy without preserving mucosal flaps in combination with silicone stent and steroid-soaked gelfoam

To report clinical outcomes of endoscopic dacryocystorhinostomy (En-DCR) combined with stenting and without preserving the nasal and lacrimal mucosal flaps. In this prospective interventional case series, patients with primary acquired nasolacrimal duct obstruction who were candidates for En-DCR were enrolled. Patients with a known history of previous DCR, sinus surgery, rhinoplasty, nasal trauma, nasal anomaly, canalicular or punctal occlusion, or less than one year of follow-up were excluded. All patients underwent En-DCR and stenting followed by ostial packing using Gelfoam soaked with dexamethasone. The patients were assessed preoperatively, on the first postoperative day, after 2 weeks, 3 months, and 1 year. Postoperative outcomes were anatomical and functional success, defined as patent irrigation test and resolution of epiphora, respectively. The nasolacrimal drainage system was evaluated anatomically and functionally during the follow-up period. Eighty-three patients with a mean age of 54.36±15.27 years were enrolled. Of these, 61 patients (73.5%) were women. The mean duration of follow-up was 20.7±6.9 months. Anatomical success was achieved in all patients and remained stable during the study duration and at 1 year. Functional failure leading to epiphora was observed in 1 patient 3 months after surgery and resolved after re-DCR at year 1. Preoperative tenderness and purulent reflux were observed in 12%, 33.7% of which completely resolved postoperatively. Moderate and severe hemorrhage was observed in 12 (14.5%) and 2 (2.4%) patients, respectively. En-DCR without mucosal flap preservation in combination with silicone stent and steroid-soaked Gelfoam is a safe and highly successful procedure in patients with primary acquired nasolacrimal duct obstruction.

Application of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose

To investigate the feasibility and effectiveness of bilateral facial perforator artery flap in repairing large area defect in middle and lower part of nose. The clinical data of 18 patients with large area defect in middle and lower part of nose repaired by bilateral facial perforator artery flap between January 2019 and December 2022 were retrospectively analyzed. Among them, there were 13 males and 5 females, the age ranged from 43 to 81 years, with an average of 63 years. There were 3 cases of nasal trauma, 4 cases of basal cell carcinoma, 8 cases of squamous cell carcinoma, 1 case of lymphoma, and 2 cases of large area solar keratosis. The size of the defect ranged from 3.0 cm×3.0 cm to 4.5 cm×4.0 cm; the size of unilateral flap ranged from 3.0 cm×1.3 cm to 3.5 cm×2.0 cm, and the size of bilateral flaps ranged from 3.3 cm×2.6 cm to 4.5 cm×4.0 cm. One patient developed skin flap necrosis after operation, and a frontal skin flap was used to repair the wound; 1 case gradually improved after removing some sutures due to venous congestion in the skin flap, and the wound healing was delayed after dressing change; the remaining 16 cases of bilateral facial perforator artery flaps survived well and all wounds healed by first intention, without any "cat ear" malformation. All 18 patients had first intention healing in the donor area, leaving linear scars without obvious scar hyperplasia, and no facial organ displacement. All patients were followed up 3-12 months, with an average of 6 months. Due to the appropriate thickness of the flap, none of the 18 patients underwent secondary flap thinning surgery. All flaps had good blood circulation, similar texture and color to surrounding tissues, symmetrical bilateral nasolabial sulcus, and high patient satisfaction. The bilateral facial perforator artery flaps for repairing large area defect in middle and lower part of nose can achieve good appearance and function, and the operation is relatively simple, with high patient satisfaction.

High-flow nasal cannula (HFNC) vs continuous positive airway pressure (CPAP) vs nasal intermittent positive pressure ventilation as primary respiratory support in infants of ≥ 32 weeks gestational age (GA): study protocol for a three-arm multi-center randomized controlled trial

BackgroundHealth problems in neonates with gestational age (GA) ≥ 32 weeks remain a major medical concern. Respiratory distress (RD) is one of the common reasons for admission of neonates with GA ≥ 32 weeks. Noninvasive ventilation (NIV) represents a crucial approach to treat RD, and currently, the most used NIV modes in neonatal intensive care unit include high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and nasal intermittent positive pressure ventilation. Although extensive evidence supports the use of NIPPV in neonates with a GA < 32 weeks, limited data exist regarding its effectiveness in neonates with GA ≥ 32 weeks. Therefore, the aim of this study is to compare the clinical efficacy of HFNC, CPAP, and NIPPV as primary NIV in neonates with GA ≥ 32 weeks who experience RD.MethodsThis trial is designed as an assessor-blinded, three-arm, multi-center, parallel, randomized controlled trial, conducted in neonates ≥ 32 weeks’ GA requiring primary NIV in the first 24 h of life. The neonates will be randomly assigned to one of three groups: HFNC, CPAP or NIPPV group. The effectiveness, safety and comfort of NIV will be evaluated. The primary outcome is the occurrence of treatment failure within 72 h after enrollment. Secondary outcomes include death before discharge, surfactant treatment within 72 h after randomization, duration of both noninvasive and invasive mechanical ventilation, duration of oxygen therapy, bronchopulmonary dysplasia, time to achieve full enteral nutrition, necrotizing enterocolitis, duration of admission, cost of admission, air leak syndrome, nasal trauma, and comfort score.DiscussionCurrently, there is a paucity of data regarding the utilization of NIPPV in neonates with GA ≥ 32 weeks. This study will provide clinical evidence for the development of respiratory treatment strategies in neonates at GA ≥ 32 weeks with RD, with the aim of minimizing the incidence of tracheal intubation and reducing the complications associated with NIV.Trial registrationChinese Clinical Trial Registry: ChiCTR2300069192. Registered on March 9, 2023, https://www.chictr.org.cn/showproj.html?proj=171491.

Spontaneous Fracture of a Silicone Implant: A Delayed Complication of Rhinoplasty.

Silicone implants are commonly used alloplastic materials for rhinoplasty in Asia, as they are easy to manipulate, provide adequate volume augmentation, and exhibit excellent biocompatibility. However, they are associated with complications such as infection, displacement, and extrusion. Recently, we encountered an interesting complication in a 53-year-old woman presenting with palpable and visible stepping of the nasal dorsum. The patient had previously undergone rhinoplasty with an L-shaped silicone implant, and symptoms had been noticeable for approximately 1 year. Lateral nasal computed tomography revealed a fractured silicone implant. Because the patient reported no history of nasal trauma since rhinoplasty, we assumed that the silicone implant might have fractured spontaneously. The findings in this case suggest that spontaneous implant fracture can be a late complication of rhinoplasty with silicone implant.

Mesorrhine Type of Nose among Medical Students of a Medical College.

The nose is an attraction point in our face and one of the important sense organs of our body. The knowledge of the type of nose is essential for surgeons undertaking esthetic repair and reconstruction of noses The aim of this study was to find out the prevalence of the mesorhine type of nose among medical students of a medical college. A descriptive cross-sectional study was done among medical students of medical college after obtaining ethical approval from the Institutional Review Committee. Students of age groups 16-25 years from different religions with various castes/ethnicities were included. Those with craniofacial abnormalities, nasal deviation and a history of nasal trauma were excluded. All the nasal parameters were measured with the help of vernier's calliper and the nasal index was calculated. Convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Among 215 medical students, the prevalence of mesorrhine type of nose was 130 (60.46%) (53.92-67, 95% Confidence Interval). The prevalence of mesorrhine type of nose among medical students was similar to other studies done in similar settings. medical students; nose; prevalence; sexual dimorphism.

Guidelines for high-flow nasal cannula oxygen therapy in neonates (2022).

High-flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence-based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC.

Macroscopic evaluation of nasal mucosal regeneration after trauma (experimental study)

Introduction. Adhesions as a manifestation of pathological regeneration in the nasal cavity after surgical interventions is a rather pressing problem of modern medicine.The aim of the study. was to evaluate the effectiveness of regenerative treatment regimens for nasal mucosal trauma under experimental conditions.Materials and methods. A randomized experimental study was carried out on 480 male white rats, divided into six treatment-dependent groups. At control times (2, 5, 10, 14, 21, 30, 42, 60 days), 10 animals were each removed from the experiment.Results. After nasal musocal trauma on the 2−5th day the processes of alteration prevailed, which were more pronounced in the group that did not receive anti-inflammatory treatment. In the group treated with a combination of the antioxidant “Demiphosphon” and the reparant “Derinat”, already from the 10th day there there was noted a restoration of the integrity of the mucous membrane of the wound edges, by the 60th day in all 10 (100 %) animals there was a complete closure of the defect. The incidence of adhesions in the group without treatment was 11.3 % with the use of reparative agents in the groups a statistically significant reduction of the adhesion process was observed.Discussion. Other authors have described the effects of various drugs on wound healing and adhesions. The effectiveness of hyaluronic acid remains controversial; in the study presented, no nasal adhesions were detected when sodium hyaluronate (“Olifrin”) was used.Conclusion. The best result was observed in the groups where the combination of the antioxidant “Demiphosphon” and the reparative agent “Derinat” was used: in addition to the absence of adhesions, earlier closure of the defect was noted. The inclusion of reparative agents in the treatment regimens increases the effectiveness of treatment by correcting the effects on reparative regeneration processes.

High flow nasal cannula for respiratory support in term infants.

High flow nasal cannula for respiratory support in term infants.

Evaluation and management of acute epistaxis in the emergency department

Acute epistaxis, or nosebleed, is a common presentation in the emergency department (ED) that requires a systematic evaluation and prompt management. The assessment involves considering the severity of bleeding, identifying underlying causes, and implementing appropriate interventions. Modifiable risk factors, such as medication review, nasal hygiene, avoidance of nasal trauma, and humidification, should be addressed to prevent recurrence. Referral to specialists is necessary for cases of recurrent or severe bleeding, suspected underlying causes, or inadequate response to initial management. Collaboration between ED healthcare providers and specialists ensures comprehensive evaluation, specialized interventions, and long-term management. Regular follow-up appointments and patient education are essential for monitoring progress, adjusting treatment, and preventing complications. By employing a comprehensive approach, healthcare providers aim to alleviate distress, achieve hemostasis, identify underlying etiologies, and optimize patient outcomes in the ED.

An Updated Review on Atrophic Rhinitis and Empty Nose Syndrome.

Objective: Atrophic rhinitis (AR) is a rare clinical condition affecting the nasal mucosa. It is characterized by progressive nasal congestion and thick, bothersome nasal secretions. In this narrative review, pathogenesis, differences between the 2 types of AR, new management modalities, and the impact of management on lifestyle have been highlighted. Materials and Methods: An extensive literature search was conducted using PubMed, Web of Science, Google Scholar, and Saudi Digital Library databases. The articles were investigated to extract information on the pathogenesis, types, new treatment modalities, and the impact of management on lifestyle. Results: AR has primary and secondary types that affect different populations and have specific clinical presentations. Primary AR is common in women and countries with long, warm seasons. Secondary AR is the most common disease in the industrialized world. It is more common among adults who have systemic disease, have undergone extensive nasal surgery, and have experienced nasal trauma. Certain infections, autoimmune disorders, chronic sinusitis, hormonal imbalance, poor nutritional condition, and iron deficiency anemia have been suggested as etiological factors. Conservative treatment is safe, inexpensive, and effective. Hygiene, a well-balanced diet, smoking cessation, and early detection and treatment of nasal pathology can help prevent AR. Some interventions shown to improve quality of life was explained in detail. Conclusions: This paper reviewed published relevant literature on AR related to pathogenesis, types, new treatment modalities, and the impact of treatment on lifestyle, thus, providing a comprehensive view of the management and prevention of AR.

Role of Rib Graft for Tip Shaping in Primary Rhinoplasty: A Retrospective Case Series of 30 Patients.

In primary rhinoplasty, use of harvested septal cartilage often precludes the need for rib graft. Nonetheless, there are a number of indications for the use of rib graft in primary rhinoplasty. The purpose of this study was to identify the indications and techniques for rib graft use in primary rhinoplasty. A retrospective review was performed on all patients who underwent primary rhinoplasty performed by a single surgeon over a 5-year period. From these patients, those who required the use of fresh frozen allograft rib cartilage were identified. Medical record review was performed to identify demographics, ethnicity, and history of nasal trauma. Photographic analysis was also performed. Thirty of 638 consecutive primary rhinoplasties (4.7%) required rib graft. Of these, 7 patients (23.3%) demonstrated a history of nasal trauma. Furthermore, a high proportion of primary rhinoplasty patients requiring rib graft were from Asian ( n = 7 [23.3%]), Middle Eastern ( n = 4 [13.3%]), Hispanic ( n = 7 [23.3%]), and African American ( n = 9 [30%]) backgrounds. White patients were in the minority ( n = 2 [6.7%]). All primary rhinoplasties using rib graft implemented a septal extension graft. The present study demonstrates that patients requiring a rib graft in primary rhinoplasty invariably receive a septal extension graft. Furthermore, certain ethnicities associated anatomical characteristics correlated with the need for a rib graft for tip shaping. Ultimately, the use of a septal extension graft in primary rhinoplasty allows for precise and robust projection, rotation, and tip shaping in noses with thick skin, weak cartilaginous framework, and history of nasal trauma. Risk, IV.

Impact of a Nursing Intervention Bundle of Care on Nasal-CPAP-Related Nasal Injuries in Preterm Infants: A Quality Improvement Initiative

AIM: The objective is to assess the effect of the application of a nasal injury prevention bundle on the incidence and severity of nasal-continuous positive airway pressure (nCPAP)-related nasal injuries in preterm infants. METHODS: We conducted a prospective controlled before-after study in a preterm neonate, &lt;37 weeks gestation, who required nCPAP in the neonatal intensive care unit, at Mansoura University Children’s Hospital, between September 2018 through October 2019. After 2 months of nursing staff training, a nasal trauma prevention bundle was implemented. The nursing intervention bundle comprised nasal barrier dressing, regular focused checking for evolving nasal skin injury, and proper application of the CPAP device. nCPAP-related nasal injuries per 1000 days and grading of nasal injury severity were the primary outcomes. Time to onset of nasal injury after initiation of CPAP; duration of nCPAP use, duration of oxygen dependency; incidence of pneumothorax, broncho-pulmonary dysplasia; intraventricular hemorrhage; periventricular leukomalacia; late-onset sepsis; length of hospital stay; and in-hospital mortality were the secondary outcomes. RESULTS: Data from 62 preterm neonates were analyzed (31 in each group). The nasal trauma prevention bundle of care was associated with reduced nasal injury incidence per 1000 nCPAP-days (140 vs. 148.94, p = 0.03) with improved nasal injury severity staging (p = 0.003) compared to the pre-bundle era. Nasal injury developed earlier in the control group (1 [1–1] vs. 2 [1–3] days, p = 0.002) compared to the intervention group. No statistically significant differences were reported between groups regarding any of the other secondary outcomes. Longer duration of CPAP use (p = 0.009) and lack of bundle application (0.03) were the independent risk factors associated with nCPAP-related nasal injuries in preterm neonates. CONCLUSION: The implementation of a bundle of nursing interventions is associated with a substantially improved incidence and severity of nasal injuries in preterm infants receiving nCPAP.

Delayed post-traumatic intractable epistaxis due to pseudoaneurysms in concha bullosa: a case report

BackgroundDelayed post-traumatic bleeding at various sites is known due to vascular abnormalities related to structural changes in the vessel walls, in the form of pseudo aneurysms and arteriovenous malformations. Delayed epistaxis following facial trauma is a distinct entity that presents as recurrent episodes of bleeding from the nose. History of trauma is important to differentiate it from idiopathic intractable epistaxis, the management of which is less dramatic in the beginning in the form of endoscopy and electrocauterization. However, uncontrolled post-traumatic delayed epistaxis usually requires embolization. We report a rare case of intractable epistaxis associated with multiple pseudoaneurysms (PA), due to bleeding inside concha bullosa, where even embolization was unsuccessful.Case presentationA 25-year-old male patient presented to casualty and was referred to the Otorhinolaryngology department for recurrent profuse bleeding from left nasal cavity, where conservative measures like nasal packing, and electrocauterization did not help. Patient had a history of fall from height with facial bone fractures 1 month back. Angiography revealed blush with dilatation (pseudoaneurysms) in the nasal branches of internal maxillary arteries, ascending pharyngeal and labial arteries and embolization was done in the Interventional Radiology Department. Post-embolization, the patient again developed massive epistaxis. The patient was explored under general anaesthesia, to find out the site of bleed by nasal endoscopy. Collected blood was found in the left concha bullosa. Conchoplasty of the left middle turbinate was done with cauterization of bleeding vessels. The patient had no further epistaxis and was discharged in stable condition. He is asymptomatic for the last 6 months.ConclusionPost-traumatic pseudoaneurysms is a rare cause of delayed epistaxis following nasal trauma. Angiography helps in the localization of the source of bleeding inside nasal cavity and can identify pseudoaneurysmal dilatations of vessels. Our case highlights the importance of hidden bleeding points inside concha bullosa as a source of intractable epistaxis unresponsive to embolization.

Frequency of Etiological Factors Involved in patient of Epistaxis presenting at D.G Khan Hospital, D.G Khan

Objective: To determine the frequency of etiological factors involved in patient of epistaxis presenting at D.G Khan Hospital, D.G Khan. Study design: Cross sectional study Place and duration: Department of ENT, D.G Khan Hospital, D.G Khan from January 2022 to September 2022. Methodology: Total 167 patients with acute episode of nasal bleeding, either male or female, age between 10-60 years were recruited and etiological factors of episode were evaluated. Results: Total 167 patients with Epistaxis were selected. Mean age was 39.03 ± 14.97 years. Age range was 10-60 years, Males were 103 (62%) while females were 64 (38%). The commonest cause of epistaxis was idiopathic 86 (51.5%) cases, followed by nasal trauma 39 (23.4%), Nasopharyngeal carcinoma 11 (6.6%), sinusitis 9 (5.4%), tumors 5 (3%) bleeding disorder 8 (4.8%) and hypertension in 9 (5.4%) patients. Practical implication: Understanding the frequency of etiological factors involved in patients with epistaxis is a critical objective. The practical implications of this research could have significant benefits for the community: 1. Improved Clinical Practice: By determining the common causes of epistaxis, healthcare professionals can improve their diagnostic approach, providing more accurate and timely treatment, ultimately leading to better patient outcomes. 2. Early Intervention and Prevention: Understanding the etiological factors may enable the development of preventative strategies or early intervention approaches, potentially reducing the overall incidence of epistaxis. 3. Education and Awareness: This study could lead to increased public awareness about the common causes of epistaxis, encouraging individuals to take necessary precautions and seek early medical attention when needed. 4. Resource Allocation: Health resources could be better distributed based on the findings of this study, ensuring that facilities and personnel are adequately equipped to handle the most common causes of epistaxis. Overall, this study could substantially contribute to the community's overall health by enhancing the management and understanding of epistaxis. Conclusion: Results was present study showed that most common etiological factor of epistaxis was Idiopathic and nasal trauma was second in number. In most of cases, right nasal cavity was involved. Male were more victim of epistaxis as compared to females and epistaxis was commonly seen in 4th and 5th decade of life. Keywords: Epistaxis, Nosebleed, Idiopathic, etiology, nasal tumor, hypertension, nosebleed

Nasal high flow therapy for primary respiratory support in preterm infants.

Nasal high flow therapy for primary respiratory support in preterm infants.

Comparison in Patient Satisfaction Between Structural Component and Hybrid T-bar Preservation Rhinoplasty: A Retrospective Propensity Score Matched Cohort Study.

Recently, a modified dorsal split preservation technique has been described. In this method, the integrity of the elastic keystone area is preserved by separation of the upper lateral cartilages from the septal T-bar. Our study aimed to evaluate the aesthetical and functional outcome in patients treated with the dorsal T-bar preservation versus the 'gold' standard dorsal split component reduction approach. We performed a retrospective propensity score matched analysis in 234 patients enrolled for rhinoplasty. The severity of nasal obstruction was measured with the nasal obstruction symptom evaluation questionnaire (NOSE score). Aesthetic evaluation was performed with the FACE-Q nose and nostrils and Utrecht Questionnaire (UQ). Assessments were conducted prior to surgery, at 3 and at 6 months after surgery. After propensity score matching, 172 patients in two cohorts were retained. The following covariates were taken into the statistical calculation: age, gender, ethnicity, previous nasal surgery, nasal trauma, respiratory allergy, and preoperative NOSE scores. The first cohort of 110 patients underwent rhinoplasty with T-bar preservation technique (TDP). The control cohort consisted of 62 patients who underwent dorsal split component reduction (SCR). The mean preoperative scores for FACE-Q nose, FACE-Q nostrils, UQ and VAS score improved significantly in all patients postoperatively. Both techniques had comparable aesthetic outcome measures that remained unchanged between 3 and 6 months postop. Functional outcome as measured by the NOSE score was in favor of SCR at 3 months postop but the difference between both techniques was not significant anymore at 6 months postop. In contrast to SCR, in TDP, only 31% of the patients needed spreader grafts or autospreader flaps at the internal valve area only for functional reasons. The data in this study suggest similar patient satisfaction with SCR and TDP techniques for aesthetics as well as nasal function after 6 months postop. TDP is a very versatile cartilage-sparing method to aesthetically adapt the middle vault without interrupting the keystone area. It combines the popular component separation concept with the preservation of the delicate anatomy of the mid-vault. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Bubble devices versus other pressure sources for nasal continuous positive airway pressure in preterm infants.

Several types of pressure sources, including underwater bubble devices, mechanical ventilators, and the Infant Flow Driver, are used for providing continuous positive airway pressure (CPAP) to preterm infants with respiratory distress. It is unclear whether the use of bubble CPAP versus other pressure sources is associated with lower rates of CPAP treatment failure, or mortality and other morbidity. OBJECTIVES: To assess the benefits and harms of bubble CPAP versus other pressure sources (mechanical ventilators or Infant Flow Driver) for reducing treatment failure and associated morbidity and mortality in newborn preterm infants with or at risk of respiratory distress. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2023, Issue 1); MEDLINE (1946 to 6 January 2023), Embase (1974 to 6 January 2023), Maternity & Infant Care Database (1971 to 6 January 2023), and the Cumulative Index to Nursing and Allied Health Literature (1982 to 6 January 2023). We searched clinical trials databases and the reference lists of retrieved articles. We included randomised controlled trials comparing bubble CPAP with other pressure sources (mechanical ventilators or Infant Flow Driver) for the delivery of nasal CPAP to preterm infants. We used standard Cochrane methods. Two review authors separately evaluated trial quality, extracted data, and synthesised effect estimates using risk ratio (RR), risk difference (RD), and mean difference. We used the GRADE approach to assess the certainty of the evidence for effects on treatment failure, all-cause mortality, neurodevelopmental impairment, pneumothorax, moderate-severe nasal trauma, and bronchopulmonary dysplasia. We included 15 trials involving a total of 1437 infants. All trials were small (median number of participants 88). The methods used to generate the randomisation sequence and ensure allocation concealment were unclear in about half of the trial reports. Lack of measures to blind caregivers or investigators was a potential source of bias in all of the included trials. The trials took place during the past 25 years in care facilities internationally, predominantly in India (five trials) and Iran (four trials). The studied pressure sources were commercially available bubble CPAP devices versus a variety of mechanical ventilator (11 trials) or Infant Flow Driver (4 trials) devices. Meta-analyses suggest that the use of bubble CPAP compared with mechanical ventilator or Infant Flow Driver CPAP may reduce the rate of treatment failure (RR 0.76, 95% confidence interval (CI) 0.60 to 0.95; (I² = 31%); RD -0.05, 95% CI -0.10 to -0.01; number needed to treat for an additional beneficial outcome 20, 95% CI 10 to 100; 13 trials, 1230 infants; low certainty evidence). The type of pressure source may not affect mortality prior to hospital discharge (RR 0.93, 95% CI 0.64 to 1.36 (I² = 0%); RD -0.01, 95% CI -0.04 to 0.02; 10 trials, 1189 infants; low certainty evidence). No data were available on neurodevelopmental impairment. Meta-analysis suggests that the pressure source may not affect the risk of pneumothorax (RR 0.73, 95% CI 0.40 to 1.34 (I² = 0%); RD -0.01, 95% CI -0.03 to 0.01; 14 trials, 1340 infants; low certainty evidence). Bubble CPAP likely increases the risk of moderate-severe nasal injury (RR 2.29, 95% CI 1.37 to 3.82 (I² = 17%); RD 0.07, 95% CI 0.03 to 0.11; number needed to treat for an additional harmful outcome 14, 95% CI 9 to 33; 8 trials, 753 infants; moderate certainty evidence). The pressure source may not affect the risk of bronchopulmonary dysplasia (RR 0.76, 95% CI 0.53 to 1.10 (I² = 0%); RD -0.04, 95% CI -0.09 to 0.01; 7 trials, 603 infants; low certainty evidence). AUTHORS' CONCLUSIONS: Given the low level of certainty about the effects of bubble CPAP versus other pressure sources on the risk of treatment failure and most associated morbidity and mortality for preterm infants, further large, high-quality trials are needed to provide evidence of sufficient validity and applicability to inform context- and setting-relevant policy and practice.