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Modesti CL, Testa G, Salvetti M, Paini A, Riviera M, Bazza A, Bertacchini F, Aggiusti C, Lombardi D, Rampinelli V, Piazza C, Muiesan ML. Epistaxis and Clinic Blood Pressure Values: Is There a Relationship? High Blood Press Cardiovasc Prev 2024:10.1007/s40292-024-00669-7. [PMID: 39289332 DOI: 10.1007/s40292-024-00669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 09/02/2024] [Indexed: 09/19/2024] Open
Abstract
INTRODUCTION Epistaxis is the most common otorhinolaryngological emergency and historically there have been an important debate whether there is a cause-effect relationship with high blood pressure. AIM This retrospective study explored whether hypertension is a significant risk factor for epistaxis in Emergency Department (ED) patients and examined associations between blood pressure levels and epistaxis episodes. MATERIALS AND METHODS Two groups were studied: Group A (patients with epistaxis) and Group B (control). Patient characteristics, comorbidities, and medication use were recorded. Blood pressure measurements were taken upon ED arrival and after specialist evaluation. Statistical analyses included descriptive statistics, T-test, χ2 test, and logistic regression. RESULTS Group A, enrolled from April 2014 to February 2015, included 102 patients, mean age 67, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 73%, decreasing to 26% after 30 minutes. Group B, enrolled from May 2023 to August 2023, included 126 patients, mean age 59, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 60%, decreasing to 23% after 30 minutes. Both groups showed reduced blood pressure post-evaluation. Logistic regression identified anticoagulant and/or antiplatelet therapy as the main independent risk factor for epistaxis. Age, sex, blood pressure levels, and hypertension did not significantly influence epistaxis occurrence. CONCLUSION No significant correlation between hypertension and epistaxis was found. Anticoagulant and/or antiplatelet therapy was the primary independent risk factor, highlighting the importance of considering medication history in evaluating epistaxis.
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Affiliation(s)
- Claudia Lodovica Modesti
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, ASST Spedali Civili Hospital, Brescia, Italy
| | - Gabriele Testa
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, ASST Spedali Civili Hospital, Brescia, Italy
| | - Massimo Salvetti
- Internal Medicine, Department of Clinical & Experimental Sciences, University of Brescia - Medicina Generale 2 - ASST Spedali Civili Brescia, Piazzale Spedali Civili,Brescia, Italy
| | - Anna Paini
- Internal Medicine, Department of Clinical & Experimental Sciences, University of Brescia - Medicina Generale 2 - ASST Spedali Civili Brescia, Piazzale Spedali Civili,Brescia, Italy
| | - Michela Riviera
- Emergency Department and Bed Management, ASST Spedali Civili Hospital, Brescia, Italy
| | - Abramo Bazza
- Department of Clinical & Experimental Sciences, Emergency Department, ASST Cremona - Ospedale di Cremona, Brescia, Italy
| | - Fabio Bertacchini
- Internal Medicine, Department of Clinical & Experimental Sciences, University of Brescia - Medicina Generale 2 - ASST Spedali Civili Brescia, Piazzale Spedali Civili,Brescia, Italy
| | - Carlo Aggiusti
- Internal Medicine, Department of Clinical & Experimental Sciences, University of Brescia - Medicina Generale 2 - ASST Spedali Civili Brescia, Piazzale Spedali Civili,Brescia, Italy
| | - Davide Lombardi
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, ASST Spedali Civili Hospital, Brescia, Italy
| | - Vittorio Rampinelli
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, ASST Spedali Civili Hospital, Brescia, Italy
| | - Cesare Piazza
- Unit of Otorhinolaryngology - Head and Neck Surgery, Department of Surgical and Medical Specialties, Radiological Sciences and Public Health, ASST Spedali Civili, ASST Spedali Civili Hospital, Brescia, Italy
| | - Maria Lorenza Muiesan
- Internal Medicine, Department of Clinical & Experimental Sciences, University of Brescia - Medicina Generale 2 - ASST Spedali Civili Brescia, Piazzale Spedali Civili,Brescia, Italy.
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Kidwai S, Haris M, Bilal A, Saleem S, Imran H, Anwar A, Hashmi AA. High Blood Pressure-Associated Symptoms: Insights From a Population-Based Study in Pakistan. Cureus 2024; 16:e65446. [PMID: 39184750 PMCID: PMC11344628 DOI: 10.7759/cureus.65446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2024] [Indexed: 08/27/2024] Open
Abstract
Background All over the world, millions die of hypertension (HTN) every year. Given the influence of healthcare expenses, HTN represents a serious public health issue in developed and developing countries. HTN is common in Pakistan; however, there are several myths about the symptoms of raised blood pressure that need to be identified. Objective The objective of this study is to compare the frequency of high blood pressure-associated symptoms in normotensive and hypertensive adult populations in Karachi, Pakistan. Methodology A community-based cross-sectional observational study was conducted among 277 patients aged 18 years and above who were attending the OPD of different community health centers in Karachi, with and without HTN. Ethical approval was obtained, and data were collected using a convenient sampling technique on a predesigned questionnaire and analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, NY, USA). Results Out of the total study population, 88 (31.65%) were normotensive, and 189 (67.98%) were hypertensive. In the hypertensive group, approximately 100 (52.9%) were men and 89 (47.1%) were women. The mean ages of normotensives and hypertensives were 44.13 + 11.0 and 49.2 + 13.1 years, respectively. Mean age, heart rate, and smoking status were significantly different between the two groups. Among several perceived blood pressure symptoms like vision problems, sleep apnea, and abnormal heartbeat was significantly higher in the hypertensive group. Conversely, although headache, vertigo, edema, and epistaxis were more frequent in the hypertensive group, the difference was not statistically significant. Conclusions In our study, >65% of patients visiting OPD had high blood pressure. Several symptoms were found to be more prevalent in hypertensive individuals compared with non-hypertensive ones. More large-scale studies are recommended to further explore the common symptoms associated with HTN in our population.
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Affiliation(s)
- Salma Kidwai
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Muhammad Haris
- Internal Medicine, Hamdard University Hospital, Karachi, PAK
| | - Abubaker Bilal
- Internal Medicine, Jinnah Postgraduate Medical Centre, Karachi, PAK
| | - Sana Saleem
- Internal Medicine, Jinnah Medical & Dental College, Karachi, PAK
| | - Haram Imran
- Internal Medicine, Jinnah Medical & Dental College, Karachi, PAK
| | - Adnan Anwar
- Physiology, Hamdard College of Medicine & Dentistry, Karachi, PAK
- Internal Medicine, Anabiya General Hospital, Karachi, PAK
| | - Atif A Hashmi
- Pathology, Liaquat National Hospital and Medical College, Karachi, PAK
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Hovgaard LH, Grønlund C, Homøe P. Risk factors of epistaxis in rural Denmark: a cross-sectional population-based survey of data from the Lolland-Falster health study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08762-2. [PMID: 38914819 DOI: 10.1007/s00405-024-08762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/26/2024] [Indexed: 06/26/2024]
Abstract
PURPOSE Epistaxis is a common condition that affects about 60% of the population in their lifetime, with 6% needing medical attention. Little is known about the epidemiology and risk factors of epistaxis outside the health care system. This study aimed to investigate the prevalence and risk factors of epistaxis in a rural Danish population using data from the Lolland-Falster Health Study (LOFUS). METHODS We conducted a cross-sectional survey based on data from LOFUS, a household-based, prospective cohort study in the rural provincial area of Lolland-Falster, Denmark. We enrolled 10,065 participants (≥ 50 years) and collected data on demographics, comorbidities, medication, lifestyle factors, and laboratory parameters. Logistic regressions were used to test for correlations between epistaxis and different risk factors. RESULTS In total 5.3% of the participants had experienced epistaxis within the past 30 days, and 7.9% had sought medical attention for epistaxis at some point in their lives. We identified several factors that were significantly correlated with increased odds of epistaxis, such as male gender, age group 50-59 years, high BMI (> 25), allergy, diabetes, hypertension, atherosclerosis, angina, and anticoagulant treatment. Excellent or good self-reported health was correlated to significantly lower odds of epistaxis. CONCLUSION This study provides a comprehensive overview of the prevalence and risk factors of epistaxis outside the health care system. Our study suggests that preventive measures targeting these risk factors may reduce the incidence and severity of epistaxis in this population.
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Affiliation(s)
- Lisette Hvid Hovgaard
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebaekvej 1, Køge, 4600, Denmark.
| | - Casper Grønlund
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebaekvej 1, Køge, 4600, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Lykkebaekvej 1, Køge, 4600, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Desai V, Sampieri G, Namavarian A, Lee JM. Cryoablation for the treatment of chronic rhinitis: a systematic review. J Otolaryngol Head Neck Surg 2023; 52:37. [PMID: 37120607 PMCID: PMC10148426 DOI: 10.1186/s40463-023-00645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
BACKGROUND ClariFix is a novel intranasal cryotherapy device developed for clinic-based cryosurgical ablation of the posterior nasal nerves region. As a relatively new technology, there is a paucity of studies within the literature assessing the efficacy and safety profile of ClariFix for chronic rhinitis. METHODS A systematic review was completed in accordance with PRISMA guidelines. Databases searched included: Ovid Medline, Ovid EMBASE, Pubmed, Cochrane and Web of Science. Inclusion criteria consisted of studies investigating the use of ClariFix in chronic rhinitis (i.e., allergic and non-allergic rhinitis) in patients of all ages. RESULTS The initial search identified 1110 studies. Final analysis consisted of 8 articles, evaluating a total of 472 patients. The data showed a significant reduction in scores post-treatment across all studies based on validated outcome measures. In all studies, at all time intervals, there was a significant improvement in outcome scores from baseline. Minor adverse effects included post-procedural pain and discomfort, headache and palate numbness. No major adverse events were identified. CONCLUSION ClariFix is a novel intranasal cryotherapy device that was introduced in Canada in 2021. This is the first systematic review evaluating its efficacy and safety profile. Across all studies, there was a significant reduction in validated outcome scores at multiple time intervals. Further, the treatment is safe with only minor adverse effects reported by patients. Overall, the consensus from this study highlights an apparent benefit in using this intervention for chronic rhinitis that is refractory to medical management.
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Affiliation(s)
- Veeral Desai
- Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Gianluca Sampieri
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - Amirpouyan Namavarian
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada
| | - John M Lee
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
- Division of Rhinology, Department of Otolaryngology - Head and Neck Surgery, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
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Hughes JM, Teh BM, Hart CJ, Gibbs HH, Aung AK. Risk factors and management outcomes in epistaxis: a tertiary centre experience. ANZ J Surg 2023; 93:555-560. [PMID: 36539988 DOI: 10.1111/ans.18179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Risk factors and outcomes associated with severe epistaxis are not well understood. This study explores the associations between epistaxis severity, comorbidities, use of antiplatelets or anticoagulants and management outcomes. METHODS This is a retrospective cross-sectional study of all epistaxis cases presenting to the emergency department at a tertiary academic hospital from January 2016 to December 2019. Epistaxis severity was defined as mild (no intervention), moderate (required cautery and/or packing) and severe (clinical instability with reversal products, surgical or radiological intervention). Univariable and multivariable regression analyses were undertaken, with risk factors and management outcomes analysed according to severity. RESULTS A total of 543 patients with epistaxis (54.2% male, mean age 74.4 ± 15.7 years) were included in this study, with 14.7% (80) having severe epistaxis. Of these presentations 216 (39.8%) were on antiplatelets, while 207 (38.1%) were on anticoagulants. In univariate analyses, clopidogrel use, hereditary haemorrhagic telangiectasia (HHT), haematological malignancy, bleeding disorders and chronic liver disease (CLD) were associated with moderate to severe epistaxis (P < 0.05), while the use of rivaroxaban was inversely associated severity (P = 0.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first-line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1 days vs. 4.3 days; P < 0.001) and higher 2-week readmission rates (2.2% vs. 12.5%; P < 0.001) were noted with severe epistaxis compared with mild presentations. CONCLUSION Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first-line management were evident.
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Affiliation(s)
- Jed M Hughes
- Department of ENT, Head Neck Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Bing Mei Teh
- Department of ENT, Head Neck Surgery, Austin Health, Melbourne, Victoria, Australia
- Department of Otolaryngology, Head and Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Cameron J Hart
- Department of ENT, Head Neck Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Harry H Gibbs
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of General Medicine, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ar Kar Aung
- Department of General Medicine, Alfred Hospital, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Bereda G. Hypertensive Urgency and Anterior Epistaxis Caused by Antihypertensive Medication Noncompliance: A Case Report. Open Access Emerg Med 2023; 15:47-51. [PMID: 36760918 PMCID: PMC9904137 DOI: 10.2147/oaem.s400167] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Background and Aims A sudden increase in blood pressure without serious, life-threatening symptoms or indications of immediate target organ damage is referred to as "hypertensive urgency." This case study revealed the rare direct cause of epistaxis and the direct cause of hypertensive urgency in an elderly man due to antihypertensive medication noncompliance. Case Presentation A black male farmer, age 63, was brought to the emergency room on June 1st, 2022, with chief complaints of breathing difficulties, epistaxis, and disorientation. The patient was hospitalized after exhibiting symptoms of breathlessness, malaise, nausea, and vomiting. Magnetic resonance imaging, an echocardiogram, and a computed tomography scan of the brain are all clear. For the treatment of epistaxis, he received 1g of tranexamic acid intravenously three times a day for two days. He received intravenous labetalol, which was effective in treating his hypertensive urgency and rebound hypertension, utilizing repeated dosages of 5-20 mg. The patient's intravenous labetalol and previous enalapril were switched to captopril 25 mg orally three times a day for one month after starting drugs per os. Discussion The patient's hypertensive urgency is directly caused by forgetting to take his blood pressure medication and by not adhering to his previous antihypertensive drugs as prescribed. In this study, the patient's hypertension had been uncontrolled for the previous six months despite his treatment plan. Unaware that he had missed two doses of his antihypertensive medication, he was admitted to the emergency room with progressive anterior nose bleeding that persisted for four hours. The patient's elevated arterial blood pressure is what's causing the patient's nose to bleed.
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Affiliation(s)
- Gudisa Bereda
- Pharmacy Department, Alert Comprehensive Specialized Hospital, Addis Ababa, Ethiopia,Correspondence: Gudisa Bereda, Pharmacy Department, Alert Comprehensive Specialized Hospital, Addis Ababa, 1000, Ethiopia, Tel +251913118492; +251910790650, Email
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Ahn EJ, Min HJ. Age-specific associations between environmental factors and epistaxis. Front Public Health 2022; 10:966461. [PMID: 36339143 PMCID: PMC9626808 DOI: 10.3389/fpubh.2022.966461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/05/2022] [Indexed: 01/24/2023] Open
Abstract
Objective Several studies have demonstrated that environmental factors, such as meteorological factors and air pollutants, are closely associated with epistaxis. However, age-specific associations between environmental factors and epistaxis have not yet been evaluated. This study aimed to evaluate the associations between individual meteorological factors and air pollutants and epistaxis, by age. Study design A retrospective cohort study. Setting Records of patients covered by the Korean National Health Insurance Service who visited our hospital for epistaxis between January 1, 2002, and December 31, 2015, were retrospectively reviewed. Methods The 46,628 enrolled patients were divided into four age groups: age group 0 (<18 years, N = 19,580); age group 1 (18-40 years, N = 10,978); age group 2 (41-70 years, N = 13,395); and age group 3 (>70 years, N = 2,675). Cases of epistaxis and data on environmental factors were analyzed according to the day, month, and year. Stepwise logistic regression was performed to identify the environmental risk factors for epistaxis in each age group. Results Age group 0 had the highest number of patients with epistaxis, whereas age group 3 had the lowest. Relative humidity, temperature, concentrations of particulate matter (PM10) and sulfur dioxide, sunshine duration, and wind speed were significantly associated with the occurrence of epistaxis in the study population. However, analysis according to age group showed that the meteorological factors and air pollutants associated with epistaxis were different in each age group. Conclusion We suggest that the environmental risk factors for epistaxis should be differentially analyzed according to age.
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Affiliation(s)
- Eun-Jin Ahn
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea,*Correspondence: Hyun Jin Min
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Ross A, Engebretsen S, Mahoney R, Bathula S. Risk Factors and Management for Epistaxis in a Hospitalized Adult Sample. Spartan Med Res J 2022; 7:37760. [PMID: 36128022 PMCID: PMC9448657 DOI: 10.51894/001c.37760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Epistaxis is a common otolaryngologic problem that affects most of the general population. Common risk factors for epistaxis include nasal irritants, nasal/facial oxygen use, certain systemic conditions (e.g., hypertension and coagulopathies) and medication use (e.g., anticoagulants and intranasal medications). This study examined risk factors for and management of epistaxis in patients admitted for other medical conditions who developed an episode of epistaxis during their hospital admission. METHODS Patients were included in the study if they were older than 18, admitted for medical illnesses other than epistaxis and developed an episode of epistaxis during their admission during calendar year 2020 at the authors' institution's hospitals. Electronic health record data regarding sociodemographic characteristics, common risk factors (e.g. oxygen use, anticoagulant use, history of hypertension) and treatment for epistaxis (e.g. holding anticoagulation therapy, administration of oxymetazoline, nasal cautery, nasal packing) were extracted from each chart. Patients were split into otolaryngologic treatment versus no treatment groups and risk factors were compared between sample subgroups. RESULTS A total of 143 sample patients were included, with most common reason for admission being cardiovascular related, 48 (33.6%). Most patients, 104 (72.7%), did not have a previous diagnosis of epistaxis, were positive for anticoagulant use, 106 (74.1%) and were positive for hypertension, 95 (66.4%). Oxygen use showed a significantly decreased risk for intervention (OR 0.45, 95% CI: 0.23-0.894; p = 0.028). Most patients required changes in medical management (e.g., holding anticoagulation or starting nasal saline sprays/emollients). CONCLUSION These results demonstrate the common risk factors for epistaxis in patients admitted for other clinical diseases. Identifying at-risk patients for epistaxis at hospital admission can help to initiate measures to prevent epistaxis episodes. Future studies are needed to study epistaxis risk factors and identify effective preventative measures for epistaxis among hospital populations.
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Affiliation(s)
- Andrew Ross
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
| | | | - Rebecca Mahoney
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
| | - Samba Bathula
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
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Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension. Sci Rep 2022; 12:1361. [PMID: 35079036 PMCID: PMC8789858 DOI: 10.1038/s41598-022-05278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
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.
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