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Yazıcı ZM, Günaldı Ö, Tanrıverdi O, Güneş S, Gülüstan F, Koç RH, Sayın İ. Incidence and Management of Delayed Epistaxis Following Endoscopic Skull Base Surgery. Turk Arch Otorhinolaryngol 2021; 59:49-53. [PMID: 33912861 PMCID: PMC8054930 DOI: 10.4274/tao.2021.5918] [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: 09/05/2020] [Accepted: 01/17/2021] [Indexed: 12/01/2022] Open
Abstract
Objective: Among other complications of endoscopic skull base surgery, delayed epistaxis has not been given much importance. This report presents postoperative delayed nosebleed cases in a large number of patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of lesions. Methods: Three hundred and sixty three patients who were reached to the sellar region by endoscopic endonasal transsphenoidal route and operated was included in the study. Retrospective chart reviewing of these patients was performed. The correlation between the duration of nosebleeds, bleeding location, treatment methods and comorbidities of the patients were evaluated. Results: Ten patients (3.6%) reported delayed epistaxis in the postoperative period and were referred to the otolaryngology department. Postoperative epistaxis occurred between days 7th and 33th (mean 16.5) days. The treatment consisted of chemical silver nitrate cauterization in two patients, return to the operating room in three patients, nasal packing in five patients. Conclusion: Delayed postoperative epistaxis often has no obvious etiology, and intervention requires teamworking. Well-coordinated teamworking of the neurosurgeon with other specialities such as neuroradiology and otorhinolaryngology is needed to achieve better results.
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Affiliation(s)
- Zahide Mine Yazıcı
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Ömür Günaldı
- Department of Neurosurgery, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Osman Tanrıverdi
- Department of Neurosurgery, Bakırköy Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey
| | - Selçuk Güneş
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Filiz Gülüstan
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Recep Haydar Koç
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - İbrahim Sayın
- Department of Otorhinolaryngology, University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
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Pagella F, Semino L, Olivieri C, Corno S, Dore R, Draghi F, Lanzarini L, Vespro V, Buscarini E, Danesino C. Treatment of Epistaxis in Hereditary Hemorrhagic Telangiectasia Patients by Argon Plasma Coagulation with Local Anesthesia. ACTA ACUST UNITED AC 2018; 20:421-5. [PMID: 16955772 DOI: 10.2500/ajr.2006.20.2886] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Recurrent epistaxis is the most common manifestation of hereditary hemorrhagic telangiectasia (HHT). The aim of this study was to determine the role and efficacy of argon plasma coagulation (APC) in the management of epistaxis caused by HHT. Methods From 1997 to 2004, 43 patients with diagnosed HHT were treated for recurrent epistaxis with APC in our department. Results Thirty-six patients reported substantial reduction of bleeding after treatment. Of the 18 patients who previously needed blood transfusions, 13 reported substantial reduction of bleeding after treatment and no blood transfusions were necessary. Conclusion APC allows a control of epistaxis in HHT patients and guarantees a long time free from blood transfusions. This treatment modality can be performed with local anesthesia, is not invasive, is well tolerated, is inexpensive, and can be used as a first step even in patients who need to undergo several blood transfusions for their epistaxis.
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Affiliation(s)
- Fabio Pagella
- Clinica Otorinolaringoiatrica, IRCCS Policlinico S. Matteo, Università di Pavia, Italy
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Zhang J, Cao L, Wei C. Randomized controlled trial comparing Nd:YAG laser photocoagulation and bipolar electrocautery in the management of epistaxis. Lasers Med Sci 2017; 32:1587-1593. [PMID: 28707034 DOI: 10.1007/s10103-017-2285-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
The objective of this study is to evaluate the efficacy and degree of comfort of Nd:YAG laser photocoagulation compared to bipolar electrocautery in the management of epistaxis. Seventy-two consecutive patients with a history of epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either bipolar electrocautery (group 1) or Nd:YAG laser photocoagulation (group 2). The study was conducted in university-affiliated teaching hospital. Seventy-two consecutive patients who suffered from anterior epistaxis and presented to the Otolaryngology Department at the Eye, Ear, Nose and Throat Hospital, Fudan University, between June 2015 and August 2015. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 16 weeks after treatment (0 = no bleeding, 1 = reduced bleeding, 2 = the same, and 3 = worse), participant perception of discomfort during treatment (grade 0-10, where 10 is the worst pain), and therapy duration and complications. At 16 weeks, 91% of the laser patients versus 91% of the bipolar electrocautery patients had no reported bleeding. The outcome scores at 4 and 16 weeks after treatment showed no significant difference between the two groups (P = 0.5 and P = 0.98, respectively; P > 0.05). The median pain levels experienced during the office laser and bipolar electrocautery procedures were 3.0 and 4.0, respectively, and the median durations of the laser and electrocautery therapies were 3.0 and 4.0, respectively. Neither groups had complications. It can be concluded that Nd:YAG laser photocoagulation and bipolar electrocautery are both effective in the treatment of epistaxis. These two therapies are recommended. As a whole, these two therapies, performed in an office setting, are timely, efficacious, and well tolerated in the treatment of epistaxis.
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Affiliation(s)
- Jing Zhang
- Departments of Laser Plastic Surgery, Fudan University, Shanghai, China.
| | - Luhong Cao
- Otolaryngology Department at the Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wei
- Departments of Otolaryngology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Sichuan, China.
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Halderman AA, Sindwani R, Woodard TD. Hemorrhagic Complications of Endoscopic Sinus Surgery. Otolaryngol Clin North Am 2016; 48:783-93. [PMID: 26318796 DOI: 10.1016/j.otc.2015.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Major complications during endoscopic sinus surgery are rare and occur in 0.36% to 3.1% of patients. Postoperative hemorrhage accounts for 23% to 39% of complications. Despite being rare, major hemorrhage can be serious for the patient. This article discusses hemorrhagic complications during and following endoscopic sinus surgery, focusing on a review of the surgical anatomy, common pitfalls to avoid, preventative measures, and management of certain catastrophic complications for which preparedness can mean the difference between life and death.
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Affiliation(s)
- Ashleigh A Halderman
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA
| | - Raj Sindwani
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA
| | - Troy D Woodard
- Section of Rhinology, Sinus and Skull Base Surgery, Head and Neck Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue/A71, Cleveland, OH 44195, USA.
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Evaluation of Etiology and Treatment Methods for Epistaxis: A Review at a Tertiary Care Hospital in Central Nepal. Int J Otolaryngol 2015; 2015:283854. [PMID: 26346242 PMCID: PMC4546759 DOI: 10.1155/2015/283854] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 07/22/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction. Epistaxis is one of the most common emergencies in Otorhinolaryngology.
It is usually managed with simple conservative measures but occasionally it is a life threatening condition. Identification of
the cause is important, as it reflects the management plan being followed. Aims and Objectives. To analyze the
etiology and treatment methods for patients with epistaxis. Methods. A retrospective study was done in a tertiary care
hospital in central Nepal. The study period was from May 2014 to April 2015. Results. A total of
84 patients had epistaxis; 52 were males and 32 were females. The most common cause of epistaxis was idiopathic
(38.09%) followed by hypertension (27.38%), trauma (15.47%), and coagulopathy (8.33%). Regarding
treatment methods, most (52.38%) of our patients required anterior nasal packing. Chemical cautery was sufficient to stop
bleeding in 14.28% of patients while electrocautery and posterior nasal packing were performed in 2.38% and 16.66%
patients, respectively. Two (2.38%) patients required endoscopic sphenopalatine arterial ligation. Conclusion.
Hypertension, trauma and coagulopathy were the most common etiological factors among the patients in whom etiology was found
although in most of the patients etiology could not be found. Anterior nasal packing was the most common treatment method applied
to these patients.
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Kumar M V V, Prasad K U R, Gowda P R B, S R M, P K C. Rigid nasal endoscopy in the diagnosis and treatment of epistaxis. J Clin Diagn Res 2013; 7:831-3. [PMID: 23814722 DOI: 10.7860/jcdr/2013/4421.2995] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 02/27/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding. METHODS Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. RESULTS The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3rd and after the 5th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits. INTERPRETATION AND CONCLUSION Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.
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Affiliation(s)
- Vinay Kumar M V
- Assitant Professor, Department of ENT, Hassan Institute of Medical Sciences , Hassan, Karnataka, India
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Zalagh M, Errami N, Bouaity B, Hemmaoui B, Itoua W, Benariba F. [Intractable epistaxis in Osler-Rendu-Weber syndrome]. REVUE DE STOMATOLOGIE ET DE CHIRURGIE MAXILLO-FACIALE 2011; 112:310-312. [PMID: 21940027 DOI: 10.1016/j.stomax.2011.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Revised: 07/08/2010] [Accepted: 08/10/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Osler-Rendu-Weber syndrome is an inherited disorder characterized by mucocutaneous and visceral telangiectasia. It is often revealed by recurrent epistaxis. It is sometimes profuse and intractable. Hemostasis may be problematic. CASE STUDY A 61-year-old male patient presented with severe epistaxis due to Osler-Rendu-Weber syndrome. Embolization of the external carotid branches was needed for hemostasis. DISCUSSION Embolization of external carotid artery branches can be an effective therapeutic alternative when usual treatments fail.
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Affiliation(s)
- M Zalagh
- Service d'oto-rhino-laryngologie, hôpital militaire d'instruction Mohamed V, Rabat, Morocco.
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Abstract
Epistaxis is a common condition that can be managed conservatively in most cases. When these measures, including anterior and posterior packing of the nasal cavity, are unsuccessful at controlling the bleeding, interruption of the blood supply to the sinonasal area can be performed, either by surgical ligation or by transarterial embolization. Embolization should be preceded by thorough diagnostic angiography. Aside from aiding with subsequent selective catheterization and embolization, such angiography may reveal significant anatomic anomalies, anastomoses, or an unsuspected cause of epistaxis. Taking these findings into account, the interventionalist may decide to refrain from embolization or adjust the technique to minimize the risk of adverse events, which are mostly related to inadvertent embolization of the internal carotid artery or ophthalmic artery. We present a review of the various causes of epistaxis and the treatment options, with emphasis on endovascular embolization. We also describe the protocol of our institution for endovascular management of this condition.
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Affiliation(s)
- P W A Willems
- Division of Neuroradiology, Department of Medical Imaging, Toronto Western Hospital, Toronto, Ontario, Canada.
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Daoud EM, . RMD, . LMS, . MMS. Plasma Level of Tissue Factor Pathway Inhibitor in Children With Idiopathic Recurrent Epistaxis (Nosebleeds). JOURNAL OF MEDICAL SCIENCES 2007. [DOI: 10.3923/jms.2007.1310.1314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Vergara Hernández J, Ordóñez Ordóñez LE. [Surgical versus non-surgical treatment of posterior epistaxis]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2006; 57:41-6. [PMID: 16503032 DOI: 10.1016/s0001-6519(06)78661-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A study was performed in order to compare the efficiency of surgical versus non-surgical treatment in patients hospitalized for epistaxis regarding the source of bleeding, and to identify failure-predicting factors related to specific treatments. 62 patients were included in the study, 36 (58%) of whom suffered from posterior epistaxis and 26 (42%) experienced anterior bleeding. The single factor associated with failure of the non-surgical treatment was the posterior source of the bleeding (p = 0.001). These patients were also hospitalized for a longer period (8, 17 days) than those with anterior epistaxis (4, 62 days) (p = 0.001). The percentage of success for the primary non-surgical treatment in patients with posterior epistaxis was 45% (14/31), significantly smaller (p = 0.0001) than the successful reached in the primary surgical procedure, 87% (13/15); endoscopic cauterization of the sphenopalatine artery. These results support endoscopic cauterization of the sphenopalatine artery as primary care in posterior epistaxis.
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Affiliation(s)
- J Vergara Hernández
- Servicio de Otorrinolarinigología, Hospital Universitario Clínica San Rafael, Bogotá, Colombia
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11
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Pino Rivero V, González Palomino A, Pantoja Hernández CG, Trinidad Ruiz G, Pardo Romero G, Montero García C, Rejas Ugena E, Blasco Huelva A. [Statistical study regarding anemia in patients admitted with epistaxis. Importance of its control and the associated risk factors]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2005; 56:305-8. [PMID: 16240920 DOI: 10.1016/s0001-6519(05)78620-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. MATERIAL AND METHODS Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. RESULTS We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. CONCLUSIONS Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated.
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Affiliation(s)
- V Pino Rivero
- Servicio de Otorrinolaringología, Complejo Hospitalario Infanta Cristina, Badajoz.
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Abstract
Epistaxis is one of the commonest ENT emergencies. Although most patients can be treated within an accident and emergency setting, some are complex and may require specialist intervention. There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population with their associated morbidity who often require more intensive treatment and subsequent admission. Treatment strategies have been broadly similar for decades. However, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Recent evidence suggests that this, combined with the use of stepwise management plans, should limit patient complications and the need for admission. This review discusses the various treatment options and integrates the traditional methods with modern techniques.
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Affiliation(s)
- L E R Pope
- Department of Otolaryngology and Head and Neck Surgery, St Michael's Hospital, Bristol, UK
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