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Qing J, Cai Y, Tang S, Wang Y. Clinical Characteristics and Risk Factors for Allergic Rhinitis in Children with Epistaxis. Int J Clin Pract 2023; 2023:6731414. [PMID: 37691857 PMCID: PMC10484648 DOI: 10.1155/2023/6731414] [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] [Received: 03/22/2023] [Revised: 08/02/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023] Open
Abstract
Background Epistaxis is frequently observed in children with allergic rhinitis. However, few studies have addressed the clinical characteristics and risk factors for allergic rhinitis in children with epistaxis. This study aimed to describe the factors associated with allergic rhinitis in children with epistaxis. Methods In total, we recruited 80 children (aged 3-14 years) who presented with epistaxis at a tertiary hospital between January 2014 and January 2022. The follow-up duration was at least 3 months, and we performed a multivariate logistic regression analysis to identify the risk factors for allergic rhinitis. Results Among the 80 children examined, 57 (71.25%) had allergic rhinitis. Epistaxis mainly occurred in autumn in children with allergic rhinitis; in contrast, it mostly occurred in summer in children without it (P = 0.029). Mites are common allergens for allergic rhinitis in children with epistaxis; the univariate analysis revealed significant differences between allergic-rhinitis group and nonallergic-rhinitis group in the number of allergens (P < 0.001) and total IgE (P < 0.001). The difference in severity of nasal symptoms between the two groups was statistically significant and included nasal obstruction (P < 0.001), rhinorrhea (P < 0.001), sneezing (P < 0.001), and nasal itching (P < 0.001). After adjusting for potential confounders, the severity of rhinorrhea symptoms was found to be associated with an increased risk of allergic rhinitis in children with epistaxis (odds ratio: 3.86; 95% confidence interval: 1.61-9.26; P = 0.003). Conclusions Observing the onset season, number of allergens, total IgE, and nasal symptoms in cases of epistaxis could suggest the presence of associated allergic rhinitis and reduce the number of missed diagnoses; antiallergic drugs could help control epistaxis in these cases.
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Affiliation(s)
- Jing Qing
- Department of Otorhinolaryngology, Ningbo First Hospital, Ningbo 315000, Zhejiang, China
| | - Yili Cai
- Department of Acupuncture, Ningbo First Hospital, Ningbo 315000, Zhejiang, China
| | - Shixiong Tang
- Department of Otorhinolaryngology, Ningbo First Hospital, Ningbo 315000, Zhejiang, China
| | - Yaowen Wang
- Department of Otorhinolaryngology, Ningbo First Hospital, Ningbo 315000, Zhejiang, China
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Garry S, Wauchope J, Hintze JM, Ryan EJ, O'Cathain E, Heffernan CB. Factors affecting Naseptin treatment success - A prospective cohort study. Int J Pediatr Otorhinolaryngol 2023; 171:111620. [PMID: 37348251 DOI: 10.1016/j.ijporl.2023.111620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To assess patient factors to predict treatment success of Naseptin for recurrent paediatric epistaxis. METHODS This prospective cohort study of paediatric patients referred to a tertiary paediatric otolaryngology clinic with recurrent epistaxis treated with Naseptin cream and education. Patients with red flag symptoms and bleeding diathesis were omitted, along with patients with concurrent otolaryngology complaints. Statistical analysis included logistic regression analysis to assess for predictive factors contributing to treatment success. RESULTS 125 of 210 patients on the waiting list met the inclusion criteria and were given a complete trial of Naseptin. 80.8% (n = 101) of patients found that the frequency and severity of epistaxis had reduced, with the remaining 19.2% (n = 24) reporting that the episodes of epistaxis remained the same and required further management (i.e., silver nitrate cautery). Five patients (4%) reported minor side effects (skin irritation etc.) with no significant adverse events reported. CONCLUSION We found that Naseptin is a safe, well-tolerated treatment that should be trialled in most cases of recurrent paediatric epistaxis. Most children will benefit from it with complete epistaxis cessation or at least reduced frequency and severity.
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Affiliation(s)
- S Garry
- Department of Otolaryngology, Children's Health Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland.
| | - J Wauchope
- Department of Otolaryngology, Children's Health Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland
| | - J M Hintze
- Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland
| | - E J Ryan
- Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland
| | - E O'Cathain
- Department of Otolaryngology, Children's Health Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland
| | - C B Heffernan
- Department of Otolaryngology, Children's Health Ireland at Temple Street, Dublin 1, Ireland; Department of Surgery, Royal College of Surgeons, Dublin 2, Ireland
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Ross A, Engebretsen S, Mahoney R, Bathula S. Risk Factors and Management for Epistaxis in a Hospitalized Adult Sample. Spartan Med Res J 2022; 7:37760. [PMID: 36128022 PMCID: PMC9448657 DOI: 10.51894/001c.37760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/17/2022] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Epistaxis is a common otolaryngologic problem that affects most of the general population. Common risk factors for epistaxis include nasal irritants, nasal/facial oxygen use, certain systemic conditions (e.g., hypertension and coagulopathies) and medication use (e.g., anticoagulants and intranasal medications). This study examined risk factors for and management of epistaxis in patients admitted for other medical conditions who developed an episode of epistaxis during their hospital admission. METHODS Patients were included in the study if they were older than 18, admitted for medical illnesses other than epistaxis and developed an episode of epistaxis during their admission during calendar year 2020 at the authors' institution's hospitals. Electronic health record data regarding sociodemographic characteristics, common risk factors (e.g. oxygen use, anticoagulant use, history of hypertension) and treatment for epistaxis (e.g. holding anticoagulation therapy, administration of oxymetazoline, nasal cautery, nasal packing) were extracted from each chart. Patients were split into otolaryngologic treatment versus no treatment groups and risk factors were compared between sample subgroups. RESULTS A total of 143 sample patients were included, with most common reason for admission being cardiovascular related, 48 (33.6%). Most patients, 104 (72.7%), did not have a previous diagnosis of epistaxis, were positive for anticoagulant use, 106 (74.1%) and were positive for hypertension, 95 (66.4%). Oxygen use showed a significantly decreased risk for intervention (OR 0.45, 95% CI: 0.23-0.894; p = 0.028). Most patients required changes in medical management (e.g., holding anticoagulation or starting nasal saline sprays/emollients). CONCLUSION These results demonstrate the common risk factors for epistaxis in patients admitted for other clinical diseases. Identifying at-risk patients for epistaxis at hospital admission can help to initiate measures to prevent epistaxis episodes. Future studies are needed to study epistaxis risk factors and identify effective preventative measures for epistaxis among hospital populations.
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Affiliation(s)
- Andrew Ross
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
| | | | - Rebecca Mahoney
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
| | - Samba Bathula
- Otolaryngology-Head and Neck Surgery, Detroit Medical Center
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Barrow BE, Alur AA, Kasdan ML, Wilhelmi BJ. Wine, Honey, and Boiling Oil: A Modern Understanding of Ancient Wound Care Practices. Am Surg 2022:31348221078981. [PMID: 35232246 DOI: 10.1177/00031348221078981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The origins of wound care date back to ancient civilizations. From boiling oil to honey to wine, healers and caregivers have adopted a fascinating array of items to cleanse, dress, and bandage wounds over the ages. While wound care practices have developed over time, the physicians and surgeons of ancient times and the Middle Ages helped build the foundation for present-day wound care. A modern scientific understanding of these treatments illustrates why practitioners abandoned some practices while others remain in use today.
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Affiliation(s)
- Brooke E Barrow
- School of Medicine, RinggoldID:5170University of Louisville, Louisville, KY, USA
| | - Abhishek A Alur
- School of Medicine, RinggoldID:5170University of Louisville, Louisville, KY, USA
| | - Morton L Kasdan
- Department of Surgery, RinggoldID:5170University of Louisville, Louisville, KY, USA
| | - Bradon J Wilhelmi
- Department of Surgery, RinggoldID:5170University of Louisville, Louisville, KY, USA
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Küçükcan NE, Kanmaz MA. Can we determine recurrent epistaxis by hemogram parameters in children? Int J Pediatr Otorhinolaryngol 2021; 146:110747. [PMID: 33945954 DOI: 10.1016/j.ijporl.2021.110747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/21/2021] [Accepted: 04/24/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Epistaxis in children is a common reason for admission at otolaryngology outpatient clinics. Patients are diagnosed by clinical examination and laboratory tests. We aimed to evaluate epistaxis using simple blood parameters useful for diagnosis. MATERIAL AND METHODS This study includes a retrospective analysis of 240 patients, including 120 study group and 120 healthy pediatric patients, who applied to the ENT outpatient clinic with the diagnosis of epistaxis between 2018 and 2020. This study is designed to analyze the predictive values of neutrophil-lymphocyte ratio (NLR), eosinophil-LR (ELR), platelet-LR (PLR), plateletcrit (PCT), mean platelet volume (MPV), and platelet distribution width (PDW) in pediatric epistaxis. RESULTS Serological factors were assessed and no statistical associations in MPV, PDW, PLR, and ELR values were found. However, significant changes were found for PCT and NLR within the patient and control groups. The average PCT was lower in the study group in comparison to the controls (p = 0.022). The average NLR was higher in the study group in comparison to the controls (p = 0.004). CONCLUSION The examination of children with epistaxis, as well as their management, following admission to the outpatient clinic continues to evolve. Although many studies have investigated the hemogram parameters and platelet indices, the PCT value has never been investigated in epistaxis. To our knowledge, our study is the first to demonstrate a relationship to PCT values and epistaxis.
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Ozdamar OI, Ozbilen Acar G. Efficacy and Safety of Intranasal Medical Management in Pediatric Patients with Idiopathic Recurrent Epistaxis. Medeni Med J 2020; 35:1-7. [PMID: 32733743 PMCID: PMC7384491 DOI: 10.5222/mmj.2020.78614] [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: 01/02/2020] [Accepted: 02/28/2020] [Indexed: 11/29/2022] Open
Abstract
Objective: The goal of the study was to verify the efficacy and safety of topical medical treatment in idiopathic recurrent pediatric epistaxis patients by intranasal usage of both an antimicrobial and a moisturizing agent as a first-step management modality. Method: Sixty-seven out of 326 pediatric patients with idiopathic recurrent epistaxis selected on a chart review of follow-up were enrolled in the study. The study was designed as an analysis of two groups: one group included 35 individuals (52.2% of the total cohort) having a hyperemic nasal mucosa and the second group included 32 individuals (47.8% of the total cohort) having a hypervascular nasal mucosa on physical examination before treatment. Results: The study was performed with a total of 67 children (age range 3-17 years) including 36 males (53.7% of total cohort) and 31 females (46.3% of total cohort). The mean age was 9.78±4.09 years. There was not any statistically significant difference between the groups in terms of age, duration of follow-up and recurrence time of epistaxis (p>0.05). Recurrence of epistaxis was seen in 22.9% (8/35) of hyperemic nasal mucosa group and in 34.4% (11/32) of hypervascular nasal mucosa group (p>0.05). Conclusion: We advise the use of both an intranasal antimicrobial ointment and a mucosal moisturizing gel as an effective, noninvasive and easily applicable medical treatment option for pediatric patients with idiopathic recurrent epistaxis before more invasive methods of epistaxis control.
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Affiliation(s)
- Osman Ilkay Ozdamar
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Istanbul, Turkey
| | - Gul Ozbilen Acar
- Istanbul Medeniyet University Goztepe Training and Research Hospital, Department of Otorhinolaryngology Head and Neck Surgery, Istanbul, Turkey
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Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, Lin KW, Lind MM, Poetker DM, Riley CA, Schneider JS, Seidman MD, Vadlamudi V, Valdez TA, Nnacheta LC, Monjur TM. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg 2020; 162:S1-S38. [PMID: 31910111 DOI: 10.1177/0194599819890327] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Nosebleed, also known as epistaxis, is a common problem that occurs at some point in at least 60% of people in the United States. While the majority of nosebleeds are limited in severity and duration, about 6% of people who experience nosebleeds will seek medical attention. For the purposes of this guideline, we define the target patient with a nosebleed as a patient with bleeding from the nostril, nasal cavity, or nasopharynx that is sufficient to warrant medical advice or care. This includes bleeding that is severe, persistent, and/or recurrent, as well as bleeding that impacts a patient's quality of life. Interventions for nosebleeds range from self-treatment and home remedies to more intensive procedural interventions in medical offices, emergency departments, hospitals, and operating rooms. Epistaxis has been estimated to account for 0.5% of all emergency department visits and up to one-third of all otolaryngology-related emergency department encounters. Inpatient hospitalization for aggressive treatment of severe nosebleeds has been reported in 0.2% of patients with nosebleeds. PURPOSE The primary purpose of this multidisciplinary guideline is to identify quality improvement opportunities in the management of nosebleeds and to create clear and actionable recommendations to implement these opportunities in clinical practice. Specific goals of this guideline are to promote best practices, reduce unjustified variations in care of patients with nosebleeds, improve health outcomes, and minimize the potential harms of nosebleeds or interventions to treat nosebleeds. The target patient for the guideline is any individual aged ≥3 years with a nosebleed or history of nosebleed who needs medical treatment or seeks medical advice. The target audience of this guideline is clinicians who evaluate and treat patients with nosebleed. This includes primary care providers such as family medicine physicians, internists, pediatricians, physician assistants, and nurse practitioners. It also includes specialists such as emergency medicine providers, otolaryngologists, interventional radiologists/neuroradiologists and neurointerventionalists, hematologists, and cardiologists. The setting for this guideline includes any site of evaluation and treatment for a patient with nosebleed, including ambulatory medical sites, the emergency department, the inpatient hospital, and even remote outpatient encounters with phone calls and telemedicine. Outcomes to be considered for patients with nosebleed include control of acute bleeding, prevention of recurrent episodes of nasal bleeding, complications of treatment modalities, and accuracy of diagnostic measures. This guideline addresses the diagnosis, treatment, and prevention of nosebleed. It focuses on nosebleeds that commonly present to clinicians via phone calls, office visits, and emergency room encounters. This guideline discusses first-line treatments such as nasal compression, application of vasoconstrictors, nasal packing, and nasal cautery. It also addresses more complex epistaxis management, which includes the use of endoscopic arterial ligation and interventional radiology procedures. Management options for 2 special groups of patients-patients with hereditary hemorrhagic telangiectasia syndrome and patients taking medications that inhibit coagulation and/or platelet function-are included in this guideline. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not intended to be a comprehensive, general guide for managing patients with nosebleed. In this context, the purpose is to define useful actions for clinicians, generalists, and specialists from a variety of disciplines to improve quality of care. Conversely, the statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experience and assessment of individual patients. ACTION STATEMENTS The guideline development group made recommendations for the following key action statements: (1) At the time of initial contact, the clinician should distinguish the nosebleed patient who requires prompt management from the patient who does not. (2) The clinician should treat active bleeding for patients in need of prompt management with firm sustained compression to the lower third of the nose, with or without the assistance of the patient or caregiver, for 5 minutes or longer. (3a) For patients in whom bleeding precludes identification of a bleeding site despite nasal compression, the clinician should treat ongoing active bleeding with nasal packing. (3b) The clinician should use resorbable packing for patients with a suspected bleeding disorder or for patients who are using anticoagulation or antiplatelet medications. (4) The clinician should educate the patient who undergoes nasal packing about the type of packing placed, timing of and plan for removal of packing (if not resorbable), postprocedure care, and any signs or symptoms that would warrant prompt reassessment. (5) The clinician should document factors that increase the frequency or severity of bleeding for any patient with a nosebleed, including personal or family history of bleeding disorders, use of anticoagulant or antiplatelet medications, or intranasal drug use. (6) The clinician should perform anterior rhinoscopy to identify a source of bleeding after removal of any blood clot (if present) for patients with nosebleeds. (7a) The clinician should perform, or should refer to a clinician who can perform, nasal endoscopy to identify the site of bleeding and guide further management in patients with recurrent nasal bleeding, despite prior treatment with packing or cautery, or with recurrent unilateral nasal bleeding. (8) The clinician should treat patients with an identified site of bleeding with an appropriate intervention, which may include one or more of the following: topical vasoconstrictors, nasal cautery, and moisturizing or lubricating agents. (9) When nasal cautery is chosen for treatment, the clinician should anesthetize the bleeding site and restrict application of cautery only to the active or suspected site(s) of bleeding. (10) The clinician should evaluate, or refer to a clinician who can evaluate, candidacy for surgical arterial ligation or endovascular embolization for patients with persistent or recurrent bleeding not controlled by packing or nasal cauterization. (11) In the absence of life-threatening bleeding, the clinician should initiate first-line treatments prior to transfusion, reversal of anticoagulation, or withdrawal of anticoagulation/antiplatelet medications for patients using these medications. (12) The clinician should assess, or refer to a specialist who can assess, the presence of nasal telangiectasias and/or oral mucosal telangiectasias in patients who have a history of recurrent bilateral nosebleeds or a family history of recurrent nosebleeds to diagnose hereditary hemorrhagic telangiectasia syndrome. (13) The clinician should educate patients with nosebleeds and their caregivers about preventive measures for nosebleeds, home treatment for nosebleeds, and indications to seek additional medical care. (14) The clinician or designee should document the outcome of intervention within 30 days or document transition of care in patients who had a nosebleed treated with nonresorbable packing, surgery, or arterial ligation/embolization. The policy level for the following recommendation, about examination of the nasal cavity and nasopharynx using nasal endoscopy, was an option: (7b) The clinician may perform, or may refer to a clinician who can perform, nasal endoscopy to examine the nasal cavity and nasopharynx in patients with epistaxis that is difficult to control or when there is concern for unrecognized pathology contributing to epistaxis.
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Affiliation(s)
- David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Spencer C Payne
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Stacey L Ishman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | | | - Rachel S Bercovitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | | | | | | | - Jesse M Hackell
- Pomona Pediatrics, Boston Children's Health Physicians, Pomona, New York, USA
| | | | | | | | - Meredith Merz Lind
- Nationwide Children's Hospital/The Ohio State University, Columbus, Ohio, USA
| | | | | | - John S Schneider
- Washington University School of Medicine, St Louis, Missouri, USA
| | - Michael D Seidman
- AdventHealth Medical Group, Celebration, Florida, USA.,University of Central Florida, Orlando, Florida, USA.,University of South Florida, Tampa, Florida, USA
| | | | | | - Lorraine C Nnacheta
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| | - Taskin M Monjur
- American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
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Comparison of topical treatment methods used in recurrent anterior epistaxis: a randomized clinical trial. Braz J Otorhinolaryngol 2019; 87:132-136. [PMID: 31439531 PMCID: PMC9422598 DOI: 10.1016/j.bjorl.2019.07.002] [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: 12/19/2018] [Revised: 03/03/2019] [Accepted: 07/10/2019] [Indexed: 11/23/2022] Open
Abstract
Introduction Recurrent epistaxis is a common medical problem faced by ENT specialists, emergency physicians, and pediatricians. The facts that many treatment modalities are being searched and no single treatment method is universally accepted yet support this information. Objective We aimed to compare the clinical efficacy of topical antiseptic ointment, topical decongestant ointment and chemical cauterization treatments, which are frequently used in recurrent anterior epistaxis, both singly and in combination. Material-methods Between August 2017 and February 2018, 137 patients who were diagnosed with recurrent anterior epistaxis were randomly divided into 5 groups. group I received topical antiseptic ointment, group II received topical decongestant ointment, group III received chemical cauterization, group IV received topical antiseptic ointment + chemical cauterization and group V received topical decongestant ointment + chemical cauterization treatment. All patients were phoned 2 weeks and 1 month after the treatment and questioned about the presence (failure) or absence (success) of at least 1 episode of epistaxis. Patients with comorbid diseases were excluded. Treatment success was statistically analysed. Results There was no significant difference (p > 0.05) between the groups in the success rate at 15th day after treatment. Group IV and group V had higher success rates at 30th day after treatment compared with group I and group II (p < 0.05). In group III 30th day treatment success was not different from the other 4 groups (p > 0.05). Conclusion Although the number of patients who improved with chemical cauterization (group III) was higher in our study, no significant difference was observed in single treatment modalities (group I‒III) at 14th day and 30th day after treatment. Although no statistically significant difference was observed between combined treatments (group IV—V) and single treatments (group I‒III) in the 2nd week after treatment, combined treatments were significantly more effective in the 1st month.
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Béquignon E, Teissier N, Gauthier A, Brugel L, De Kermadec H, Coste A, Prulière-Escabasse V. Emergency Department care of childhood epistaxis. Emerg Med J 2016; 34:543-548. [PMID: 27542804 DOI: 10.1136/emermed-2015-205528] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 07/17/2016] [Accepted: 07/24/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The aim of this review is to determine an efficient and safe primary strategy care for paediatric epistaxis. DATA SOURCES We searched PubMed and Cochrane databases for studies referenced with key words 'epistaxis AND childhood'. This search yielded 32 research articles about primary care in childhood epistaxis (from 1989 to 2015). Bibliographic references found in these articles were also examined to identify pertinent literature. We compared our results to the specific management of adult epistaxis classically described in the literature. RESULTS Epistaxis is one of the most common reasons for referral of children to a hospital ENT outpatient department. The bleeding usually originates from the anterior septum, as opposed to adults. Crusting, digital trauma, foreign bodies and nasal colonisation with Staphylococcus aureus have been suggested as specific nosebleed factors in children. Rare aetiologies as juvenile nasopharyngeal angiofibroma appear later during adolescence. There are different modes of management of mild epistaxis, which begin with clearing out blood clots and bidigital compression. An intranasal topical local anaesthetic and decongestant can be used over 6 years of age. In case of active bleeding, chemical cauterisation is preferred to anterior packing and electric cauterisation but is only feasible if the bleeding site is clearly visible. In case of non-active bleeding in children, and in those with recurrent idiopathic epistaxis, antiseptic cream is easy to apply and can avoid 'acrobatic' cauterisation liable to cause further nasal cavity trauma. CONCLUSIONS Aetiologies and treatment vary with patient age and the existence or not of active bleeding at the time of the examination. Local treatments are usually easy to perform, but physicians have to ponder their indications depending on the possible complications in order to inform parents and to know paediatric epistaxis specificities.
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Affiliation(s)
- E Béquignon
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France.,INSERM U955, Créteil, France.,Université Paris-Est, Créteil, France.,Department of Oto-rhino-laryngology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - N Teissier
- Department of Paediatric otorhinolaryngology, Robert Debré Hospital, AP-HP, Paris, France.,INSERM U1141, Paris, France
| | - A Gauthier
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France
| | - L Brugel
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France
| | - H De Kermadec
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France
| | - A Coste
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France.,INSERM U955, Créteil, France.,Université Paris-Est, Créteil, France.,Department of Oto-rhino-laryngology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - V Prulière-Escabasse
- Department of Oto-rhino-laryngology Surgery, Intercommunal Hospital, Créteil, France.,INSERM U955, Créteil, France.,Université Paris-Est, Créteil, France
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Korkmaz M, Çetinkol Y, Korkmaz H, Batmaz T. Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment. Balkan Med J 2016; 33:212-5. [PMID: 27403392 DOI: 10.5152/balkanmedj.2015.151239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/15/2015] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that low-grade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children. AIMS This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients. STUDY DESIGN Retrospective cross-sectional study. METHODS Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group. RESULTS Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments. CONCLUSION Despite the high colonization rates, topical antibacterial treatment was not found superior to non-antibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.
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Affiliation(s)
- Mukadder Korkmaz
- Department of Otorhinolaryngology, Ordu University School of Medicine, Ordu, Turkey
| | - Yeliz Çetinkol
- Department of Microbiology, Ordu University School of Medicine, Ordu, Turkey
| | - Hakan Korkmaz
- Department of Otorhinolaryngology, Ordu University School of Medicine, Ordu, Turkey
| | - Timur Batmaz
- Clinic of Otorhinolaryngology, Ordu University Training and Research Hospital, Ordu, Turkey
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11
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Epistaxis and Staphylococcus aureus colonization in the nasal vestibule: is it a cause or consequence? J Craniofac Surg 2015; 25:e513-5. [PMID: 25377978 DOI: 10.1097/scs.0000000000001015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to investigate the relation between epistaxis and nasal colonization of Staphylococcus aureus in a population of patients with recurrent epistaxis. A total of 361 men and women were recruited, 245 patients with epistaxis (114 had crusting in the nasal vestibule; 131 did not) and 116 control subjects. A microbiology swab was taken from the anterior nasal cavity of each subject. Staphylococcus aureus was found to be more common in the epistaxis group when compared with the control group with a percentage of 31.8% and 4.3%, respectively (P < 0.05). There was no difference in the prevalence of S. aureus between the crust and non-crust groups (P > 0.05). When positive cultures were grouped and compared according to season, it was observed that the positive culture with epistaxis was much higher (44.82 %) in the autumn period. Staphylococcus aureus colonization in the nasal vestibule is more likely to be observed in individuals who have recurrent epistaxis than in those who do not have. It seems that this colonization may have a role in the etiology of epistaxis. However, with an altered medium of the nasal vestibule after each epistaxis period, it is also possible to speculate that this colonization is may be the consequence of epistaxis itself.
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Myers SL, Yang CZ, Bittner GD, Witt KL, Tice RR, Baird DD. Estrogenic and anti-estrogenic activity of off-the-shelf hair and skin care products. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2015; 25:271-7. [PMID: 24849798 PMCID: PMC4318791 DOI: 10.1038/jes.2014.32] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 05/05/2023]
Abstract
Use of personal care products is widespread in the United States but tends to be greater among African Americans than whites. Of special concern is the possible hazard of absorption of chemicals with estrogenic activity (EA) or anti-EA (AEA) in these products. Such exposure may have adverse health effects, especially when it occurs during developmental windows (e.g., prepubertally) when estrogen levels are low. We assessed the ethanol extracts of eight commonly used hair and skin products popular among African Americans for EA and AEA using a cell proliferation assay with the estrogen sensitive MCF-7:WS8 cell line derived from a human breast cancer. Four of the eight personal care products tested (Oil Hair Lotion, Extra-dry Skin Lotion, Intensive Skin Lotion, Petroleum Jelly) demonstrated detectable EA, whereas three (Placenta Hair Conditioner, Tea-Tree Hair Conditioner, Cocoa Butter Skin Cream) exhibited AEA. Our data indicate that hair and skin care products can have EA or AEA, and suggest that laboratory studies are warranted to investigate the in vivo activity of such products under chronic exposure conditions as well as epidemiologic studies to investigate potential adverse health effects that might be associated with use of such products.
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Affiliation(s)
- Sharon L. Myers
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
- University of California Davis Health System, Sacramento, CA, USA
| | | | - George D. Bittner
- CertiChem, Austin, TX, USA
- Neurobiology Section and School of Biology, University of Texas, Austin, TX, USA
| | - Kristine L. Witt
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Raymond R. Tice
- Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Donna D. Baird
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
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Davies K, Batra K, Mehanna R, Keogh I. Pediatric epistaxis: epidemiology, management & impact on quality of life. Int J Pediatr Otorhinolaryngol 2014; 78:1294-7. [PMID: 24882453 DOI: 10.1016/j.ijporl.2014.05.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Epistaxis in the pediatric population is a common problem for both primary care physicians (PCPs) and otolaryngologists. Although a frequent reason for referral to ENT clinics, data is lacking regarding causes, effects on quality of life and common treatment modalities. METHODS Prospective, clinical and questionnaire based study, with ethical approval. We identified 50 cases of pediatric epistaxis (<16 years old) over a 6-month period. A thorough clinical history was taken, first aid measures and management outcome was recorded. The impact of recurring epistaxis on parental quality of life was assessed using the Parental Stress Index Short Form (PSISF). RESULTS Thirty-three males and 17 females (2:1) were included. Mean age at presentation was 8.8 years. Initial management was inadequate, with only 30% of carers applying appropriate first aid measures. Quality of life was significantly affected in 10% of cases with primary parental concerns being fear of excessive blood loss and the stress of soiled bedclothes and night wear. Children were most affected by the negative impact on sporting activity. Otolaryngology consultation found the common causes to be iatrogenic trauma and rhinitis affecting "Littles" area. Of which 78% required silver nitrate cautery, and 22% just required reassurance and advice CONCLUSIONS Recurrent minor nosebleeds in children can be troublesome and alarming for parents and children. We found the PSISF an easy and reliable method of assessing patient and parental stress in dealing with this problem. Raising awareness of simple management strategies among parents and PCPs could significantly reduce associated quality of life issues. Mucosal hydration, cautery and first aid advice are the fundamentals of management.
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Affiliation(s)
- Karen Davies
- Department of Otolaryngology Head and Neck Surgery, UCHG, Ireland.
| | - Kadambari Batra
- Department of Otolaryngology Head and Neck Surgery, UCHG, Ireland
| | - Rania Mehanna
- Department of Otolaryngology Head and Neck Surgery, UCHG, Ireland
| | - Ivan Keogh
- Department of Otolaryngology Head and Neck Surgery, UCHG, Ireland; Academic Department of Otolaryngology, NUIG, Ireland
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Abstract
BACKGROUND Recurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition. OBJECTIVES To assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children. SEARCH METHODS We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 March 2012. SELECTION CRITERIA We identified all randomised controlled trials (RCTs) (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The two authors reviewed the full-text articles of all retrieved trials of possible relevance and applied the inclusion criteria independently. DATA COLLECTION AND ANALYSIS We graded trials for risk of bias using the Cochrane approach. One author performed data extraction in a standardised manner and this was rechecked by the other author. Where necessary we contacted investigators to obtain missing information. We did not undertake a meta-analysis because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented. MAIN RESULTS Five studies (four RCTs and one quasi-randomised controlled trial) involving 468 participants satisfied the inclusion criteria. The identified RCTs compared 0.5% neomycin + 0.1% chlorhexidine (Naseptin®) cream with no treatment, Vaseline® petroleum jelly with no treatment, 75% with 95% silver nitrate nasal cautery, and silver nitrate cautery combined with Naseptin® against Naseptin® alone; the quasi-randomised controlled trial compared Naseptin® antiseptic cream with silver nitrate cautery. Overall results were inconclusive, with no statistically significant difference found between the compared treatments upon completion of the trials, however 75% silver nitrate was more effective than 95% silver nitrate at two weeks following application. The group treated with 75% silver nitrate had 88% complete resolution of epistaxis compared to 65% in the group treated with 95% silver nitrate (P = 0.01). No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic). The pain scores were significantly less in those treated with 75% silver nitrate, the mean score being 1 compared to a mean score of 5 in those treated with 95% silver nitrate; this was statistically significant (P = 0.001).We carried out a 'Risk of bias' assessment of each study according to the Cochrane methodology and judged that two randomised controlled trials had a low risk of bias, two had an unclear risk of bias and the quasi-randomised controlled trial had a high risk of bias. AUTHORS' CONCLUSIONS The optimal management of children with recurrent idiopathic epistaxis is unknown, however if silver nitrate nasal cautery is undertaken 75% is preferable to 95% as it is more effective in the short term and causes less pain. High-quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.
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Affiliation(s)
- Ali Qureishi
- Department of Otolaryngology, Queen’s Medical Centre, Nottingham, UK
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Role of bacterial biofilms in idiopathic childhood epistaxis. Eur Arch Otorhinolaryngol 2012; 270:909-14. [PMID: 22885868 DOI: 10.1007/s00405-012-2132-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 07/18/2012] [Indexed: 10/28/2022]
Abstract
The objective of the study is to conduct a prospective trial investigating the possible role of bacterial biofilms in the pathogenesis of severe idiopathic childhood epistaxis. This study included 84 cases of severe idiopathic epistaxis, aged below 16 years, who were prepared for cautery under general anesthesia. A nasal swab was taken for bacterial culture and a nasal mucosal specimen (≤ 3 mm(2)) was taken from the suspected site of bleeding just prior to cautery and sent for bacterial identification by pathogen specific fluorescence in situ hybridization (FISH) and also for detection of bacterial biofilms by scanning electron microscope (SEM). Nasal mucosal specimens from 20 children of the same age prepared for reduction of fracture nasal bones and have no nasal problems were taken as a control group. Bacterial culture was positive in 27.3 % of patients and the most common organism was Staphylococcus aureus (19 %). By SEM, biofilm formation was detected in only six patients (7.1 %). Evaluation of nasal specimens with FISH was positive for pathogenic bacteria in 37 % of cases; the most common organism was S. aureus (22.6 % of cases). In the control group, no biofilm was detected by SEM and no pathogenic bacteria were cultured or detected by FISH. The difference between the two groups was statistically significant. Bacterial biofilm does not seem to play a major role in the pathogenesis of idiopathic epistaxis in children (only positive in 7.1 % of cases by SEM) although a low-grade chronic inflammation is not infrequently present (37 % of cases detected by FISH). FISH is more sensitive than bacterial culture in detecting bacterial infections. S. aureus was the most common pathogen detected by both techniques.
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Lin C, Mao C, Zhang J, Li Y, Chen X. Healing effect of bioactive glass ointment on full-thickness skin wounds. Biomed Mater 2012; 7:045017. [DOI: 10.1088/1748-6041/7/4/045017] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Is local ointment or cauterization more effective in childhood recurrent epistaxis. Int J Pediatr Otorhinolaryngol 2012; 76:783-6. [PMID: 22409966 DOI: 10.1016/j.ijporl.2012.02.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 02/12/2012] [Accepted: 02/13/2012] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare the efficacy of nasal antiseptic ointment and silver nitrate cautery in the treatment of children with recurrent epistaxis. METHODS In this prospective and randomized study, a hundred children with recurrent epistaxis were assigned into two groups. In group 1, patients underwent silver nitrate cauterization, in group 2 patients were treated with nasal antiseptic ointment (oxytetracycline hydrochloride-polymyxin B sulfate); and both groups were followed for 3 months. All of the patients were investigated for allergy with skin prick test. RESULTS The ages of patients were similar in both groups (group 1: 9.2±2.7; group 2: 8.2±2.2; p=0.069). Thirty-eight percent of the patients in group 1 and 52% of the patients in group 2 had epistaxis in the three months follow-up. The difference between groups was not significant (p=0.159). Thirteen (26%) of the patients in group 1 and 12 (24%) of the patients in group 2 were found to have allergic symptoms and positive prick test. The rate of allergy was similar in both groups (p=0.817). CONCLUSION Nasal antiseptic ointment and silver nitrate cauterization were found to have similar outcomes in the treatment of recurrent epistaxis.
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Sautter NB, Smith TL. Hereditary hemorrhagic telangiectasia-related epistaxis: innovations in understanding and management. Int Forum Allergy Rhinol 2012; 2:422-31. [PMID: 22566463 DOI: 10.1002/alr.21046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/15/2012] [Accepted: 03/20/2012] [Indexed: 12/26/2022]
Abstract
BACKGROUND Epistaxis is the most common manifestation of hereditary hemorrhagic telangiectasia (HHT), affecting approximately 90% of patients at some point during their lifetime. Bleeding is chronic and varies from mild, self-limited episodes to severe, transfusion-dependent or life-threatening epistaxis. Treatment options vary from conservative, nonsurgical management to more aggressive surgical approaches. A number of treatment options have been introduced in recent years. There is little consensus in the literature regarding treatment algorithms. The objective of this investigation was to provide a contemporary review of HHT-related epistaxis, including pathophysiology, disease manifestations, and state-of-the-art treatment modalities. METHODS A systematic review of the literature for HHT-related epistaxis was performed using the search terms "hereditary hemorrhagic telangiectasia" and "epistaxis." Additional literature search regarding current recommendations for HHT evaluation and recent developments in genetic mechanisms, pathophysiology, and treatment of HHT was also performed. RESULTS A total of 308 articles were identified and reviewed for appropriateness of inclusion whereas 64 articles met inclusion criteria. Treatment options range from topical and hormonal therapy to more aggressive surgical modalities. Most treatment descriptions are case series, with few randomized controlled trials. A number of new and novel therapies have been introduced in recent years. CONCLUSION HHT is a heterogeneous disease requiring multidisciplinary evaluation and treatment. Therapeutic options for HHT-related epistaxis vary from conservative, nonsurgical measures to more aggressive surgical treatments. A graduated treatment plan is recommended. Patients present with a wide degree in variation of severity of epistaxis, and treatment is best tailored to the individual patient.
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Affiliation(s)
- Nathan B Sautter
- Oregon Sinus Center, Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, OR 97239, USA.
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Montague ML, Whymark A, Howatson A, Kubba H. The pathology of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol 2011; 75:1032-4. [PMID: 21676473 DOI: 10.1016/j.ijporl.2011.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 05/10/2011] [Accepted: 05/10/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Epistaxis is common in children, but its cause remains unknown. About half the children who present with epistaxis have prominent vessels on the nasal septum. The aim of this study was to determine the pathological nature of the prominent septal vessels in children with recurrent epistaxis. METHODS 4mm punch biopsies of the nasal septal mucosa were taken from 5 children undergoing nasal cautery under general anaesthesia. RESULTS Histology showed that the prominent vessels were thin-walled arterioles and capillaries with a surrounding inflammatory infiltrate. There was no evidence of venous varicosities or arterial microaneurysms. CONCLUSION We postulate a mechanism for septal neovascularisation due to chronic low-grade inflammation as a cause for recurrent epistaxis in children.
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Affiliation(s)
- Mary-Louise Montague
- Department of Paediatric Otolaryngology, Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, Scotland, United Kingdom.
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Calder N, Kang S, Fraser L, Kunanandam T, Montgomery J, Kubba H. A double-blind randomized controlled trial of management of recurrent nosebleeds in children. Otolaryngol Head Neck Surg 2009; 140:670-4. [DOI: 10.1016/j.otohns.2009.01.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Revised: 01/14/2009] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
Abstract
Background: To establish whether a treatment regimen of silver nitrate cautery and 4 weeks of antiseptic nasal cream is superior to antiseptic cream treatment alone in the management of pediatric epistaxis. Study Design: Double-blind randomized controlled trial. Subjects and Methods: Children with epistaxis and visible anterior septal vessels were invited to participate. Patients were randomized to receive treatment or control. Treatment patients received silver nitrate cautery, followed by antiseptic cream for 4 weeks. Control patients received sham cautery followed by antiseptic cream for 4 weeks. Results: A total of 109 patients were randomized and results were available for 93 (85%). Of those receiving cautery, 21 (45.7%) of 46 had no bleeding in the 4 weeks before follow-up. Of those receiving only antiseptic cream 14 (29.8%) of 47 had no bleeding. (χ2 = 2.49; P = 0.114). More children in the active treatment group had an improvement in their symptoms compared with controls (42 of 46; 91.3%) in the treatment group vs 33 of 47 (70.2%) controls (χ2 = 6.626; P = 0.01; relative risk reduction = 71 percent, number needed to treat = 4.7). Conclusion: When using subjective improvement in symptoms as the outcome measure, silver nitrate cautery with antiseptic cream twice daily for 4 weeks appears to give a small but statistically significant benefit when compared to antiseptic cream alone.
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Affiliation(s)
- Nicholas Calder
- Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
| | - Swee Kang
- Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
| | - Lyndsay Fraser
- Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
| | - Tash Kunanandam
- Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
| | | | - Haytham Kubba
- Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland
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Joice P, Ross P, Robertson G, White P. The effect of hand dominance on recurrent idiopathic paediatric epistaxis. Clin Otolaryngol 2009; 33:570-4. [PMID: 19126131 DOI: 10.1111/j.1749-4486.2008.01831.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES No published data exists to support the belief that nose picking contributes to recurrent idiopathic paediatric epistaxis. If nose picking is implicated then there may be a higher incidence of epistaxis on the side of the dominant hand. The objective of the study was to determine whether nose picking has a significant role in paediatric epistaxis by comparing hand dominance and side of epistaxis. DESIGN AND SETTING A prospective, consecutive cohort of new epistaxis referrals to a tertiary paediatric centre over a 14-month period were assessed for hand dominance and reported side of the epistaxis. The presence of septal excoriation, crusting and prominent blood vessels was also recorded. PARTICIPANTS One hundred and forty-eight new epistaxis referrals. MAIN OUTCOME MEASURES Dominant hand, side of epistaxis history and side of positive examination findings. RESULTS No statistically significant association between hand dominance and either epistaxis history or examination findings was identified. A statistically significant association between epistaxis history and examination findings was identified P < 0.001, K = 0.614, SE 0.571. CONCLUSIONS The study does not provide evidence to support the belief that paediatric epistaxis is influenced by nose picking. The study provides evidence that patients' epistaxis history and positive examination findings are a consistent marker of previous epistaxis.
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Affiliation(s)
- P Joice
- Department of ENT, NHS Tayside, Ninewells Hospital, Dundee, UK.
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Abstract
A survey of current literature on the topic of epistaxis revealed only a circumscript number of publications with a high methodologic value. The analysis of these publications showed that there is a controversy on the necessity of routine coagulation tests in epistaxis patients. These tests should only be performed in cases with clinical evidence of a coagulation disorder. Also, there is an ongoing controversy on the value of local cooling with ice or cold packs. Nasal creams and decongestive nose drops have been found to be effective in uncomplicated epistaxis. Rhinoscopically and endoscopically targeted coagulation of bleeding vessels and nasal packing are recommended treatment options. There is a debate on discontinuation of anticoagulant therapy, if INR is within normal limits in Cumadin patients. Intractable epistaxis requires a broad armamentarium of different diagnostic and therapeutic options. Recurrent epistaxis in hereditary syndromes remains to be a challenge, although some advances have been made in diagnosis and symptomatic treatment. Some new medical drugs, as Viagra or Cialis may have nosebleeds as side-effects.
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Affiliation(s)
- B J Folz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Karl Hansen Klinik, Antoniusstrasse 19, 33175 Bad Lippspringe, Deutschland.
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Nasal bacterial carriage in adult epistaxis: is neomycin the answer? The Journal of Laryngology & Otology 2008; 123:623-5. [PMID: 18761771 DOI: 10.1017/s0022215108003460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION After treatment of epistaxis, patients are routinely supplied with an intranasal bactericidal cream containing neomycin. Neomycin cream is effective in preventing recurrent paediatric epistaxis. This study aimed to assess whether there is an increased rate of nasal bacterial infections in adult epistaxis patients. METHODS Between October 2004 and April 2005, nasal swabs were taken from adult patients presenting with epistaxis, and from a control group comprising elective ENT patients. RESULTS There were 23 controls and 26 epistaxis patients. Staphylococcus aureus was grown in 21 per cent and 23 per cent, respectively. There was no significant difference in bacterial carriage rates between the epistaxis and control groups. CONCLUSIONS The epistaxis and control groups demonstrated the same bacterial species and the same proportion of bacterial carriage. Although the majority of bacterial species encountered were sensitive to neomycin, a significant proportion was not. These results do not support the routine use of neomycin in the prevention of recurrent adult epistaxis.
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Topical management of anterior epistaxis: a national survey. The Journal of Laryngology & Otology 2008; 123:91-5. [DOI: 10.1017/s0022215108003009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:The use of nasal creams and ointments in the conservative management of anterior epistaxis is well documented and supported. This study set out to obtain a national opinion, in order to establish current practice.Design:A survey of all Scotland-based otolaryngology clinicians was conducted. Participants were asked which topical treatment they used in their practice, how often and for how long they advocated its use, and how they advised their patients to apply it.Results:The overall response rate was 91 per cent. We discuss and compare the varying responses for the questions posed, and discuss the possible reasons for these in greater detail.Conclusions:This study demonstrates a high degree of variation in this practice, arising from a lack of concrete evidence and influenced by anecdotal experience and personal preferences. Definitive comparative studies are required if a ‘gold standard’ topical approach for the management of anterior epistaxis is to emerge.
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Whymark AD, Crampsey DP, Fraser L, Moore P, Williams C, Kubba H. Childhood epistaxis and nasal colonization with Staphylococcus aureus. Otolaryngol Head Neck Surg 2008; 138:307-10. [PMID: 18312876 DOI: 10.1016/j.otohns.2007.10.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Revised: 10/23/2007] [Accepted: 10/30/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Epistaxis is very common in children but its cause remains unknown. We postulate that nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and ultimately new vessel formation. STUDY DESIGN A prospective case-control study. SUBJECTS AND METHODS Sixty-seven children were recruited, 42 with epistaxis (22 had crusting in the nasal vestibule; 20 did not) and 25 control subjects. A microbiology swab was taken from the anterior nasal cavity of each child. RESULTS All groups were equally likely to have a positive culture. S aureus was more common in the epistaxis group (P = 0.008) compared with the control group. There was no difference in the prevalence of S aureus between crust and noncrust groups. Epistaxis patients were much less likely to have isolates of respiratory pathogens or a skin commensal. CONCLUSION Children with epistaxis are more likely to have nasal colonization with S aureus than controls. Our data would support the hypothesis that S aureus replaces existing nasal flora and causes inflammation and new vessel formation.
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Affiliation(s)
- Andrew D Whymark
- Institution Department of Paediatric Otolaryngology, Head and Neck Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
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Affiliation(s)
- H Kubba
- Royal Hospital for Sick Children, Yorkhill, Glasgow G3 8SJ, UK.
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Long-term effectiveness of antiseptic cream for recurrent epistaxis in childhood: five-year follow up of a randomised, controlled trial. The Journal of Laryngology & Otology 2008; 122:1084-7. [DOI: 10.1017/s0022215107001600] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectives:To determine the long-term outcome for children treated for recurrent epistaxis, and to compare the efficacy of antiseptic cream treatment and nasal cautery.Study design and participants:Retrospective analytical cohort study of 88 children treated for recurrent epistaxis in 2001.Methods:Five-year data on chlorhexidine–neomycin cream usage, nasal cautery, current epistaxis frequency and emergency room attendance was collected by telephone interview and case record review.Results:During their first clinic visit, 51 per cent of the children had been treated with cautery and cream and 35 per cent with cream alone; 14 per cent had received no treatment. Five years later, 65 per cent of these children were still having ongoing epistaxis. Those who had undergone cautery and received cream had the highest ongoing bleeding rate (77 per cent).Conclusion:The majority of children treated at our clinic for recurrent epistaxis had ongoing bleeding five years later. Despite the proven short-term efficacy of chlorhexidine–neomycin cream, few patients receive further courses of cream or are referred back to the clinic.
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Abstract
PURPOSE OF REVIEW The treatment of epistaxis has undergone significant changes in recent years. Gone are the days when patients had an uncomfortable posterior nasal pack inserted then spent several days on the ward only to bleed again on its removal. New packing devices, ingenious haemostatic agents and endoscopic surgical approaches have been developed to provide a variety of effective and well-tolerated treatment options. This paper will discuss the evolution and utility of these devices and techniques for managing difficult epistaxis patients. RECENT FINDINGS Modern packing devices are much easier to insert than traditional gauze packs and are no less effective. A major advance in the management of posterior epistaxis has been the development of the technique of endoscopic ligation. SUMMARY Anterior epistaxis is generally easy to control with local cautery. The optimal management of posterior epistaxis is to insert a pack to control the bleeding before taking the patient to the operating theatre to ligate the sphenopalatine artery endoscopically.
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Affiliation(s)
- Richard Douglas
- Department of Surgery, University of Auckland, Auckland, New Zealand
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Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of Epistaxis in US Emergency Departments, 1992 to 2001. Ann Emerg Med 2005; 46:77-81. [PMID: 15988431 DOI: 10.1016/j.annemergmed.2004.12.014] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE The epidemiology of emergency department (ED) visits for epistaxis is unknown. We use national data to fill this gap and test hypotheses that epistaxis visits are more common with increasing age and in winter. METHODS We identify ED visit with epistaxis from 10 years of the National Hospital Ambulatory Medical Care Survey. We calculate visit rates by age and other demographic characteristics and assess mode of arrival and disposition. Results are presented with 95% confidence intervals (CIs). RESULTS From 1992 to 2001, epistaxis occurred at 4,503,000 ED visits, or 0.46% (95% CI 0.41% to 0.51%) of all visits. Per 1,000 population, 1.7 (95% CI 1.5 to 1.9) ED visits for epistaxis occurred annually. The age-related frequency was bimodal, with peaks among those younger than 10 years (4.0 per 1,000 visits) and aged 70 to 79 years (12.0 per 1,000 visits). Most cases (83%; 95% CI 80% to 86%) were atraumatic. Traumatic cases were younger than atraumatic cases (mean age 31 versus 49 years). From December to February, atraumatic epistaxis occurred in 0.50% (95% CI 0.40% to 0.60%) of all visits versus 0.34% (95% CI 0.30% to 0.39%) during nonwinter months. Fifteen percent (95% CI 12% to 18%) of cases arrived by ambulance, and 6% (95% CI 5% to 7%) of patients were hospitalized. CONCLUSION Epistaxis accounts for about 1 in 200 ED visits in the United States. Although there is an early age peak (age >10 years), the frequency increases from age 20 years onward, with the highest rates in the elderly. Epistaxis visits are more common in the winter. Future efforts to decrease epistaxis visits might focus on education of the elderly and parents of young children about nasal mucosa care and basic approaches to home management.
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Affiliation(s)
- Daniel J Pallin
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
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Abstract
BACKGROUND Recurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self-limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition. OBJECTIVES To assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children. SEARCH STRATEGY We searched the Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 3, 2003), MEDLINE (January 1966 to August 2003), EMBASE (January 1980 to August 2003), CINAHL (January 1982 to August 2003), and reference lists of relevant articles. SELECTION CRITERIA We identified all randomised controlled trials (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo, or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The full text articles of all the retrieved trials of possible relevance were reviewed by the two reviewers and the inclusion criteria applied independently. DATA COLLECTION AND ANALYSIS Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner by one reviewer and rechecked by the other, and where necessary investigators were contacted to obtain missing information. A meta-analysis was not undertaken because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented. MAIN RESULTS Three studies - two randomised controlled trials (RCTs) and one controlled clinical trial (CCT) - involving 256 participants satisfied the inclusion criteria. One RCT compared Naseptin antiseptic cream with no treatment, the second RCT compared Vaseline(R) petroleum jelly with no treatment, and the CCT compared Naseptin antiseptic cream with silver nitrate cautery. Overall, results were inconclusive, with no statistically significant difference found between the compared treatments. No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic). REVIEWER'S CONCLUSIONS The optimal management of children with recurrent idiopathic epistaxis is unknown. High quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.
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Affiliation(s)
- M J Burton
- Department of Otolaryngology - Head and Neck Surgery, The Radcliffe Infirmary, Woodstock Road, Oxford, UK, OX2 6HE
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