Recurrent Anterior Epistaxis Research Articles

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

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

Comparison of topical treatment methods used in recurrent anterior epistaxis: a randomized clinical trial

IntroductionRecurrent epistaxis is a common medical problem faced by ENT specialists, emergency physicians, and pediatricians. The facts that many treatment modalities are being searched and no single treatment method is universally accepted yet support this information. ObjectiveWe aimed to compare the clinical efficacy of topical antiseptic ointment, topical decongestant ointment and chemical cauterization treatments, which are frequently used in recurrent anterior epistaxis, both singly and in combination. Material-methodsBetween August 2017 and February 2018, 137 patients who were diagnosed with recurrent anterior epistaxis were randomly divided into 5 groups. group I received topical antiseptic ointment, group II received topical decongestant ointment, group III received chemical cauterization, group IV received topical antiseptic ointment + chemical cauterization and group V received topical decongestant ointment + chemical cauterization treatment. All patients were phoned 2 weeks and 1 month after the treatment and questioned about the presence (failure) or absence (success) of at least 1 episode of epistaxis. Patients with comorbid diseases were excluded. Treatment success was statistically analysed. ResultsThere was no significant difference (p > 0.05) between the groups in the success rate at 15th day after treatment. Group IV and group V had higher success rates at 30th day after treatment compared with group I and group II (p < 0.05). In group III 30th day treatment success was not different from the other 4 groups (p > 0.05). ConclusionAlthough the number of patients who improved with chemical cauterization (group III) was higher in our study, no significant difference was observed in single treatment modalities (group I‒III) at 14th day and 30th day after treatment. Although no statistically significant difference was observed between combined treatments (group IVV) and single treatments (group I‒III) in the 2nd week after treatment, combined treatments were significantly more effective in the 1st month.

Microwave ablation versus silver nitrate cautery for treating recurrent epistaxis in adolescents: A prospective, randomized case-control study

ObjectiveTo compare the outcomes of adolescent patients with recurrent anterior epistaxis (RAE) treated with either silver nitrate cauterization or microwave ablation (MWA). Study designand methods: In this prospective, randomized study, one hundred 13–18-year-old adolescents with RAE were assigned to two groups: the MWA group (n = 50) or the silver nitrate cauterization group (n = 50). Both groups were followed up for 12 months. The primary and secondary outcomes were evaluated. ResultAblation hemostasis was successfully achieved within 10–20 s in all patients in the MWA group. Eighteen (36.0%) patients in the silver nitrate group had recurrent epistaxis compared to three (6.0%) in the MWA group (P = 0.01) within 2–8 weeks after treatment. Two (2/48, 4.2%) patients in the MWA group had recurrent epistaxis compared to seventeen (17/43, 39.5%) in the silver nitrate group at 6 months; this difference was statistically significant (P = 0.01). However, 8 (8/37, 21.6%) patients in the MWA group had recurrent epistaxis compared to 15 (15/41,36.6%) in the silver nitrate group at 12 months; this difference was not statistically significant (P = 0.12). No treatment-related complications, including necrosis or septal perforation were seen in either group during follow up. ConclusionsMWA may be a useful treatment for adolescents with RAE, as it had a lower incidence of recurrent epistaxis within 6 months of treatment compared to silver nitrate cauterization.

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.

Endoscopic endonasal greater palatine artery cauterization at the incisive foramen for control of anterior epistaxis

To describe the anatomy of the incisive foramen and the transnasal endoscopic approach to the greater palatine artery at this foramen, and to evaluate the importance of the greater palatine artery as a cause of recurrent anterior epistaxis. Anatomical dissection, radiographic study, and prospective case series. Academic Medical Center. Sixty-nine computed tomography scans were reviewed, and measurements were made of the incisive foramina's distance to the anterior nasal spine and subnasale. Twenty-two cadavers had sagittal split craniotomies performed prior to the measurements. The distance from the anterior nasal spine to the incisive foramen was documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery at the incisive foramen. Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Endoscopic cauterization of the greater palatine artery at the incisive foramen is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Our case series corroborates the above. 4. Laryngoscope, 126:1033-1038, 2016.

Endoscopic Endonasal Greater Palatine Artery Cauterization at the Incisive Foramen for Control of Anterior Epistaxis: An Anatomical Study and Case Series

Objectives: This study aims to describe the anatomy of the incisive foramen and the transnasal endoscopic approach to the greater palatine artery at this foramen. This study also aims to evaluate the importance of the greater palatine artery as a cause of recurrent anterior epistaxis.

Long-term efficacy of Nd:YAG laser photocoagulation vs. liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis.

The objective of this study was to evaluate the long-term efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. These patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (Group 1) or Nd:YAG laser photocoagulation (Group 2). the following outcome measures were assessed: bleeding intensity; bleeding frequency 2 years after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain), and complications. Finally, 70 patients remain in our study. At 2 years, 86 % of laser patients versus 31 % of control patients had no reported bleeding. The outcome score at 2 years after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± SD pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be further concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis in long-term efficacy. The level of pain associated with the procedure was well tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

Endoscopic Approach to Greater Palatine Artery to Control Recurrent Anterior Epistaxis

Objectives: (1) Describe the anatomy of the incisive foramen. (2) Describe the endoscopic approach to the greater palatine artery. (3) Recognize the importance of the greater palatine artery as a cause of recurrent anterior epistaxis. Methods: Cadaveric and radiographic study of the incisive foramen; illustrative case series. Seventy computed tomography (CT) scans were reviewed, and measurements were made of the incisive foramina’s distance to the anterior nasal spine and subnasale. An endoscopic approach to the incisive foramen was completed in 20 cadavers, and measurements of the distance from the anterior nasal spine to the incisive foramen were documented. We also present an illustrative case series of patients who underwent endoscopic cautery of the greater palatine artery. Results: Radiographic review of the incisive foramen revealed a mean anterior nasal spine to incisive foramen distance on the right and left of 7.9 and 8.1 mm, respectively. The mean distance from the subnasale to incisive foramen on the right and left were 24.7 and 24.9 mm, respectively. Cadaveric measurements preliminarily correspond to radiographic measurements. Conclusions: Endoscopic cauterization of the greater palatine artery is a safe and effective method to control recurrent anterior epistaxis. The incisive foramen can be predictively found within 1 cm of the anterior nasal spine. Preoperative evaluation of a CT scan can help aid a surgeon in determining the relative contribution of the greater palatine artery to the anterior septal blood supply, and guide surgical approach to control recurrent anterior epistaxis. Our case series corroborates the above.

Radiofrequency coagulation versus liquid paraffin plus antiseptic cream in the treatment of recurrent anterior epistaxis

ObjectivesTo evaluate the efficacy of radiofrequency coagulation and to compare it with that of liquid paraffin plus antiseptic cream in the management of recurrent anterior epistaxis. DesignProspective clinical trial. Between February 2011 and July 2012, one hundred consecutive patients with histories of recurrent anterior epistaxis were randomly assigned to receive treatment consisting of either a combination of liquid paraffin plus antiseptic cream (group 1) or radiofrequency coagulation (group 2). SettingBenha University Hospital. Main outcome measuresThe Epistaxis Severity Score; before treatment, at 4, 12weeks, 6 and 12months after treatment, participant’s perception of discomfort during the management and complications. ResultsThe severity score of the 94 patients who had full data at 4weeks after treatment shows no statistically significant differences between the two groups. However, at 12weeks; 85% of the radiofrequency group versus 40% of paraffin-antiseptic group patients had reported no bleeding. At 6months; 74% of the radiofrequency group versus 25% of the paraffin-antiseptic group patients reported no bleeding. At 12months, 70% of the radiofrequency group versus 23% of the paraffin-antiseptic group patients reported no bleeding. Both groups had no complications. The level of pain associated with the procedure was tolerable. Mean duration of the radiofrequency procedure was 14.2min. ConclusionsIt can be concluded that radiofrequency coagulation is a safe, convenient rapid and simple procedure that is associated with a significant improvement in epistaxis severity in cases of recurrent anterior epistaxis. This therapy could be performed in office settings.

A prospective randomised controlled trial of Nd:YAG laser photocoagulation versus liquid paraffin plus antiseptic cream in the treatment of recurrent epistaxis

To evaluate the efficacy of Nd:YAG laser photocoagulation with that of liquid paraffin plus antiseptic cream in the management of recurrent epistaxis. Prospective clinical study. Eighty consecutive patients with histories of recurrent epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either a combination of liquid paraffin plus antiseptic cream (group 1) or Nd:YAG laser photocoagulation (group 2). University-affiliated teaching hospital. Eighty consecutive patients who suffered from recurrent anterior epistaxis presented to the Otolaryngology Department at the Eye and ENT Hospital, Fudan University between February 2011 and June 2011. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 12 weeks after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, 3 = worse), participant's perception of discomfort during the management (grade 0-10, where 10 is the worst pain) and complications. At 12 weeks, 85% of laser patients versus 40% of control patients had no reported bleeding. The outcome score at 4 weeks after treatment showed no significant difference between the two groups (P = 0.130, P > 0.05); however, the outcome score at 12 weeks after treatment showed a significant difference between the two groups (P = 0.000, P < 0.01). The median and mean ± sd pain levels experienced were 5.0 and 5.2 ± 2.2. Both groups had no complications. It can be concluded that Nd:YAG laser photocoagulation is a preferable therapy in the treatment of recurrent epistaxis, especially in terms of long-lasting efficacy. The level of pain associated with the procedure was tolerated. It is a simple, easy, safe and rapid therapy, which can be performed in an office setting.

Effectiveness of a Nasal Saline Gel in the Treatment of Recurrent Anterior Epistaxis in Anticoagulated Patients

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients.

Refractory Severe Thrombocytopenia Associated with Intravenous Treprostinil Use: a Case Report

Background: Intravenous epoprostenol was the first drug approved by the U.S. Food and Drug Administration for the treatment of pulmonary arterial hypertension. Treprostinil, a tricyclic benzidene prostocycline analog of epoprostenol has been favored over epoprostenol due to its more advantageous mode of administration and similar efficacy. All prostocyclines are known to cause thrombocytopenia, but severe platelet reductions are rare below 100,000/μL.Aim: We report the first case of severe thrombocytopenia associated with intravenous treprostinil with subsequent recovery of a normal platelet count following transition to epoprostenol.Case Report: A 55 year-old Caucasian woman diagnosed with idiopathic pulmonary artery hypertension noted significant improvement in symptoms and exercise tolerance following initiation of intravenous treprostinil. However, she developed new onset severe thrombocytopenia with her platelet count falling to 51,000/μL (150,000–399,000/μL) and recurrent anterior epistaxis after receiving intravenous treprostinil for six months. She had no known hematologic disorders or history of recurrent bleeding and was not receiving any other new medications. There was no evidence of disseminated intravascular coagulation, hemolysis, coagulation factor deficiency, or splenic sequestration. Empiric treatment with corticosteroids was started for positive antiplatelet IgG direct antibody, but the platelet count further declined to 25,000/μL. The patient was subsequently transitioned from intravenous treprostinil to epoprostenol under the assumption that her severe thrombocytopenia was an idiosyncratic reaction rather than a class effect of prostocyclines. Her platelet count had returned to normal two weeks after the transition.Conclusion: In practice, patients developing thrombocytopenia from epoprostenol are frequently switched to treprostinil hoping to attenuate the degree of thrombocytopenia. This case is the first report of severe thrombocytopenia associated with intravenous treprostinil, as well as its successful resolution following transition to another prostocycline analog, epoprostenol. Although the exact mechanism of thrombocytopenia is unknown, it raises a question if the cyclohexane ring on treprostinil compared to the lactone ring on epoprostenol can potentially lead to more severe thrombocytopenia. Although at this point, it is uncertain if severe thrombocytopenia is an idiosyncratic reaction to treprostinil, this report will hopefully draw attention to this potential adverse effect and identify the mechanism of this reaction.

A reliable medical treatment for recurrent mild anterior epistaxis.

The LaryngoscopeVolume 109, Issue 9 p. 1535-1537 Article A Reliable Medical Treatment for Recurrent Mild Anterior Epistaxis† Scott D. London MD, Scott D. London MD Department of Otolaryngology Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia.Search for more papers by this authorWilliam H. Lindsey MD, Corresponding Author William H. Lindsey MD Department of Otolaryngology Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia.William H. Lindsey, MD, Suite 302, Medical Office Building, Augusta Medical Center, 93 Medical Center Drive, Fishersville, VA 22939, U.S.A.Search for more papers by this author Scott D. London MD, Scott D. London MD Department of Otolaryngology Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia.Search for more papers by this authorWilliam H. Lindsey MD, Corresponding Author William H. Lindsey MD Department of Otolaryngology Head and Neck Surgery, University of Virginia Health Sciences Center, Charlottesville, Virginia.William H. Lindsey, MD, Suite 302, Medical Office Building, Augusta Medical Center, 93 Medical Center Drive, Fishersville, VA 22939, U.S.A.Search for more papers by this author First published: 04 January 2009 https://doi.org/10.1097/00005537-199909000-00033Citations: 7 † Presented at the Meeting of the Southern Section of the American Laryngological, Rhinological and Otological Society, Inc., New Orleans, Louisiana, January 15, 1999. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume109, Issue9September 1999Pages 1535-1537 RelatedInformation

Experimental surgical treatment for recurrent epistaxis

Purpose: To evaluate a new technique of submucosal supraperichondrial (SMSP) dissection of the nasal septum and its subsequent effect on the vascularity of the mucosa. A reduction may decrease the rate of recurrent anterior epistaxis. Materials and Methods: The procedure was performed on one side of the nasal septum of 16 laboratory rabbits. After healing occurred 3 months later, the animals' septa were excised and stained. Both sides were then compared by using standardized microscopic field analysis. Results: The reduction in both the number of blood vessels on the operated side of the septum and the proportion of area occupied by these vessels was statistically significant ( P < .004). Conclusion: This technique led to a reduction in the vascularity of the nasal septal mucosa, 3 months after dissection was performed. Healing, which occurs by a process of fibrosis, yielded a less vascularized tissue. Although further laboratory and clinical assessment is recommended, this technique may prove valuable in reducing the rate of recurrent anterior epistaxis.