Severe Epistaxis Research Articles

The Use of Beta-Blockers in Hereditary Hemorrhagic Telangiectasia-Related Epistaxis: A Systematic Review.

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease affecting 1 in 5000 individuals. Epistaxis is seen in more than 90% of patients with HHT. Severe recurrent epistaxis can significantly decrease quality of life and may be resistant to standard treatment measures. Dysregulation of angiogenesis has been shown to cause the proliferation of abnormal blood vessels. As such, antiangiogenic treatments have been investigated including beta-blockers. A systematic review of the efficacy of beta-blockers in topical treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, and severity. A systematic search was performed using the PubMed, Embase via Ovid, and Cochrane databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of beta-blocker treatment of epistaxis in patients with HHT were included for qualitative analysis. Five studies (3 randomized controlled trials and 2 case series) with a total of 132 patients were included. Administration (systemically or topically via a spray or gel) of timolol and propranolol showed mixed evidence of improvement in epistaxis frequency, severity, and duration when compared with control groups. The evidence for propranolol appears more promising than timolol. There are significant limitations in the included studies, and further investigation with larger longitudinal or randomized prospective trials is recommended. The available evidence suggests that beta-blocker treatment may have a positive effect on HHT-related epistaxis.

Modified Endoscopic Denker's Approach for Management of Anterior Maxillary Sinus Tumors: Multicenter Series of 58 Cases.

Tumors involving the anterior portion of the maxillary sinus remain technically challenging to access via an endoscopic approach. The modified endoscopic Denker's (MED) procedure was recently introduced to address such lesions. We present a multicenter series of 58 patients with tumors involving the anterior maxillary sinus successfully resected using a MED procedure and present the clinical outcomes and complications. A multi-institution retrospective chart review was performed on patients who underwent the MED approach for the management of tumors involving the anterior maxillary sinus from 2009 to 2020. Demographic data, pathology, surgical outcomes, and complications were reviewed. Fifty-eight patients were identified, including 34 (58.6%) male and 24 (41.4%) female patients. The most common pathologies included: inverted papilloma (n = 27; 46.6%), adenoid cystic carcinoma (n = 9; 15.5%), and squamous cell carcinoma (n = 8; 13.8%). Thirty-eight patients (65.5%) underwent MED alone, while 20 (34.5%) had combined expanded endonasal approaches for lesions extending beyond the maxillary sinus. All maxillary sinus lesions were successfully accessed with the MED procedure without the need for an additional approach. After a mean follow-up of 30 months (range, 1-127), 8 of 58 (13.8%) patients developed complications related to the MED, including epiphora requiring an additional procedure (n = 4; 6.9%), prolonged facial/palatal numbness (n = 3; 5.2%), severe epistaxis (n = 1; 1.7%), and vestibular stenosis (n = 1; 1.7%), the latter of which occurred following postoperative radiation. The MED procedure is a safe and highly effective approach for benign and malignant tumors involving the anterior maxillary sinus. However, patients should be counseled preoperatively on potential complications including the risk of facial numbness and epiphora.

Children with Epistaxis and Risk Factors for Bleeding Disorders: Importance of Preoperative Diagnostic

Objective: To determine the frequency of previously undetected bleeding problems in kids with severe epistaxis who required intraoperative nasal cautery after failing medicinal treatment. Study design: Retrospective study Setting: Khyber Teaching Hospital Peshawar . Subjects and methods: Children (under the age of 19) with epistaxis who have been referred to an otolaryngologist must also have no known bleeding disorders, have had surgical nasal cautery, and have failed medicinal treatment. Information gathered includes epistaxis duration/severity, past bleeding patterns, and bleeding in the family. All patients had a screening CBC, PT, and PTT. Results: 47 (19%) of the 248 participants who were referred for epistaxis matched the inclusion criteria (mean age 9.2 0.5 years;61.7 percent male). 31.9 percent (15/47) of the patients had abnormal coagulation findings, however only 2 patients continued to have them after repeat testing. 15 patients were sent to haematology, where 5 had bleeding disorders (3 had type 1 von Willebrand's disease, 1 had a condition of platelet aggregation, and 1 had minor factor VII insufficiency). 10.6% (5/47) of the group as a whole had a bleeding disorder. Previous trips to the emergency department for epistaxis were one of the clinically significant predictors of developing a bleeding disorder (p = 0.04). Younger patients who presented with epistaxis showed a tendency (p = 0.07). Conclusion: Children who have repeated epistaxis while receiving medical treatment are more likely to develop a bleeding condition. 10.6% (5/47) of the patients in this highly selected cohort were found to have a bleeding condition. Only 20% (1/5) of individuals with a bleeding issue were identified by screening coagulation testing (PT, PTT). In most individuals, the diagnosis was not made until after a thorough haematology examination. Keywords: epistaxis, bleeding disorders, children, diagnostic

Infraorbitary artery epistaxis

Epistaxis is a common complication of endoscopic sinus surgery. Bleeding occurs more frequently due to injury of the sphenopalatine artery branches. Pathologies of the maxillary sinus that produce bone resorption and descent from the orbital floor into the sinus, expose the orbital fat and the infraorbital artery (IOA) to an injury that can cause severe epistaxis which is difficult to treat. Two cases of epistaxis due to an injury of the infraorbital artery in the maxillary sinus are described in our study.

Analysis of 79 Hospitalized Severe Epistaxis Patients and Review of Literature

Analysis of 79 Hospitalized Severe Epistaxis Patients and Review of Literature

Neurosurgical Complications in Patients with Nasopharyngeal Cancer Accompanied by Skull Base Erosion: A case report

A 66-year-old patient with nasopharyngeal cancer who had received chemotherapy and radiation therapy visited our emergency center with severe epistaxis. The patient was followed up with internal carotid artery trapping after a pseudoaneurysm was revealed in computed tomography angiography. Cerebrospinal fluid leakage was noted during follow-up observation after the intervention. This case presents various neurosurgical complications that can occur in patients with nasopharyngeal cancer.

Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension

There is a consensus that arterial hypertension (AH) is associated with stroke. Therefore, this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. Histological sections were obtained from hypertensive and normotensive individuals, regardless of epistaxis. Our results showed that the group with AH had: (a) smaller median diameter of the lumen of arteries and arterioles; (b) increased thickness of the intimal arteries and arterioles, slight inflammatory infiltrate, and rupture of internal elastic lamina; (c) greater thickness of the middle tunica in arterioles; (d) lower percentage of histological sections with non-injured intimal layers in capillaries, arterioles, and small arteries; (e) lower percentage of histological sections with intact media tunic and/or myocytes juxtaposed in arteries and arterioles; (f) no difference between the diameters of small arteries or arterioles. The intima was thicker in individuals with severe epistaxis than in the normotensive group, but it did not differ from the AH group. Thus, hypertension may cause structural lesions in the vascular layers, and in the absence of tissue repair and the persistence of AH, these lesions may favour vascular rupture, especially during hypertensive peaks.

Hereditary Hemorrhagic Telangiectasia in a Geriatric Patient: A Case of Treatment Resistance

Hereditary hemorrhagic telangiectasia (HHT) is a condition known for frequent and severe epistaxis, telangiectasias that form along various surfaces of the body, and potentially life-threatening arteriovenous malformations (AVMs) that may develop in major organ systems. Management of this condition begins with prompt diagnosis, followed by careful screening for systemic complications, and care to minimize morbidity associated with blood loss. We hereby describe a case of treatment-resistant HHT in a geriatric patient who suffers from recurrent and severe epistaxis warranting frequent hospitalizations and blood transfusions. The case underscores the need to recognize HHT early, begin treatment promptly, and closely follow these patients to minimize the risk of hospital readmission.

Validation of epistaxis severity score for hereditary hemorrhagic telangiectasia in Japan

ObjectiveThis study aimed to assess the health-related QoL (HR-QoL) of patients with hereditary hemorrhagic telangiectasia (HHT), with emphasis on the role/social aspects, and validate the Japanese version of the epistaxis severity score (ESS) in these patients. MethodsThe Japanese version of the ESS was created through forward and reverse translation, and consultation with the original author. A validation analysis was performed by comparing ESS severity with the invasiveness of previous treatments for epistaxis and assessing the correlation between the ESS and HR-QoL. Medical history forms, ESS questionnaires, and the Medical Outcomes Study Short Form 36 (SF-36) were distributed to participants with HHT in August 2020. The relation between the ESS and summary scores of SF-36 was assessed by performing analysis of variance and Spearman's correlation. ResultsIn total, 73 participants were included in this study. The average ESS was 5.02; there were mild (32.9%), moderate (45.2%), and severe (21.9%) epistaxis groups. Patients with higher ESS received a significantly more invasive treatment (Fisher's exact test, p < 0.05). The ESS was also negatively correlated with the physical component score (PCS) (r = -0.489, p < 0.001). Comorbid liver and gastrointestinal arteriovenous malformations significantly reduced the PCS (p < 0.05). Multiple regression analysis revealed that the ESS was a significant variable (p < 0.01). The role/social component score was significantly lower in the severe ESS group than in the mild or moderate group. ConclusionThe Japanese version of the ESS was considered valid and may be useful as an outcome measure of future HHT-associated epistaxis trials in Japan.

Refractory epistaxis and Stamm's S-point.

Ethmoidal arteries are gaining increasing importance as the main source of severe refractory epistaxis. In this direction, Stamm's S-point, a specific bleeding point in the upper nasal septum, around the projection of the axilla of middle turbinate, posterior to the septal body, was recently described. The aim of this review was to present recent data on S-point and its role in severe refractory epistaxis. Due to the hidden location posterior to the septal body, S-point is not easily identified by anterior rhinoscopy. When systematic endoscopic assessment was performed in severe epistaxis to search for the precise bleeding point, S-point was clearly the most identified (23.7-28.3%). Electrocauterization of bleeding point had high success rates (91.5-100%) and decreased the risk of recurrence bleeding. Stamm's S-point plays an important role in severe refractory epistaxis, due to its frequency and stability. However, this specific bleeding point could not be easily identified, so systematic endoscopic assessment should be performed. Recent data has shifted the paradigm of the main source of severe epistaxis from the sphenopalatine artery to ethmoidal arteries and presented high success rates for electrocauterization of bleeding points as single treatment of severe epistaxis.

The use of flutamide for the neoadjuvant treatment of juvenile nasopharyngeal angiofibroma: a review of the literature comparing results by pubertal status and tumor stage

Juvenile nasopharyngeal angiofibroma (JNA) is a rare but potentially life-threatening fibrovascular tumor that is seen almost exclusively in adolescent males and usually presents with symptoms of nasal obstruction or severe epistaxis. The current gold standard of treatment consists of complete surgical resection; however, this is inherently challenging because of the tumor's invasive nature and a substantial risk of intraoperative hemorrhage. Flutamide, an anti-androgen antineoplastic agent, has been used preoperatively in attempts to reduce tumor volume allowing for surgical resection with more conservative procedural techniques and reduce intraoperative blood loss. A literature review of PubMed and CINAHL was used to identify and analyze 29 male patients with JNA to determine the efficacy of the preoperative use of flutamide. Our analyses indicate that flutamide may be effective as a neoadjuvant agent by reducing tumor volume prior to resection in some patients but seemed to be more effective in the early stages of JNA without advanced tumor invasion. However, individual tumor response to flutamide was variable. Additionally, postpubertal patients seemed to demonstrate a greater reduction in tumor volume with flutamide compared to their prepubertal counterparts. Dosing regimen and side effects associated with flutamide therapy are also discussed. Flutamide may be an effective neoadjuvant therapy in some cases of juvenile nasopharyngeal angiofibroma, but larger scale, case-control studies are likely needed to further expand on this conclusion. Postpubertal males with early-stage disease seemed to be the population that may benefit most from this treatment protocol.

Cyanosis in a Previously Well Child.

Cyanosis in a Previously Well Child.

SEVERE THROMBOCYTOPENIA DUE TO IV EPOPROSTENOL: DON'T MUCK WITH THE PLATELETS

TOPIC: Pulmonary Vascular Disease TYPE: Fellow Case Reports INTRODUCTION: Prostacyclin related thrombocytopenia has been reported in patients with pulmonary arterial hypertension (PAH); however, the degree of thrombocytopenia is usually mild to moderate[1]. We present a case of severe thrombocytopenia in a patient with PAH being treated with intravenous (IV) epoprostenol (Epo) CASE PRESENTATION: A 42-year-old African-American female with idiopathic PAH developed worsening thrombocytopenia over a few months. She had previously been treated with IV treprostinil (Trp) for 11 years but was transitioned to escalating dose of IV Epo due to disease progression. She denied taking any new medications and her outpatient regimen was unchanged and included IV Epo, ambrisentan, tadalafil, ranolazine, furosemide, spironolactone, cetirizine, esomeprazole, and escitalopram. While on IV Trp, her platelet count was ~180,000 /uL but after switching to Epo, it gradually worsened to a nadir of 16,000 /uL prompting hospital admission. Her complete blood count revealed mild anemia attributed to chronic disease. A peripheral blood smear did not reveal schistocytes and her comprehensive metabolic panel was normal. Flow cytometry did not reveal clonal proliferation while her infectious and autoimmune serologies were also negative. Heparin-induced thrombocytopenia was ruled out and an ultrasound of the spleen was normal. Bone marrow biopsy showed unremarkable FISH analysis and cytology. The degree of thrombocytopenia precluded safe lung transplantation and she was treated with IV steroids and IV immunoglobulins for possible ITP without improvement. Based on the temporal relation and the George scale for drug induced thrombocytopenia[2], Epo was thought to be the most likely etiology and it was switched back to IV Trp. Her hospital course was complicated by severe epistaxis causing acute hypoxemic respiratory and right ventricular failure requiring initiation of ECMO. The patient's platelet count recovered over the next few days and she was successfully transplanted. The temporal relation of Epo initiation and discontinuation correlates well with the trajectory of the platelets DISCUSSION: Around two-thirds of all patients on IV Epo have some degree of thrombocytopenia, the majority of which were mild. The mechanisms for drug-induced thrombocytopenia are many; one such mechanism could include autoantibodies[3]. It did not appear to be a class effect or related to hemodynamics as platelet counts recovered after switching back to Trp. Hence, thrombocytopenia is likely due to a direct effect of Epo on platelets CONCLUSIONS: Thrombocytopenia is a well-recognized side effect of IV Epo which can sometimes be severe. It appears to have a dose-dependent relationship and may improve with changing to an alternative prostacyclin. It is critical to recognize this phenomenon as profound thrombocytopenia can not only be dangerous, but also preclude lung transplant candidacy, should it become necessary REFERENCE #1: Hargett CW, Ahearn GS, Krichman AM, Ward VR, Thoma M, Tapson VF. Thrombocytopenia Associated with Chronic Intravenous Epoprostenol Therapy. Chest. 2004;126(4):760S. doi:10.1378/chest.126.4_meetingabstracts.760s-b REFERENCE #2: George JN, Aster RH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. doi:10.1182/asheducation-2009.1.153 REFERENCE #3: Bakchoul T, Marini I. Drug-Associated Thrombocytopenia. http://ashpublications.org/hematology/article-pdf/2018/1/576/1255769/hem01879.pdf. Accessed February 8, 2021. DISCLOSURES: No relevant relationships by Qamar Ahmad, source=Web Response No relevant relationships by Kareem Ahmad, source=Web Response No relevant relationships by Shambhu Aryal, source=Web Response no disclosure on file for Aaron Bagnola;Speaker/Speaker's Bureau relationship with Genentech Please note: $5001 - $20000 by Anne Brown, source=Web Response, value=Honoraria Advisory Committee Member relationship with Vertex Please note: $1001 - $5000 by Anne Brown, source=Web Response, value=Honoraria Advisory Committee Member relationship with Promedior Please note: $5001 - $20000 by Anne Brown, source=Web Response, value=Consulting fee no disclosure on file for Vikramjit Khangoora;Speaker/Speaker's Bureau relationship with Genentech Please note: 2019 Added 03/10/2021 by Christopher King, source=Web Response, value=Honoraria Advisory Committee Member relationship with United therapeutics Please note: 2020 Added 03/10/2021 by Christopher King, source=Web Response, value=Consulting fee Advisory Committee Member relationship with actelion Please note: 2019-2020 Added 03/10/2021 by Christopher King, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with actelion Please note: 2020-2021 Added 03/10/2021 by Christopher King, source=Web Response, value=Royalty Advisory Committee Member relationship with Boehringer Ingelheim Please note: 2019-2020 Added 03/10/2021 by Christopher King, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Boehringer Ingelheim Please note: 2020-2021 Added 03/10/2021 by Christopher King, source=Web Response, value=Royalty Consultant relationship with Veracyte Please note: $1001 - $5000 by Steven Nathan, source=Web Response, value=Honoraria Consultant relationship with United Therapeutics Please note: $5001 - $20000 by Steven Nathan, source=Web Response, value=Consulting fee Consultant relationship with Bellerophon Please note: $5001 - $20000 by Steven Nathan, source=Web Response, value=Consulting fee Speaker/Speaker's Bureau relationship with Roche-Genentech Please note: $5001 - $20000 by Steven Nathan, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Boerhinger-Ingelheim Please note: $20001 - $100000 by Steven Nathan, source=Web Response, value=Honoraria No relevant relationships by Oksana Shlobin, source=Web Response No relevant relationships by Anju Singhal, source=Web Response

A New Device for Managing Refractory Epistaxis in ICU Patients with COVID-19

Epistaxis is a common and a well-known symptom. Nasal packing is an effective treatment in most cases [1]. The COVID-19 disease treatment includes conventional or high flow nasal oxygen therapy and systemic anticoagulation [2]. Patients in intensive care unit may require therapeutic anticoagulation for venous thromboembolism, hyperinflammatory status, extracorporeal membrane oxygenation (ECMO) and multiple other pathologies. The use of therapeutic anticoagulation increases risk of nose bleeding, and its management may be challenging. CAVI-T (Figures 1 &amp; 2) is a new asymmetrical low-pressure balloon that have shown promising results to control epistaxis in emergency. We report herein the management of severe epistaxis in two COVID-19 patients admitted to ICU for severe respiratory failure.

Ciddi Epistaksis olan Hastalarda Rutin Koagülasyon Teslerinin Değerlendirmesi

Aim: There are studies about coagulation parameters are not required in the management of epistaxis. The aim of the present study was to investigate whether or not coagulation tests are required and its relationship with medications in severe epistaxis cases that require intervention. Material and Method: The patients above 16 years who had presented to emergency department due to epistaxis, who had undergone anterior/posterior nasal packing or electro-cautery to the nasal mucosa were included the study. The demographic characteristics, blood count, coagulation test, anti-platelet and anti-coagulant medications, the procedures carried out for stopping bleeding, whether reversal treatment or blood transfusion was needed were recorded. Results: A total of 469 patients, it was found that coagulation parameters had been tested in 141(30.2%). While PT, aPTT and INR values of the anti-coagulant using patients were significantly higher(p&amp;lt;0.001, p=0.003, p&amp;lt;0.001, respectively), the platelet and hemoglobin values were not found to be associated with anti-platelet drug and anti-coagulant use(p=0.304, p=0.098, respectively). The patients were allocated to two groups as those any parameter of whom was impaired or not. While a significant difference was found between the groups with regard to hemoglobin values(p=0.006), no patients were determined to need reversal treatment or hemoglobin replacement.Conclusion: Routine coagulation testing is not required for patients who have epistaxis that cannot be stopped with conservative methods and who are using anti-platelet drugs as it does not lead to a difference in treatment. Coagulation tests may not be performed in patients who use anti-coagulants based on the results.

CT-088: Tamoxifen: An Anti-Estrogen Effectively Controlling Osler-Weber-Rendu Disorder

Osler-Weber-Rendu disease (OWRD) is an uncommon autosomal dominant disorder affecting the blood vessels throughout the body leading to vascular dysplasia. Patients have a high tendency for bleeding. The prognosis is overall good, as long as bleeding is adequately controlled. Here we report the case of a 48-year-old male patient who was referred to our institution for blood transfusion incompatibility. History goes back to two years ago when he started complaining of severe periodic epistaxis and gingival bleeding. He received more than 20 units of packed red blood cells (PRBCs) over the past 2 years. His physical examination was pertinent for telangiectasia overlying the nostrils and the lips. While taking a further detailed history, he mentioned that his sister was diagnosed with a liver hematoma secondary to an arterio-venous malformation (AVM) which was treated with embolization. Laboratory work-up didn’t reveal any abnormality in primary nor secondary hemostasis (normal platelet count, no von Willebrand factor deficiency, normal PT/PTT/fibrinogen/factor XIII/bleeding time). Total body CT angiography was negative for any AVM. Consequently, the patient was diagnosed with OWRD based on epistaxis, telangiectasias and family history of a first-degree relative with OWRD. Genetic testing was not available. He received moisturizing topical therapies to humidify the nasal mucosa. Our main aim was to control the bleeding episodes in order to defer blood transfusions. Thus, he was started on oral tranexamic acid (TXA) 1 gram three times per day and tamoxifen 20 mg per day. He also received regular intravenous iron. The bleeding episodes became less frequent. It has been 1 year without any blood transfusion. He is continuing TXA, tamoxifen and intravenous iron replacement regularly. Clinicians must be aware of this rare genetic disorder. Early diagnosis leads to improvement of the patients’ quality of life by initiating a medical and supportive treatment. Tamoxifen appears to be an effective agent in minimizing the bleeding episodes due to Osler-Weber-Rendu disease.

Anesthesia in A Patient With an Internal Carotid Artery Aneurysm Presenting as Massive Recurrent Projectile Epistaxis: A Case Report

Severe projectile epistaxis due to non-traumatic internal carotid artery aneurysms is potentially life threatening but extremely rare, with hardly any report existing in the literature. We present the case of a 21-year old male with a history of recurrent torrential epistaxis associated with headache and dizziness. Catheter angiography revealed two aneurysmal dilatations at the cavernous and supraclinoid segments of the right internal carotid artery.

Case Report: A Case of Leukocyte Adhesion Deficiency, Type III Presenting With Impaired Platelet Function, Lymphocytosis and Granulocytosis

Fermitin family homolog 3 (FERMT3), alternatively kindlin-3 (KIND3), is an integrin binding protein (of 667 residues) encoded by the FERMT3 gene. The molecule is essential for activating integrin αIIbβ3 (the fibrinogen receptor) on platelets and for the integrin-mediated hematopoietic cell (including platelets, T lymphocytes, B lymphocytes, and granulocytes) adhesion. Its defects are associated with impaired primary hemostasis, described as “Glanzmann's thrombasthenia (MIM#273800)-like bleeding problem.” The defects are also associated with infections, designated as “LAD1 (leukocyte adhesion deficiency, type I; MIM#116920)-like immune deficiency.” The entity that joins the impaired primary hemostasis with the leukocyte malfunction has been termed “leukocyte adhesion deficiency, type III” (LAD3, autosomal recessive, MIM#612840), representing a defective activation of the integrins β1, β2, and β3 on leukocytes and platelets. Here, we report a male toddler with novel compound heterozygous variants, NM_178443.2(FERMT3):c.1800G>A, p.Trp600* (a non-sense variant) and NM_178443.2(FERMT3):c.2001del p.*668Glufs*106 (a non-stop variant). His umbilical cord separated at about 3 weeks of age. A skin rash (mainly petechiae and purpura) and recurrent episodes of severe epistaxis required blood transfusions in early infancy. His hemostatic work-up was remarkable for a normal platelet count, but abnormal platelet function screen with markedly prolonged collagen-epinephrine and collagen-ADP closure times. The impaired platelet function was associated with reduced platelet aggregation with all agonists. The expression of platelet receptors was normal. Other remarkable findings were persistent lymphocytosis and granulocytosis, representing defects in diapedesis due to the integrin dysfunction. The natural history of his condition, structure and sequence analysis of the variations, and comparison with other LAD3 cases reported in the literature are presented.

Sclerotherapy Versus Cautery/Laser Treatment for Epistaxis in Hereditary Hemorrhagic Telangiectasia.

Surgical interventions for epistaxis management in hereditary hemorrhagic telangiectasia (HHT) demonstrate short-term success and require repeated procedures for disease control. Although electrocautery and/or laser photocoagulation (C ± L) are most frequently performed, sodium tetradecyl sclerotherapy (STS) is emerging as a promising newer treatment. We hypothesized that in a 24-month time period, STS would require fewer treatments than C ± L to maintain epistaxis severity within the mild range. Retrospective study. We retrospectively assessed 67 patients with HHT with moderate and severe epistaxis that were treated periodically with C ± L (34 patients) versus STS (33 patients). The primary outcome was the number of procedures needed to maintain the epistaxis severity score (ESS) as mild. Secondary outcomes assessed for differences in postoperative complications, hemoglobin levels, iron stores, hematologic support, and quality-of-life (QoL) scores. To maintain ESS in the mild range, 1.6 STS procedures (range, 1-4) were performed versus 3.6 C ± L procedures (range, 1-8) (P=.003). Significant postoperative differences included reduction in nasal crusting (3% vs. 32%, P=.001), foul odor (3% vs. 35%, P < .001), and septal perforation (3% vs. 29%, P=.006) after STS. There were no significant differences between the two treatments in hemoglobin levels, iron stores, hematologic support, or QoL scores. STS is able to attain satisfactory epistaxis control with significantly fewer procedures and lower postoperative complications than C ± L. STS should be considered as the initial surgical intervention for epistaxis in patients with HHT. 4 Laryngoscope, 132:920-925, 2022.

Analysis of risk factors in patients admitted with epistaxis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Epistaxis can be classified into anterior and posterior epistaxis. All bleeding occurs as a result of disruption of the intact nasal mucosa, whether due to trauma, inflammation, or neoplasm. Management depends on the severity of the bleeding and its underlying cause.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This study was done in department of otorhinolaryngology in a tertiary care centre from September 2018 to December 2020. A total of 143 patients were studies. All patients admitted in our department as a case of epistaxis were analysed for the risk factors present in them which could be the cause of epistaxis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study it was seen the risk factor involved in majority of patients was hypertension (70%), followed closely by diabetis mellitis and deranged coagulogram (65%). Chronic kidney disease was an associated risk factor in 64% of patients. All these factors cause microangiopathies which in turn lead to bleeding.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The current study can be taken as indirect evidence that while raised blood pressure is seen in patients with severe epistaxis but in general the diseases associated with microangiopathies.&lt;/p&gt;