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Hadar A, Peleg U, Ghantous J, Tarnovsky Y, Cohen A, Sichel JY, Attal P. Pediatric Epistaxis-Effectiveness of Conservative Management. Pediatr Emerg Care 2024; 40:551-554. [PMID: 38563814 DOI: 10.1097/pec.0000000000003190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Epistaxis is an emergency medical condition that sometimes requires admission to the emergency department. Pediatric epistaxis differs from epistaxis in the older population in terms of etiology, severity, and management. Our objective was to identify the distinctive features of pediatric epistaxis and determine the appropriate management. METHODS This was a retrospective study of 231 medical records of children (<18 years old) with epistaxis of a total of 1171 cases in the general population who presented to our medical center's emergency department between 2013 and 2018. RESULTS Among 231 admissions, 10 children (4.3%) presented more than once. Male patients accounted for the majority of cases (64.5%), and the average age was 9.4 years. Two children were treated with aspirin because of cardiac valve disease. Anterior bleeding was detected in 101 cases (43.7%), whereas posterior origin was observed in 8 cases (3.5%). In 122 cases (52.8%), there was no active bleeding observed. Nose injury was the cause of epistaxis in 24 cases (10.4%), and 16 admissions (6.9%) followed nasal surgical interventions. Nineteen children (8%) had abnormal coagulation tests, and 7 patients (3%) received blood transfusions. Chemical cauterization was performed in 89 cases (39.3%), and anterior packing was needed in only 9 cases (3.9%). Nine children required hospitalization (3.9%), and 2 needed surgical intervention to control bleeding. Compared with the adult population, there were significantly fewer cases of active bleeding, recurrent epistaxis, anterior packing, or need for hospitalization in the pediatric population. CONCLUSIONS Epistaxis is significantly less severe in the pediatric population, with only a few cases requiring major intervention. Endoscopic examination of the entire nasal cavity and routine coagulation tests are not mandatory unless there is a history of recurrent epistaxis, known coagulopathy, antiplatelet/anticoagulation therapy, or a suspicion of juvenile idiopathic angiofibroma. We suggest using absorbable packs, which offer advantages over cauterization or nonabsorbable packs.
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Affiliation(s)
- Ayalon Hadar
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
| | - Uri Peleg
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
| | - Jameel Ghantous
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
| | - Yehuda Tarnovsky
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jean-Yves Sichel
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
| | - Pierre Attal
- From the Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University
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Servos Li MM, Hamersley ERS, Baldassari C. Nasal Disorders. Pediatr Rev 2024; 45:188-200. [PMID: 38556515 DOI: 10.1542/pir.2023-006012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.
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Affiliation(s)
- Mariah M Servos Li
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
| | - Erin R S Hamersley
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, VA
| | - Cristina Baldassari
- Department of Otolaryngology-Head and Neck Surgery, Eastern Virginia Medical School, Norfolk, VA
- Department of Pediatric Sleep Medicine, Children's Hospital of the King's Daughters, Norfolk, VA
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Gómez-Hervás J, Merino-Galvez E. Influence of meteorological variables on the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate (Lorca, Spain). Eur Arch Otorhinolaryngol 2024; 281:1307-1315. [PMID: 37898593 DOI: 10.1007/s00405-023-08300-6] [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: 04/13/2023] [Accepted: 10/17/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND OBJECTIVES Epistaxis is a common emergency for otorhinolaryngologists. Although the aetiological factors have been widely studied, they remain subject to debate. The role of meteorological variables has been discussed in recent years, but results have been inconsistent. Given a lack of prior data, the aim of our study was to identify the meteorological variables that influence the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate in Spain. METHODS Case-control study. CASES patients who attended the accident and emergency department of a secondary level hospital for epistaxis over a 9-year period (2011-2019). Controls were established by simple random sampling among emergency rooms visits in general (patients who attended the same centre over the same period of time). Sociodemographic, clinical and meteorological variables were all taken into account. RESULTS 2749 patients in the epistaxis group and 2764 in the control group. There were significant differences in the epistaxis group, with a higher proportion of male (62.85%) and older patients. Univariate and multivariate analysis revealed that the daily minimum temperature and maximum wind speed were factors significantly associated with the onset of epistaxis. In addition, logistic regression analysis showed that decreases in minimum temperature and increases in maximum wind speed were associated with an increase in epistaxis (p < 0.01). No association was found between hospital admission and the weather conditions. CONCLUSION Our findings suggest that low minimum temperatures and high wind speeds are associated with the number of visits to hospital accident and emergency departments for epistaxis, but not with hospital admission.
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Affiliation(s)
- Javier Gómez-Hervás
- Hospital Universitario Rafael Méndez [Rafael Mendez University Hospital], Ctra. N-340, 30813, Lorca, Murcia, Spain.
| | - Esteban Merino-Galvez
- Universidad Católica San Antonio de Murcia [San Antonio Catholic University of Murcia, Guadalupe, Spain
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Wei EX, Green A, Chang MT, Hwang PH, Sidell DR, Qian ZJ. Environmental Risk Factors for Pediatric Epistaxis vary by Climate Zone. Laryngoscope 2024; 134:1450-1456. [PMID: 37589269 DOI: 10.1002/lary.30961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION AND OBJECTIVE Prior studies have provided variable results regarding environmental risk factors for epistaxis. These studies were conducted in varying climate zones, which may explain discrepancies in results. The objective of this study is to investigate correlations between season, temperature, and humidity on frequency of pediatric epistaxis across climate zones. METHODS Children seen in the outpatient setting for epistaxis were identified from the 2007-2010 IBM MarketScan database. Climate zones were assigned according to International Energy Conservation Code (IECC) classification, where temperature zones in the United States and territories were assigned on an ordinal scale from 1 (tropical) to 8 (subarctic), and humidity zones were categorized as moist, dry, or marine. The control population was a sample of all well-child visits matched by age and county. RESULTS We identified 184,846 unique children seen for epistaxis and 1,897,012 matched controls. Moderate temperature zones were associated with lower odds of epistaxis compared with the hottest and coldest zones. Humidity was associated inversely with epistaxis rates in moderate temperature zones but was not a significant predictor of epistaxis in climates with extreme heat. Additionally, summer was associated with lower odds of epistaxis compared to winter. Interestingly, however, there were significantly higher rates of cautery procedures during summer months, driven largely by increased procedures performed in clinic, as opposed to the operating room or emergency room. CONCLUSIONS Environmental risk factors for epistaxis vary by climate zone. The model presented reconciles prior reports and may allow for more personalized clinical management based on regional climate. LEVEL OF EVIDENCE 3 Laryngoscope, 134:1450-1456, 2024.
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Affiliation(s)
- Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Allen Green
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Michael T Chang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Peter H Hwang
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Douglas R Sidell
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, California, U.S.A
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Lucas JP, Shaffer A, Rushchak M, Stapleton A, Padia R. Environmental impact on pediatric epistaxis and the utility of diagnostic studies: A single-institutional review. Int J Pediatr Otorhinolaryngol 2024; 176:111827. [PMID: 38128356 DOI: 10.1016/j.ijporl.2023.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Pediatric 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. METHODS A 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. RESULTS Of 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. CONCLUSIONS Environmental 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.
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Affiliation(s)
- Jordyn P Lucas
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States; Eastern Virginia Medical School, Department of Otolaryngology, 600 Gresham Dr. #1100, Norfolk, VA, 23507, United States; Children's Hospital of the King's Daughter, Department of Pediatric Otolaryngology, 601 Children's Lane, Norfolk, VA, 23507, United States.
| | - Amber Shaffer
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Marina Rushchak
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Amanda Stapleton
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Reema Padia
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States; University of Utah, Department of Otolaryngology, Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT, 84113, United States
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Yusuf HM, Rasheed A, Hetts S, Kim H, Loftus P, Conrad M. Exploring effects of atmospheric conditions in hereditary hemorrhagic telangiectasia. Int Forum Allergy Rhinol 2023; 13:2172-2179. [PMID: 37189284 DOI: 10.1002/alr.23183] [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: 01/26/2023] [Revised: 05/08/2023] [Accepted: 05/11/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant disorder characterized by recurrent epistaxis, telangiectasias, and visceral arteriovenous malformations. Individuals with HHT often identify low humidity and temperature as detrimental to epistaxis severity. We set out to assess the relationship between humidity and temperature on epistaxis severity in patients with HHT. METHODS Retrospective cross-sectional study at an academic hospital with an HHT center between July 1, 2014 and January 1, 2022. The primary outcome of this study was ESS. Pearson correlation analyses and multiple linear regression analyses were performed to test the association between weather variables and epistaxis severity scre (ESS). Results were reported as coefficient and 95% confidence interval (CI). RESULTS Four hundred twenty-nine patients were included in the analysis. Through a Pearson correlation analysis, neither humidity (regression coefficient = -0.01; 95% CI, -0.006 to 0.003; p = 0.50), daily low temperature (regression coefficient = 0.01; 95% CI, -0.011 to 0.016; p = 0.72), or daily high temperature (regression coefficient = 0.01; 95% CI, -0.004 to 0.013; p = 0.32) were significantly correlated with ESS. In a multiple linear regression analysis, adjusting for both daily low temperature and humidity, medications taken, demographics, and genotype, neither daily low temperature (regression coefficient = -0.02; 95% CI, -0.04 to 0.01; p = 0.14) nor humidity (regression coefficient = 0.01; 95% CI, -0.01 to 0.01; p = 0.64) were significantly associated with ESS. CONCLUSION We have shown in a large clinical sample that neither humidity nor temperature were strongly correlated with HHT patient epistaxis severity.
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Affiliation(s)
- Hamzah M Yusuf
- School of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Amna Rasheed
- Touro College of Medicine, Vallejo, California, USA
| | - Steven Hetts
- Neurointerventional Radiology, University of California, San Francisco, California, USA
| | - Helen Kim
- Center for Cerebrovascular Research, University of California, San Francisco, California, USA
| | - Patricia Loftus
- Otolaryngology, University of California, San Francisco, California, USA
| | - Miles Conrad
- Radiology, School of Medicine, University of California San Francisco, San Francisco, California, USA
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Yan F, Patel HP, Isaacson G. Age Distribution of Epistaxis in Outpatient Pediatric Patients. EAR, NOSE & THROAT JOURNAL 2023:1455613231207291. [PMID: 37864343 DOI: 10.1177/01455613231207291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Objectives: Little is known about the prevalence of epistaxis in children. Existing reports focus on hospitalized children or those presenting to an emergency department. To better understand pediatric epistaxis in clinical practice, we sought out a searchable, representative outpatient database and examined the incidence of epistaxis in children of different ages. Methods: A cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from the years 2007 to 2011 was performed. The NHAMCS is a Centers for Disease Control and Prevention-curated national sample of data from visits to non-federally employed office-based physicians and health centers. We queried the NHAMCS to determine the cumulative incidence of epistaxis in children of different age groups. The International Classification of Diseases Ninth Revision code 784.7 was chosen to identify epistaxis. Comparisons of rates were performed using the chi-squared test. A P-value of <.05 was considered statistically significant. Results: In total, 55,435,691 children [27,816,237 (50.2%) males, 55,435,691 (77.2%) white] were included. The overall cumulative incidence rate of epistaxis was 2.4/1000 children. Children in the 3- to 5-year range had the highest cumulative incidence of epistaxis (5.0/1000), followed by those in the 6 to 8 (3.0/1000), 9 to 11 (2.0/1000), 0 to 2 (1.9/1000), 12 to 14 (1.6/1000), and 15 to 17 (0.5/1000) year ranges (P < .001). Conclusion: Pediatric epistaxis is common in the office setting (2.4 per 1000 children)-and well above emergency department estimates (1.7 per 1000 people). Children between the ages of 3 to 5 years have the highest cumulative incidence. Epistaxis is sufficiently unusual in infants and the late teens that alternative causes for nasal bleeding should be included in the differential diagnosis.
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Affiliation(s)
- Flora Yan
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Hetvi P Patel
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Glenn Isaacson
- Departments of Otolaryngology - Head & Neck Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
- Department of Pediatrics, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Ahn EJ, Min HJ. Environmental factors differentially affect epistaxis among preschool and school-aged children. Front Public Health 2023; 11:1178531. [PMID: 37621609 PMCID: PMC10446964 DOI: 10.3389/fpubh.2023.1178531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023] Open
Abstract
Introduction Environmental factors are closely associated with pediatric epistaxis. Whether this association differs according to age has not been previously reported. Therefore, we tried to evaluate the differences in associations between environmental factors and epistaxis in children of different ages. Methods A total of 20,234 patients with epistaxis who visited the hospital between January 1, 2002, and December 31, 2015, were enrolled in this study. The patients were divided into two groups according to their ages: preschool-aged (<6 years) and school-aged children (6-18 years). Daily, monthly, and yearly data on environmental factors were collected. We performed a stepwise logistic regression to identify the potential environmental risk factors for epistaxis in each age group. Results The mean number of epistaxis cases per month in both groups was highest in September. The cases were lowest in February in preschool-aged children and in November in school-aged children. Temperature, humidity, maximum wind speed, and sunshine duration were associated with epistaxis in preschool-aged children. Average wind speed, particulate matter (>10 μm diameter), temperature, humidity, sunshine duration, and sulfur dioxide concentration were associated with epistaxis in school-aged children. Conclusion This study indicates that the differences in environmental risk factors for epistaxis are associated with the patient's age.
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Affiliation(s)
- Eun-Jin Ahn
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University, Medical Center, Chung-Ang University College of Medicine, Seoul, Republic of Korea
- Biomedical Research Institute, Chung-Ang University Hospital, Seoul, Republic of Korea
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Teo WY, Wong HB, Hwarng GYH, Tan HKK. Outcome of childhood epistaxis with treatment of allergic rhinitis: a randomized controlled study. Eur J Pediatr 2023; 182:1127-1135. [PMID: 36595087 DOI: 10.1007/s00431-022-04701-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 01/04/2023]
Abstract
The purpose of this study is to (1) to determine if treatment of underlying allergic rhinitis (AR) in children will affect epistaxis outcome, (2) to compare efficacy of three outpatient AR treatment regimens in epistaxis outcomes, and (3) to investigate potential factors in the pathogenesis of epistaxis with underlying AR. A single-blind randomized-controlled study was conducted in the Otolaryngology clinic in KK Women's and Children's Hospital. Sixty children aged below 18 years with underlying untreated AR, with first presentation of epistaxis, were randomized to three different AR treatments: treatment 1, antihistamine (20 patients); treatment 2, nasal steroid spray (20 patients); and treatment 3, both antihistamine and nasal steroid spray (20 patients). Epistaxis severity and frequency were assessed. Pre-treatment, 95% of patients within each of the three treatment groups described epistaxis symptoms. Post-treatment, there was improvement in epistaxis outcome (resolution of epistaxis) with 20% (4/20), 40% (8/20), and 60% (12/20) of patients in treatment groups 1 (antihistamine), 2 (nasal steroid spray), and 3 (combined therapy) respectively, who reported resolution of epistaxis. Treatment regimens containing nasal steroid spray resulted in greater improvement of epistaxis severity and frequency. Combined therapy (treatment 3) resulted in the best epistaxis outcome at 1-month follow-up. Majority (90%) reported nose-picking/rubbing behavior. CONCLUSIONS Intranasal corticosteroids are superior to oral antihistamines in relieving itch or rhinorrhea in AR. Intranasal corticosteroids may be important in treating epistaxis with underlying AR, because digital trauma from itch/rhinorrhea-related nose-picking/rubbing frequently leads to epistaxis. Results from this study will be important to primary and emergency physicians, community pediatricians, and pediatric allergists and otolaryngologists. WHAT IS KNOWN • Childhood epistaxis commonly co-exists with allergic rhinitis (AR), causing significant symptoms and distress to patients. • There are currently no studies reporti ng on epistaxis outcome aft er treatment of underlying AR. WHAT IS NEW • This is a single-blind randomized-controlled study of 60 children aged below 18 years with underlying untreated AR, with first presentation of epistaxis to a children's hospital in Singapore Patients were randomized to three different regimens to treat AR: treatment 1, antihistamine; treatment 2, nasal steroid spray; and treatment 3, both antihistamine and nasal steroid spray. • Treatment regimens containing nasal steroid spray improved epistaxis outcomes, with combined therapy of antihistamine and nasal steroid spray resulting in the best outcome for resolution of epistaxis among the three treatment regimens.
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Affiliation(s)
- Wan-Yee Teo
- Division of Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore.
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, 100 Bukit Timah Road, Singapore, Singapore.
- SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore.
- Pediatric Brain Tumor Research Office, SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore.
| | - Hwee-Bee Wong
- Clinical Trials and Epidemiology Research Unit, Singapore, Singapore
| | - Gwen Yung Hsin Hwarng
- Division of Medicine, KK Women's & Children's Hospital, 100 Bukit Timah Road, Singapore, Singapore
| | - Henry K K Tan
- SingHealth Duke-NUS Academic Medical Center, Singapore, Singapore
- Department of Otolaryngology, Division of Surgery, KK Women's & Children's Hospital, Singapore, Singapore
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10
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Differential effect of meteorological factors and particulate matter with ≤ 10-µm diameter on epistaxis in younger and older children. Sci Rep 2022; 12:21029. [PMID: 36470979 PMCID: PMC9723103 DOI: 10.1038/s41598-022-25630-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
The differential effect of meteorological factors and air pollutants on pediatric epistaxis in younger and older children has not been evaluated. We evaluated the distribution of pediatric epistaxis cases between younger (0-5 years) and older children (6-18 years). Subsequently, we assessed and compared the effects of meteorological variables and the concentration of particulate matter measuring ≤ 10 μm in diameter (PM10) on hospital epistaxis presentation in younger and older children. This retrospective study included pediatric patients (n = 326) who presented with spontaneous epistaxis between January 2015 and August 2019. Meteorological conditions and PM10 concentration were the exposure variables, and data were obtained from Korea Meteorological Administration 75. The presence and cumulative number of epistaxis presentations per day were considered outcome variables. Air temperature, wind speed, sunshine duration, and PM10 concentration in younger children, and sunshine duration and air pressure in older children, significantly correlated with the presence of and cumulative number of epistaxis presentations per day. The PM10 concentration was not a significant factor in older children. Thus, meteorological factors and PM10 concentration may differentially affect epistaxis in younger (0-5-year-olds) and older (6-18-year-olds) children. Risk factors for pediatric epistaxis should be considered according to age.
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11
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DİKİCİ O, DURGUT O. Effects of Nasal Pathologies in Paediatric Epistaxis. ACTA MEDICA ALANYA 2022. [DOI: 10.30565/medalanya.1127833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to investigate the effects of nasal pathologies in paediatric patients with recurrent epistaxis.
Methods: A total of 100 (61 boys, 39 girls) patients aged 2–17 years (mean age: 8.9 ± 3.6 years) were included in this study. Anterior rhinoscopy and flexible nasal endoscopy were used to examine all the patients. The epistaxis duration, treatment in active epistaxis by parents, medical history, medical treatment and interventions were recorded. The location of the epistaxis site, nasal mucosa type, the presence of nasal vestibulitis, nasal septum deviation location and type, adenoid size and the degree of inferior turbinate hypertrophy were recorded.
Results: The deviation was present in 31 (62%) patients with recurrent epistaxis and in 14 (28%) patients without epistaxis. The presence of deviation was significantly higher in the epistaxis group than control group (p = 0.001). The nasal mucosa type was friable mucosa in 37 (74%) patients, vascularised mucosa in 11 (22%) patients and friable – vascularised mucosa in 2 (4%) patients in recurrent epistaxis group. A significant relationship was detected between nasal mucosa type and age, the presence of the deviation, deviation location, Mladina type in epistaxis group (p = 0.005, p = 0.004, p = 0.008, p = 0.015).
Conclusion: Nasal septum deviation, inferior turbinate hypertrophy and nasal mucosa type are associated with paediatric recurrent epistaxis.
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Affiliation(s)
- Oğuzhan DİKİCİ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, BURSA YÜKSEK İHTİSAS SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, KULAK-BURUN-BOĞAZ HASTALIKLARI ANABİLİM DALI
| | - Osman DURGUT
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, BURSA YÜKSEK İHTİSAS SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, CERRAHİ TIP BİLİMLERİ BÖLÜMÜ, KULAK-BURUN-BOĞAZ HASTALIKLARI ANABİLİM DALI
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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: 0] [Impact Index Per Article: 0] [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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Particulate Matter 10 (PM 10) Is Associated with Epistaxis in Children and Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094809. [PMID: 33946392 PMCID: PMC8124263 DOI: 10.3390/ijerph18094809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/20/2022]
Abstract
The impact of atmospheric concentration of particulate matter ≤10 μm in diameter (PM10) continues to attract research attention. This study aimed to evaluate the effects of meteorological factors, including PM10 concentration, on epistaxis presentation in children and adults. We reviewed the data from 1557 days and 2273 cases of epistaxis between January 2015 and December 2019. Eligible patients were stratified by age into the children (age ≤17 years) and adult groups. The main outcome was the incidence and cumulative number of epistaxis presentations in hospital per day and month. Meteorological factors and PM10 concentration data were obtained from the Korea Meteorological Administration. Several meteorological factors were associated with epistaxis presentation in hospital; however, these associations differed between children and adults. Only PM10 concentration was consistently associated with daily epistaxis presentation in hospital among both children and adults. Additionally, PM10 concentration was associated with the daily cumulative number of epistaxis presentations in hospital in children and adults. Furthermore, the monthly mean PM10 concentration was significantly associated with the total number of epistaxis presentations in the corresponding month. PM10 concentration should be regarded as an important environmental factor that may affect epistaxis in both children and adults.
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Min SJ, Kang H, Kim KS, Min HJ. Minimal temperature, mean wind speed, and mean relative humidity are associated with spontaneous epistaxis in Seoul, Korea. Auris Nasus Larynx 2020; 48:98-103. [PMID: 32718810 DOI: 10.1016/j.anl.2020.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Epistaxis is a commonly encountered condition; however, factors that have been associated with epistaxis are controversial. Although several previous studies have evaluated the relationship between meteorological factors and epistaxis, studies conducted in Korea has been nearly reported. We attempted to evaluate the meteorological factors associated with the frequency of patients presenting with epistaxis in a tertiary hospital. METHODS We retrospectively reviewed the medical records of patients presenting with spontaneous epistaxis in an urban tertiary medical center, during one year. Patients with a clear etiology for epistaxis (such as trauma, previous surgery) were regarded as cases of secondary epistaxis and were excluded from this study. Daily climatic data were collected from the website of Korea Meteorological Administration. Meteorological factors affecting the frequency of patients presenting with epistaxis were statistically analyzed. RESULTS Among 350 enrolled subjects, 219 were males and 131 were females, and the mean age was 44.94 ± 26.02 years. Univariate and multivariate regression analyses revealed that minimal temperature and mean wind speed were significant factors that affected the presence of patients presenting with epistaxis to the hospital. Furthermore, ordinal logistic regression analysis showed that decreases in minimal temperature and mean relative humidity were associated with a increase in the number of patients presenting with epistaxis. CONCLUSION Minimal temperature and mean wind speed were significantly different between days with epistaxis and days without epistaxis patients presenting with epistaxis, and minimal temperature and mean relative humidity were associated with number of patients presenting with epistaxis. Our findings suggested that these meteorological factors might affect the spontaneous epistaxis in Seoul, Korea.
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Affiliation(s)
- Sung Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Hyun Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Kyung Soo Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea
| | - Hyun Jin Min
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Chung-Ang University Hospital, 224-1 Heukseok-dong, Dongjak-gu, Seoul 06973, Republic of Korea.
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PedMap: a pediatric diseases map generated from clinical big data from Hangzhou, China. Sci Rep 2019; 9:17867. [PMID: 31780760 PMCID: PMC6883068 DOI: 10.1038/s41598-019-54439-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Epidemiological knowledge of pediatric diseases may improve professionals’ understanding of the pathophysiology of and risk factors for diseases and is also crucial for decision making related to workforce and resource planning in pediatric departments. In this study, a pediatric disease epidemiology knowledgebase called PedMap (http://pedmap.nbscn.org) was constructed from the clinical data from 5 447 202 outpatient visits of 2 189 868 unique patients at a children’s hospital (Hangzhou, China) from 2013 to 2016. The top 100 most-reported pediatric diseases were identified and visualized. These common pediatric diseases were clustered into 4 age groups and 4 seasons. The prevalence, age distribution and co-occurrence diseases for each disease were also visualized. Furthermore, an online prediction tool based on Gaussian regression models was developed to predict pediatric disease incidence based on weather information. PedMap is the first comprehensive epidemiological resource to show the full view of age-related, seasonal, climate-related variations in and co-occurrence patterns of pediatric diseases.
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Lu YX, Liang JQ, Gu QL, Pang C, Huang CL. Pediatric Epistaxis and Its Correlation Between Air Pollutants in Beijing From 2014 to 2017. EAR, NOSE & THROAT JOURNAL 2019; 99:513-517. [PMID: 31138029 DOI: 10.1177/0145561319852581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Epistaxis is a common symptom in children. The effect of air pollution on epistaxis is not yet clear. OBJECTIVES To explore the characteristics of pediatric epistaxis in Beijing and its correlation with air pollutants. MATERIAL AND METHODS Data were collected from 2014 to 2017 in Otolaryngology Department of Capital Institute of Pediatrics. Children diagnosed with epistaxis with relevant information with the same period of municipal air pollutants' concentration were compared. RESULTS The annual visits of epistaxis showed a bimodal trend. The incidence of epistaxis in infants was low, increased with age, reached the peak between the ages of 4 to 5, and then gradually decreased with age. In different age groups, male patients were more than females. From 2014 to 2017 in Beijing, particulate matter less than 2.5 μm in diameter (PM2.5), particulate matter less than 10 μm in diameter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), and carbon monoxide (CO) showed a downtrend, lower in summer than in the other 3 seasons. Ozone (O3) was significantly higher in 2016 and 2017, showed an increase trend in summer. The incidence of epistaxis was negatively correlated with PM2.5, PM10, SO2, NO2 and CO, which was positively correlated with O3 (P < .05). CONCLUSIONS Pediatric epistaxis in Beijing changes with age and has obvious seasonal variation. There are some correlations between air pollutants and the incidence of epistaxis in children.
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Affiliation(s)
- Ying-Xia Lu
- Department of Otolaryngology-Head and Neck Surgery, 36776Capital Institute of Pediatrics, Beijing, China
| | - Jie-Qiong Liang
- Department of Otolaryngology-Head and Neck Surgery, 36776Capital Institute of Pediatrics, Beijing, China
| | - Qing-Long Gu
- Department of Otolaryngology-Head and Neck Surgery, 36776Capital Institute of Pediatrics, Beijing, China
| | - Chong Pang
- Department of Otolaryngology-Head and Neck Surgery, 36776Capital Institute of Pediatrics, Beijing, China
| | - Chun-Lei Huang
- Department of Otolaryngology-Head and Neck Surgery, 36776Capital Institute of Pediatrics, Beijing, China
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