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Jiang T, Yu J, Zhang Q, Tu Y, Liu C, Chen A, Ji H, Shi L, Wan Y, Yu L. Relationship between bleeding sites and clinical data: experience of 646 epistaxis cases in 8 years. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08552-w. [PMID: 38467822 DOI: 10.1007/s00405-024-08552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/12/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. METHODS We retrospectively reviewed the data of 646 hospitalized epistaxis patients. RESULTS The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50 years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. CONCLUSION The bleeding sites can be identified in most epistaxis patients. Age > 50 years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans.
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Affiliation(s)
- Tianjiao Jiang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Jinzhuang Yu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Qian Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Yanyi Tu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Chuanping Liu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Aiping Chen
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Hongzhi Ji
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Li Shi
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Yuzhu Wan
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China
| | - Liang Yu
- Department of Otolaryngology-Head and Neck Surgery, Shandong Provincial ENT Hospital, Shandong University, 4 Duanxing West Road, Jinan, 250022, Shandong, China.
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Sundarajan K, Mani S, Arumugam K. Management of Recurrent and Refractory Posterior Epistaxis by Transnasal Endoscopic Sphenopalatine Artery Cauterization: a Prospective Cohort Study. Indian J Otolaryngol Head Neck Surg 2023; 75:2792-2797. [PMID: 37974743 PMCID: PMC10645779 DOI: 10.1007/s12070-023-03793-3] [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: 01/09/2023] [Accepted: 04/10/2023] [Indexed: 11/19/2023] Open
Abstract
Transnasal endoscopic sphenopalatine artery occlusion procedures are becoming the standard of care for intractable posterior epistaxis. Improved endoscopic anatomical features of the lateral nasal wall and endoscopic skill with high-resolution cameras result in a higher success rate of endoscopic intervention. To evaluate the safety and effectiveness of endoscopic cauterization of the sphenopalatine artery (ESPAC) in controlling intractable posterior nasal bleeding. This prospective cohort study enrolled patients with refractory posterior epistaxis from August 2016 to December 2019. The trial recruited patients between 18 and 65 years of age with a history of recurrent and refractory posterior epistaxis receiving endoscopic arterial cauterization due to conservative treatment failure. All of the cases involved bipolar cauterization. Recurrent nosebleeds must pause for at least three months for a procedure to be considered successful. In the first 30 days following surgery, complications are recorded. 415 patients with epistaxis received both inpatient and outpatient care. Transnasal ESPAC was necessary for 36 patients (11.5%). The most common comorbidity was hypertension accounting for 9 (23%) cases. Thus, 26 of 36 (72%) cases had a unilateral ESPAC, while 10 (28%) had a bilateral ESPAC. Twenty-two (61%) and ten (28%) patients had single and two branching patterns of the sphenopalatine artery, respectively. Septal correction and middle meatus antrostomy (44%) were the most performed additional procedures. During the three-month follow-up period, 35 patients in this study had epistaxis control; the success rate of ESPAC was 97.2%. There were no significant postoperative complications found. Endoscopic sphenopalatine artery cauterization is successful in controlling 97.2% of posterior epistaxis. It is safe and effective without any significant complications.
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Affiliation(s)
- Karthik Sundarajan
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India
| | - Suresh Mani
- Department of Head and Neck Surgery, CMC, Vellore, India
| | - Karthiga Arumugam
- Upgraded Institute of Otorhinolaryngology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu 600003 India
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Yin X, Zhang X, Wang B, Li K, Duan M. Combination of a negative pressure suction device and endoscope can accurately locate the bleeding site of refractory epistaxis. Acta Otolaryngol 2021; 141:929-933. [PMID: 34633896 DOI: 10.1080/00016489.2021.1965652] [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: 10/20/2022]
Abstract
BACKGROUND Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical. OBJECTIVE To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis. METHODS A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groups via negative pressure group (NPG) and control group (CG): The negative pressure suction device combined with an endoscope was used to re-explore the epistaxis. Nasal bleeding was induced using this method to help the operator locate the site of epistaxis accurately; the bleeding was then stopped using electrocoagulation with the suction electrode. The CG was treated with endoscopic re-exploration and selective tamponade. RESULTS Compared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (all p < .05). CONCLUSION AND SIGNIFICANCE Combining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis.
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Affiliation(s)
- Xinghong Yin
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Xinhai Zhang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Bo Wang
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Keliang Li
- Department of Otolaryngology-Head & Neck Surgery, Fuyang people’s Hospital, Fuyang, China
| | - Maoli Duan
- Division of Ear, Nose and Thoat Disease, Department of Clinical Science, Intervention and Technology karolinska Institutet, Stockholm, Sweden
- Ear Nose and Throat Patient Area, Trauma and Reconstructive Medicine, Karolinska University Hospital, Stockholm, Sweden
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