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Hoffman H, Ashok Kumar A, Raventhiranathan N, Masoud HE, Gould GC. Endovascular embolization for the treatment of epistaxis: Systematic review and meta-analysis. Interv Neuroradiol 2023; 29:172-182. [PMID: 35238666 PMCID: PMC10152829 DOI: 10.1177/15910199221081715] [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: 12/14/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Endovascular embolization (EE) is a treatment option for epistaxis refractory to first-line interventions. Data regarding embolization is limited to small case series and a meta-analysis has not been performed. METHODS PubMed, Scopus, and EMBASE were used to identify studies that reported outcomes for at least 10 patients undergoing EE for epistaxis. Outcomes included procedural success, rebleeding, and complications. Pooled rates for each outcome were obtained with random effects models. RESULTS A total of 44 studies comprising 1664 patients met the inclusion criteria. The mean age ranged from 28.1 to 67 years and there were 28.4% females. The pooled procedural success rate was 87% (95% CI 83.9-89.6, I2 = 53%). Age (OR 0.95, 95% CI 0.91-1) and hereditary hemorrhagic telangiectasia ([HHT], OR 0.97, 95% CI 0.96-0.99) were associated with decreased odds of success. The pooled rebleeding rate was 16.4% (95% CI 13.6-19.6, I2 = 48%), and HHT was associated with greater odds of rebleeding (OR 1.02, 95% CI 1-1.03). The pooled overall complication rate was 14.4% (95% CI 9.8-20.6, I2 = 85.8%). The pooled rates of stroke and vision loss were 2.1% (95% CI 1.5-3.1, I2 = 1.5%) and 1.8% (95% CI 1.2-2.6, I2 = 0%), respectively. CONCLUSION EE for epistaxis has a high rate of procedural success. Interventionalists should be aware of the risk for rebleeding, especially among patients with HHT.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
| | - Apeksha Ashok Kumar
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
| | | | - Hesham E Masoud
- Department of Neurology, State
University of New York Upstate, Syracuse, NY, USA
| | - Grahame C Gould
- Department of Neurosurgery, State
University of New York Upstate, Syracuse, NY, USA
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Hoffman H, Jalal MS, Masoud HE, Gould GC. Outcomes after endovascular embolization for the treatment of nasal and oropharyngeal hemorrhage: safety, efficacy, and rebleeding. Neuroradiol J 2021; 35:329-336. [PMID: 34477042 DOI: 10.1177/19714009211042893] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Intractable nasal and oropharyngeal hemorrhage may be treated with endovascular embolization, but limited data are available. We sought to evaluate the efficacy, safety, and factors associated with rebleeding. METHODS A retrospective analysis of consecutive embolizations for nasal and oropharyngeal hemorrhage over a 10-year period at a single institution was performed. Outcomes included procedural success (defined as cessation of hemorrhage in the immediate postoperative period), rebleeding requiring an additional intervention, and procedural complications. RESULTS A total of 47 embolizations on 39 patients were included. The mean age was 60 years (standard deviation 16.1), 23.1% of patients were women, and 21 (53.8%) patients had a previously diagnosed head/neck malignancy. Bleeding sites were the nose in 20 patients and oropharynx in 21 (two patients presented with both nasal and oral bleeding). Immediate procedural success was achieved in 45 (95.7%) embolizations. Rebleeding requiring an additional intervention occurred after 11 (23.4%) embolizations at a median of one day after the procedure. In the multivariate analysis, preoperative hypotension (odds ratio 4.78, 95% confidence interval 1.04-24.61) and the use of coils (odds ratio 6.09, 95% confidence interval 1.24-46.69) were associated with rebleeding requiring repeat intervention. Complications included two watershed strokes that were anticipated due to occlusion of the internal carotid artery. CONCLUSIONS In our experience endovascular embolization was a safe and effective treatment option for stopping oral and nasal hemorrhage. However, rebleeding was present after 23.4% of treatments and was associated with preoperative hypotension and the use of coils. Further study in a large multi-institutional cohort is warranted.
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Affiliation(s)
- Haydn Hoffman
- Department of Neurosurgery, 12302State University of New York Upstate Medical University, State University of New York Upstate Medical University, Syracuse, USA
| | - Muhammad S Jalal
- Department of Neurosurgery, 12302State University of New York Upstate Medical University, State University of New York Upstate Medical University, Syracuse, USA
| | - Hesham E Masoud
- Department of Neurology, 12302State University of New York Upstate Medical University, State University of New York Upstate Medical University, Syracuse, USA
| | - Grahame C Gould
- Department of Neurosurgery, 12302State University of New York Upstate Medical University, State University of New York Upstate Medical University, Syracuse, USA
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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: 6] [Impact Index Per Article: 1.5] [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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Severe spontaneous epistaxis: retrospective study in a tertiary ENT centre. Eur Arch Otorhinolaryngol 2019; 276:1693-1699. [PMID: 30888493 DOI: 10.1007/s00405-019-05392-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the clinical profile and outcomes of different treatment strategies in patients hospitalized for spontaneous severe epistaxis. METHODS This is a retrospective descriptive study of a case series of patients hospitalized for epistaxis in the University Hospital of Ghent between 2005 and 2012. RESULTS 124 patients with, respectively, 132 episodes were included. 64% were male. The mean age was 65 years. 73% had comorbidities of which arterial hypertension was the most common. 61% were taking one or more antithrombotics and in 25.7% a recent change in the medication schedule took place. 47% of the episodes necessitated a vascular intervention. The most performed surgery was endoscopic sphenopalatine artery ligation. The 1-year success rate of conservative treatment was 47% and of vascular intervention 81%. No significant difference between the recurrence rates and need for vascular intervention of the different comorbidities and medications was detected using Pearson chi-squared and Fisher's exact testing. The overall 5-year survival rate was 83.6%. CONCLUSIONS The typical pattern of a patient presenting with severe epistaxis was a patient in the sixth decade, male, suffering from comorbidities and taking one or more antithrombotic agents. Based on the above-mentioned success rates of the different treatment options, we think all centres treating epistaxis should apply a well-defined protocol to guide the decision when to proceed with surgery. Furthermore, prospective research needs to precisely investigate the role played by comorbidities and their treatment in the occurrence of epistaxis and to test the effectiveness of proposed algorithms.
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Akdoğan MV, Hızal E, Semiz M, Topal Ö, Akkaş H, Kabataş A, Erbek SS. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis. EAR, NOSE & THROAT JOURNAL 2019; 97:E1-E5. [PMID: 30273433 DOI: 10.1177/014556131809700901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 μm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.
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Affiliation(s)
- M Volkan Akdoğan
- Department of Otorhinolaryngology, Baskent University Konya Research and Teaching Center, Saray Caddesi No:1 Selcuklu, Konya, 42080 Turkey.
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Abrich V, Brozek A, Boyle TR, Chyou PH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc 2014; 89:1636-43. [PMID: 25458126 DOI: 10.1016/j.mayocp.2014.09.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 09/10/2014] [Accepted: 09/15/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify risk factors associated with spontaneous recurrent epistaxis. PATIENTS AND METHODS This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of epistaxis recurrence. RESULTS Traditional risk factors for epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first epistaxis event. CONCLUSION Congestive heart failure is an underappreciated risk factor for recurrent epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent epistaxis to prevent major adverse cardiovascular events.
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Affiliation(s)
- Victor Abrich
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI.
| | - Annabelle Brozek
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI
| | - Timothy R Boyle
- Department of Otolaryngology, Marshfield Clinic, Marshfield, WI
| | - Po-Huang Chyou
- Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, WI
| | - Steven H Yale
- Department of Internal Medicine, Marshfield Clinic, Marshfield, WI
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Venettacci O, Nettlefold C, Chan L, Daniel M, Curotta J. Sub-labial packing: a novel method of stopping epistaxis from Little's area. Int J Pediatr Otorhinolaryngol 2013; 77:1370-1. [PMID: 23806741 DOI: 10.1016/j.ijporl.2013.05.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 05/15/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
Abstract
Epistaxis is frequently managed both by patients in the community and by health professionals. Many methods have been described in the literature about how to manage this condition. Epistaxis is usually due to anterior circulation bleeding at an area known as Kiesselbach's plexus (Little's area). Five vessels supply Little's area; one of these, the septal branch of the superior labial artery, can be compressed via an easy and novel technique, sub-labial packing. Sub-labial packing is a technique proposed as an adjunct to the standard 15 min ala nasi compression as a simple yet effective technique to stop epistaxis. We hereby report two cases of managing epistaxis from Little's area using sub-labial packing.
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Affiliation(s)
- O Venettacci
- Sir Charles Gairdner Hospital, Perth, Australia.
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Asanau A. Commentary on Kristensen VG, Nielsen AL, Gaihede M, Boll B & Delmar C (2011) Mobilisation of patients with epistaxis - a prospective, randomised study documenting a safe patient care regime. Journal of Clinical Nursing 20, 1598-1605. J Clin Nurs 2011; 20:2375. [PMID: 21752125 DOI: 10.1111/j.1365-2702.2011.03802.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander Asanau
- Department of Otolaryngology-Head and Neck Surgery, North Hospital, Saint-Etienne University Hospital Centre, Saint-Etienne Cedex, France.
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Asanau A, Timoshenko AP. Epistaxis and its complex origin. Med Hypotheses 2011; 77:156-7. [DOI: 10.1016/j.mehy.2011.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 03/12/2011] [Indexed: 11/26/2022]
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