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van der Zaag PD, Geurts S, Rozema R, Reininga IHF, van Minnen B. Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics. Eur J Trauma Emerg Surg 2024; 50:543-550. [PMID: 38197899 PMCID: PMC11035474 DOI: 10.1007/s00068-023-02428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
PURPOSE To investigate the effect of antithrombotics on the occurrence of maxillofacial haemorrhagic symptoms, and to determine if these haemorrhagic symptoms are predictors of maxillofacial fractures. METHOD A prospective cohort study was conducted of consecutive patients with maxillofacial trauma who had been admitted to the emergency department of four hospitals in the Netherlands. This study compared five haemorrhagic symptoms (peri-orbital haematoma, raccoon eyes, epistaxis, subconjunctival ecchymosis, and intra-oral haematoma) between patients not-using (NUA) and using (UA) of antithrombotics, and whether these maxillofacial haemorrhagic symptoms served as predictors for maxillofacial fractures. RESULTS Out of the 1005 patients, 812 (81%) belonged to the NUA group, and 193 (19%) to the UA group. UA patients exhibited higher frequencies of peri-orbital hematoma (54% vs. 39%, p < 0.001), raccoon eyes (10% vs. 5%, p = 0.01), and subconjunctival ecchymoses (16% vs. 7%, p < 0.001). In NUA, peri-orbital hematoma (OR = 2.5, p < 0.001), epistaxis (OR = 4.1, p < 0.001), subconjunctival ecchymosis (OR = 2.3, p = 0.02), and intra-oral hematoma (OR = 7.1, p < 0.001) were significant fracture predictors. Among UA, peri-orbital hematoma (OR = 2.2, p = 0.04), epistaxis (OR = 5.4, p < 0.001), subconjunctival ecchymosis (OR = 3.7, p = 0.008), and intra-oral hematoma (OR = 22.0, p < 0.001) were significant fracture predictors. CONCLUSION Maxillofacial haemorrhagic symptoms were observed more frequently in the UA group than in the NUA group. However, in both groups, maxillofacial haemorrhagic symptoms appear to be predictors of maxillofacial fractures. Caution is warranted in attributing these symptoms solely to antithrombotic use during emergency department assessments.
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Affiliation(s)
- Pieter Date van der Zaag
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Stephanie Geurts
- Faculty of Dentistry and Oral Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Romke Rozema
- Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge H F Reininga
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Emergency Care Network Northern Netherlands (AZNN), Northern Netherlands Trauma Registry, Groningen, The Netherlands
| | - Baucke van Minnen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Hadar A, Shaul C, Ghantous J, Tarnovsky Y, Cohen A, Zini A, Peleg U. Risk Factors for Severe Clinical Course in Epistaxis Patients. EAR, NOSE & THROAT JOURNAL 2023:1455613231189056. [PMID: 37496443 DOI: 10.1177/01455613231189056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
Purpose: Epistaxis is a common medical emergency that may require admission to the emergency department (ED) and treatment by an otolaryngologist. Currently, there are no widely accepted indications for hospitalization, and the decision is based on personal experience. Methods: A retrospective study of 1171 medical records of patients with epistaxis treated at our tertiary medical center ED from 2013 to 2018 with no age limit. The presence of recurrent epistaxis, a posterior source of bleeding, the need for hospitalization, the need for blood transfusion, or surgical intervention defined severe clinical course. Results: The 1171 admissions included 230 recurrent admissions for a total of 941 patients (60% males) who were treated by an otolaryngologist. The average age was 57.6 in the adult population (>15) and 6.6 in the pediatric population (≤15). Of all patients, 39% had hypertension; 39% took antiplatelet/anticoagulation therapy; 63% came during winter-a significant risk factor; 34 (2.9%) had reduced hemoglobin levels of >1gr%, but only 7 received a blood transfusion; 131 (11%) were hospitalized, and 21 (1.8%) required surgical control of the bleeding. Age (OR 1.02; CI 1.01-1.023), male sex (OR 2.07; CI 1.59-2.69), hypertension (OR 1.76; CI 1.27-2.45), and antiplatelet/anticoagulation therapy (OR 2.53; CI 1.93-3.33, OR 1.65; CI 1.11-2.44, respectively), were significantly correlated with severe clinical course. Conclusion: Epistaxis is significantly more common and severe in older male patients with hypertension or antiplatelet/anticoagulation therapy. However, few need a blood transfusion or surgical intervention. In borderline cases with no definitive indication for hospitalization, we suggest adopting these factors as indications for hospitalization due to their marked influence on the clinical course. Routine coagulation tests are indicated in patients treated with warfarin or combined antiplatelet + anticoagulation therapy.
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Affiliation(s)
- Ayalon Hadar
- Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Chanan Shaul
- Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Jameel Ghantous
- Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Yehuda Tarnovsky
- Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University, Jerusalem, Israel
| | - Adiel Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avraham Zini
- Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri Peleg
- Department of Otolaryngology, Head and Neck Surgery, Shaare-Zedek Medical Center, The Hebrew University, Jerusalem, Israel
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Cohen DA, Thomas Perez LS, Chemas-Velez MM, Tseng CC, Eloy JA, Fang CH. Analysis of Care and Outcomes for Epistaxis Weekend Admissions. Otolaryngol Head Neck Surg 2023; 168:1401-1410. [PMID: 36939540 DOI: 10.1002/ohn.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/23/2022] [Accepted: 12/07/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To study differences in care of patients admitted for epistaxis during the weekend compared to the weekday. STUDY DESIGN Retrospective database review. SETTING 2003 to 2014 National Inpatient Sample. METHODS Patients admitted for a primary diagnosis of epistaxis were extracted from the National Inpatient Sample from 2003 to 2014. Univariate and multivariate analyses were applied to assess differences in patient demographics, clinical characteristics, treatment, and outcomes between weekend and weekday admissions. RESULTS A total of 39,329 cases were included in our study cohort, with 28,458 weekday admissions and 10,892 weekend admissions. There was no significant difference in patient race, gender, insurance status, hospital ownership status, or location between weekend and weekday admissions (p > .05). Most weekend admissions were emergent (82.2%) and were treated with packing (51.8%). Upon performing logistic regression, the likelihood of emergent admission (odds ratio [OR] 1.41, 95% confidence interval [CI] 1.32-1.51, p < .001) and prolonged length of stay (OR 1.11, 95% CI 1.05-1.17, p < .001) was higher for weekend admissions versus weekday admissions. Moreover, odds of packing for epistaxis were significantly higher (OR 1.14, 95% CI 1.09-1.19, p < .001) on the weekend, while odds of ligation (OR 0.88, 95% CI 0.80-0.97, p = .013) and endovascular arterial embolization (OR 0.74, 95% CI 0.65-0.84, p < .001) were lower. There were no significant differences in in-hospital mortality, patient discharge disposition, and total hospital charges (p > .05). CONCLUSION Patients primarily admitted for epistaxis over the weekend were more likely to be emergent, experienced prolonged length of stay, and be treated nonoperatively with packing, than weekday admissions. No significant differences in patient insurance or hospital ownership were identified. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- David Avery Cohen
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Maria Manuela Chemas-Velez
- Department of Otolaryngology and Maxillofacial Surgery, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Christopher C Tseng
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Rutgers New Jersey Medical School, Neurological Institute of New Jersey, Newark, New Jersey, USA.,Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center-RWJBarnabas Health, Livingston, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, USA
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Etiopathogenic features of severe epistaxis in histological samples from individuals with or without arterial hypertension. Sci Rep 2022; 12:1361. [PMID: 35079036 PMCID: PMC8789858 DOI: 10.1038/s41598-022-05278-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 01/10/2022] [Indexed: 11/09/2022] Open
Abstract
There is a consensus that arterial hypertension (AH) is associated with stroke. Therefore, this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. Histological sections were obtained from hypertensive and normotensive individuals, regardless of epistaxis. Our results showed that the group with AH had: (a) smaller median diameter of the lumen of arteries and arterioles; (b) increased thickness of the intimal arteries and arterioles, slight inflammatory infiltrate, and rupture of internal elastic lamina; (c) greater thickness of the middle tunica in arterioles; (d) lower percentage of histological sections with non-injured intimal layers in capillaries, arterioles, and small arteries; (e) lower percentage of histological sections with intact media tunic and/or myocytes juxtaposed in arteries and arterioles; (f) no difference between the diameters of small arteries or arterioles. The intima was thicker in individuals with severe epistaxis than in the normotensive group, but it did not differ from the AH group. Thus, hypertension may cause structural lesions in the vascular layers, and in the absence of tissue repair and the persistence of AH, these lesions may favour vascular rupture, especially during hypertensive peaks.
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Hashemian F, Akbarpour M, Razaghi K, Emam A, Seiferabiei M, Hashemian F. Evaluating the efficacy of Achillea Millefolium ointment in the treatment of recurrent idiopathic epistaxis; a randomized double-blind clinical trial. J Herb Med 2021. [DOI: 10.1016/j.hermed.2021.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Anti-thrombotics and their impact on inpatient epistaxis management: a tertiary centre experience. Ir J Med Sci 2021; 191:1621-1629. [PMID: 34562192 PMCID: PMC9308617 DOI: 10.1007/s11845-021-02790-1] [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: 08/30/2020] [Accepted: 09/18/2021] [Indexed: 11/03/2022]
Abstract
Introduction Epistaxis represents a massive burden upon NHS resources. Despite being an extremely common reason for emergency ENT admissions, there remains significant variation in its management. Although the evidence base is continually growing, there appears to be a lack of guidance towards managing anti-coagulants and anti-platelet medications and identifying patient-specific outcomes in this setting. Epistaxis has long been associated with a multitude of risk factors but none have shown consistent, direct correlation. Materials and methods We aimed to identify if the use of anti-thrombotic medication was associated with a longer length of hospital admission or conferred a higher requirement for nasal packing, re-packing, surgery or re-admission. We conducted a retrospective analysis of 100 consecutive adult patients admitted over a 6-month period. Statistical analysis was conducted using SPSS software. Results Sixty-five percent of patients were taking anti-thrombotic medication. The variability of admission INR values in those taking warfarin did not relate with any outcome measure. There was no statistical difference between patients taking anti-thrombotic medication and those who do not, with regards to our primary outcome measures. Re-admission rates within 28 days were found to be 13%, with anti-thrombotic medication use and pre-existing cardiovascular disease recognised as commonly encountered risk factors. Three percent of patients required surgical intervention. Eight percent of patients required re-packing, with a Rapid Rhino chosen in all instances. Conclusion The use of anti-thrombotic medication is not associated with increased morbidity or increased rate of complications. Anti-thrombotic usage and more than one medical co-morbidity increase the risk of re-admission within 28 days.
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ElAlfy MS, Tantawy AAG, Eldin BEMB, Mekawy MA, Mohammad YAE, Ebeid FSE. Epistaxis in a Pediatric Outpatient Clinic: Could It be an Alarming Sign? Int Arch Otorhinolaryngol 2021; 26:e183-e190. [PMID: 35602268 PMCID: PMC9122762 DOI: 10.1055/s-0041-1726040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 11/24/2020] [Indexed: 11/01/2022] Open
Abstract
Abstract
Introduction Epistaxis is a common presentation among children.
Objective To investigate the suitability of a simple tool of assessment for patients with epistaxis that could guide in subgrouping those with possible bleeding tendencies who may need further assessment.
Methods Children who presented to a tertiary outpatient clinic with epistaxis of an unknown cause were recruited. They underwent thorough clinical assessment and answered the pediatric bleeding questionnaire and the epistaxis severity score. All patients underwent complete blood count as well as coagulation profile, and confirmatory diagnostic tests were performed as needed.
Results Among the 30,043 patients who presented to the outpatient clinic over a year, 100 children had epistaxis, with an estimated annual frequency of 1 in 300. A total of 84% of the patients were younger than 12, and nearly half of these were younger than 6 years. Seventy-six patients had recurrent epistaxis, and 12 had systemic comorbidities. A significant higher percentage of patients presented with epistaxis in the hot months of the year. A total of 90% of the patients presented anterior bleeding, and the majority were treated with nasal compression only. Forty-three patients presented with epistaxis only; 37 of them were diagnosed as idiopathic epistaxis, and 6 had local causes. Fifty-seven patients presented with other bleeding manifestations, 47 of whom had a definite bleeding disorder and the other 10 had undiagnosed bleeding tendency. Those with other bleeding manifestations showed a higher frequency of positive family history of epistaxis; of being referred from a primary care physician; of having alarming low platelet count, and of presenting less seasonal variability. A bleeding score ≥ 2 showed significant value in suspecting an underlying systemic pathology as a cause of epistaxis.
Conclusion The pediatric bleeding questionnaire is a useful and simple tool in the identification of pediatric patients who need further diagnostic testing to detect any underlying bleeding tendency.
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Affiliation(s)
- Mohsen Saleh ElAlfy
- Department of Pediatrics, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | | | | | - Mohamed Amin Mekawy
- Department of Clinical Pathology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
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Davies T, Alatsatianos A, Slim MAM, Royce W, Whymark A. The impact of frailty on epistaxis admission, a retrospective cohort study. Clin Otolaryngol 2021; 46:983-990. [PMID: 33756072 DOI: 10.1111/coa.13765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/10/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Epistaxis is frequently managed with intra-nasal packing devices, traditionally requiring patient admission. Current COVID-19 guidelines encourage ambulatory care where possible in this patient cohort. This paper aims to establish the impact of the Clinical Frailty Scale, anticoagulant/antiplatelet therapeutics and season variation on pre-pandemic admissions to help identify patients suitable for ambulatory epistaxis management. DESIGN Retrospective cohort study SETTING: Scottish Regional Health Board PARTICIPANTS: Adult patients attending secondary care with epistaxis between March 2019 and March 2020. MAIN OUTCOME MEASURES Likelihood of epistaxis hospital admission based on Clinical Frailty Scale. RESULTS 299 epistaxis presentations were identified, of which 122 (40.8%) required admission. Clinical Frailty Scale of ≥4 had an increased likelihood of admission (OR 3.15 (95% CI:1.94-5.16), P < .05). In the majority of presentations (66.2%), patients were taking either an antiplatelet or anticoagulant. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20-3.33), P < .05 and dual antiplatelet (OR: 2.82 (95% CI: 1.02-7.86), P < .05) demonstrated increased likelihood of admission. CONCLUSIONS We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Clinical Frailty Scale (CFS) could be utilised in risk stratification to identify suitable patients for outpatient management. Patients with CFS ≤ 3 could be considered for outpatient management of their epistaxis. It is likely that patients with CFS ≥4 on anticoagulant or dual antiplatelet will require admission.
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Affiliation(s)
- Timothy Davies
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Anton Alatsatianos
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Mohd Afiq Mohd Slim
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - William Royce
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
| | - Andrew Whymark
- Department of Otolaryngology, University Hospital Crosshouse, Kilmarnock, UK
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Althaus AE, Arendt U, Hoffmann F, Lüske J, Freitag MH, Jobski K, Dörks M. [Epistaxis and anticoagulation therapy: an analysis based on health insurance data from Lower Saxony]. HNO 2021; 69:206-212. [PMID: 32929520 PMCID: PMC8289754 DOI: 10.1007/s00106-020-00940-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hintergrund Die Epistaxis ist ein häufiges Symptom in der Arztpraxis und assoziiert mit verschiedenen Komorbiditäten und Medikamenten, insbesondere Antikoagulanzien. Trotz ihrer Alltäglichkeit gibt es nur wenige Daten zur Häufigkeit ihres Auftretens und möglichen Risikofaktoren. Methoden Die Studie untersuchte anhand einer großen Patientenpopulation (AOK Niedersachsen) über 10 Jahre (2007–2016) die Versorgung von Epistaxis in Niedersachsen. Alter bei Diagnose, Begleitmedikation und Komorbiditäten wurden analysiert und die Prävalenz dargestellt. Ergebnisse 162.167 Versicherte der AOK Niedersachen wurden zwischen 2007 und 2016 aufgrund einer Epistaxis in 308.947 Fällen ärztlich vorstellig. Die meisten Patienten wurden ausschließlich ambulant behandelt (96,6 %). Über den Studienzeitraum stieg die Prävalenz um 21 % (Anstieg von 8,7 auf 9,3 pro 1000 Versicherte/Jahr) bei stabiler Prävalenz für stationäre Vorstellungen (0,2 pro 1000 Versicherte/Jahr). Die höchsten Prävalenzen fanden sich bei Personen bis 20 und über 80 Jahre. In 17,5 % aller Epistaxisfälle wurden Antithrombotika erfasst (9,5 % orale Antikoagulanzien). Über den Studienzeitraum konnte eine erhöhte Verschreibung von Antikoagulanzien (7,7 % in 2007 auf 11,8 % in 2016, insbesondere NOAK) dokumentiert werden. Schlussfolgerung Neben der arteriellen Hypertonie, dem männlichen Geschlecht sowie der typischen Altersverteilung bestand auch häufig eine Medikation mit Antikoagulanzien. Über den untersuchten Zeitraum zeigte sich eine Zunahme von Epistaxisfällen bei gleichzeitig ansteigender Verschreibungshäufigkeit von NOAK, nicht jedoch von schweren hospitalisationsbedürftigen Epistaxisfällen. Eine abschließende Beurteilung hinsichtlich eines möglichen kausalen Zusammenhangs muss in weiteren Studien untersucht werden.
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Affiliation(s)
- A E Althaus
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland. .,, Theaterwall 43, 26122, Oldenburg, Deutschland.
| | - U Arendt
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - F Hoffmann
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - J Lüske
- Praxis Dr. Lüske, Oldenburg, Deutschland
| | - M H Freitag
- Department für Versorgungsforschung, Abteilung Allgemeinmedizin, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - K Jobski
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
| | - M Dörks
- Department für Versorgungsforschung, Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Carl von Ossietzky Universität Oldenburg, Oldenburg, Deutschland
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Reuben A, Appelboam A, Stevens KN, Vickery J, Ewings P, Ingram W, Jeffery AN, Body R, Hilton M, Coppell J, Wainman B, Barton A. The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial. Ann Emerg Med 2021; 77:631-640. [PMID: 33612282 DOI: 10.1016/j.annemergmed.2020.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. Tranexamic acid is an agent that contributes to blood clot stability. The aim of this study is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing. METHODS From May 5, 2017, to March 31, 2019, a double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom. Participants with spontaneous epistaxis, persisting after simple first aid and the application of a topical vasoconstrictor, were randomly allocated to receive topical tranexamic acid or placebo. The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week. RESULTS The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group. The difference was not statistically significant (odds ratio 1.107; 95% confidence interval 0.769 to 1.594; P=.59). Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures. CONCLUSION In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing.
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Affiliation(s)
- Adam Reuben
- Royal Devon and Exeter NHS Foundation Trust, Exeter, England.
| | | | - Kara N Stevens
- Medical Statistics Group, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth University, Plymouth, England
| | - Jane Vickery
- Peninsula Clinical Trials Unit, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth University, Plymouth, England
| | - Paul Ewings
- National Institute of Health Research (NIHR) Research Design Service South West, United Kingdom; Taunton and Somerset NHS Foundation Trust, Taunton, Somerset, England
| | - Wendy Ingram
- Peninsula Clinical Trials Unit, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth University, Plymouth, England
| | - Alison N Jeffery
- Peninsula Clinical Trials Unit, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth University, Plymouth, England
| | - Richard Body
- Division of Cardiovascular Science, The University of Manchester, Emergency Department, Manchester University NHS Foundation Trust, Manchester, England
| | - Malcolm Hilton
- Royal Devon and Exeter NHS Foundation Trust, Exeter, England
| | - Jason Coppell
- Royal Devon and Exeter NHS Foundation Trust, Exeter, England
| | - Brian Wainman
- Peninsula Clinical Trials Unit, Faculty of Health, Medicine, Dentistry and Human Sciences, University of Plymouth University, Plymouth, England
| | - Andy Barton
- National Institute of Health Research (NIHR) Research Design Service South West, United Kingdom
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Ketterer MC, Reuter TC, Knopf A, Hildenbrand T. [Risk profile analysis of stationary epistaxis patients]. Laryngorhinootologie 2021; 101:120-126. [PMID: 33461228 DOI: 10.1055/a-1342-0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Epistaxis is a disease well known to general practitioners and ENT specialists in the outpatient sector as well as in hospitals. The aim of this study was to analyze data of patients that were treated as inpatients at the ENT university hospital Freiburg between 2014-2018. MATERIALS AND METHODS This retrospective study analyzes data of admitted patients with epistaxis regarding age, medication, bleeding site, underlying health conditions, radiological imaging and treatment. Risk factors for longer inpatient length of stay and readmission were identified. RESULTS Median length of stay was 3.5 days. 55 % of the patients suffered from posterior epistaxis. 72.3 % of patients were treated with anticoagulants at the time of admission. The most prevalent medical conditions were hypertension (66 %) and arrhythmia due to atrial fibrillation (36.1 %). 63.5 % of the patients were treated by nasal packing. 97 patients (14.6 %) had to be treated surgically. Surgical treatment, transfusion, posterior epistaxis and anticoagulant treatment were risk factors for longer length of inpatient stay. Preexisting hypertension, posterior bleeding and single anticoagulant treatment increased the risk of readmission. CONCLUSIONS Determination and consideration of risk factors allow identification of patients at risk of longer inpatient length of stay and readmission. Adequate management accounting for risk profiles of patients could help reduce morbidity.
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Affiliation(s)
- Manuel Christoph Ketterer
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Thea Charlott Reuter
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Andreas Knopf
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
| | - Tanja Hildenbrand
- Klinik für Hals- Nasen- Ohrenheilkunde, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert- Ludwigs- Universität Freiburg, Deutschland
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Hypertension causes structural lesions in the microvasculature of the posterior nasal mucosa. Hypertens Res 2020; 44:591-594. [PMID: 33173212 DOI: 10.1038/s41440-020-00572-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/10/2020] [Accepted: 10/10/2020] [Indexed: 01/10/2023]
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13
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Liu DT, Besser G, Parzefall T, Riss D, Mueller CA. Winter peaks in web-based public inquiry into epistaxis. Eur Arch Otorhinolaryngol 2020; 277:1977-1985. [PMID: 32180015 PMCID: PMC7286850 DOI: 10.1007/s00405-020-05915-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/03/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Epistaxis represents the most frequent ear, nose, throat-related emergency symptom. Seasonal variation in epistaxis incidence, with peaks during winter months, is widely accepted, although the literature itself remains inconclusive. The objective of this study was to evaluate public inquiry into nose bleeding, by considering Google-based search query frequency on "Epistaxis"-related search terms and to assess possible seasonal variations globally. METHODS Epistaxis-related search terms were systematically collected and compared using Google Trends (GT). Relative search volumes for the most relevant epistaxis-related terms, covering a timeframe from 2004 to 2019 were analysed using cosinor time series analysis for the United States of America, Germany, the United Kingdom, Italy, Canada, Australia, and New Zealand. RESULTS Graphical representation revealed seasonal variations with peaks during winter months in the majority of countries included. Subsequent cosinor analysis revealed these variations to be significant (all p < 0.001). CONCLUSION Public interest in seeking epistaxis-related information through the Internet displayed seasonal patterns in countries from both hemispheres, with the highest interest during winter months. Further studies exploring causality with environmental factors are warranted.
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Affiliation(s)
- David Tianxiang Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Gerold Besser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Parzefall
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Dominik Riss
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christian A Mueller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Kallenbach M, Dittberner A, Boeger D, Buentzel J, Kaftan H, Hoffmann K, Jecker P, Mueller A, Radtke G, Guntinas-Lichius O. Hospitalization for epistaxis: a population-based healthcare research study in Thuringia, Germany. Eur Arch Otorhinolaryngol 2020; 277:1659-1666. [PMID: 32124006 PMCID: PMC7198635 DOI: 10.1007/s00405-020-05875-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/17/2020] [Indexed: 12/17/2022]
Abstract
Purpose Epistaxis is the most common ENT emergency. The aim was to determine population-based data on severe epistaxis needing inpatient treatment. Methods Retrospective population-based cohort study in the federal state Thuringia in 2016 performed on all 840 inpatients treated for epistaxis in otolaryngology departments (60.1% male, median age: 73 years; 63.9% under anticoagulation). The association between patients’ and treatment characteristics and longer inpatient stay (≥ 4 days) as well as readmission for recurrent epistaxis was analyzed using univariable and multivariable statistics. Results The overall incidence of epistaxis needing inpatient treatment was higher for men (42 per 100,000) than for women (28 per 100,000). The highest incidence was reached for men > 85 years (222 per 100,000). Most important independent predictors for longer inpatient stay were localization of the bleeding not in the anterior nose (OR = 2.045; CI = 1.534–2.726), recurrent bleeding during inpatient treatment (OR = 2.142; CI = 1.508–3.042), no electrocoagulation (OR = 2.810; CI = 2.047–3.858), and blood transfusion (OR = 2.731; CI = 1.324–5.635). Independent predictors for later readmission because of recurrent epistaxis were male gender (OR = 1.756; CI = 1.155–2.668), oral anticoagulant use (OR = 1.731; CI = 1.046–2.865), and hereditary hemorrhagic telangiectasia (OR = 13.216; CI 5.102–34.231). Conclusions Inpatient treatment of epistaxis seems to be variable in daily routine needing standardization by clinical guidelines and strategies to shorten inpatient treatment and to reduce the risk of readmission. Electronic supplementary material The online version of this article (10.1007/s00405-020-05875-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Max Kallenbach
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Andreas Dittberner
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Holger Kaftan
- Department of Otorhinolaryngology, Helios-Klinikum, Erfurt, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany
| | - Peter Jecker
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07740, Jena, Germany.
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McMullin B, Atkinson P, Larivée N, Chin CJ. Examining seasonal variation in epistaxis in a maritime climate. J Otolaryngol Head Neck Surg 2019; 48:74. [PMID: 31888757 PMCID: PMC6937692 DOI: 10.1186/s40463-019-0395-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022] Open
Abstract
Background Epistaxis is a common reason patients present to the emergency department. There is significant variation in climate across Canada. Our study aimed to determine if epistaxis is related to season, temperature and humidity in a Maritime climate. Methods Ethics approval was obtained. A retrospective chart review was performed. Patients who presented to the Saint John Regional Hospital Emergency Room between July 2015 and December 2017 with a diagnosis of epistaxis were identified. Weather data was collected from Environment Canada. We performed multiple univariate analyses examining confounding variables. Results In total, 476 cases of epistaxis were identified. There was a significant seasonal variation; the highest number of epistaxis cases occurred in the winter (p < 0.001). A negative correlation was seen between mean daily humidity and epistaxis (R2 = 0.7794). Conclusion The highest number of cases presented in the winter and a negative correlation was found between epistaxis and mean daily humidity.
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Affiliation(s)
- Ben McMullin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie University, Horizon Health Network, Saint John, NB, Canada
| | - Natasha Larivée
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Christopher J Chin
- Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada. .,Division of Otolaryngology- Head & Neck Surgery, Department of Surgery, Dalhousie University, Halifax, NS, Canada.
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One-year all-cause mortality for 338 patients admitted with epistaxis in a large tertiary ENT centre. The Journal of Laryngology & Otology 2019; 133:487-493. [PMID: 31062677 DOI: 10.1017/s0022215119000860] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Epistaxis is the most common ENT emergency. This study aimed to assess one-year mortality rates in patients admitted to a large teaching hospital. METHOD This study was a retrospective case note analysis of all patients admitted to the Queen Elizabeth University Hospital in Glasgow with epistaxis over a 12-month period. RESULTS The one-year overall mortality for a patient admitted with epistaxis was 9.8 per cent. The patients who died were older (mean age 77.2 vs 68.8 years; p = 0.002), had a higher Cumulative Illness Rating Scale-Geriatric score (9.9 vs 6.7; p < 0.001) and had a higher performance status score (2 or higher vs less than 2; p < 0.001). Other risk factors were a low admission haemoglobin level (less than 128 g/dl vs 128 g/dl or higher; p = 0.025), abnormal coagulation (p = 0.004), low albumin (less than 36 g/l vs more than 36 g/l; p < 0.001) and longer length of stay (p = 0.046). CONCLUSION There are a number of risk factors associated with increased mortality after admission with epistaxis. This information could help with risk stratification of patients at admission and enable the appropriate patient support to be arranged.
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Unsal AA, Dubal PM, Pfaff JA, Friedel ME, Eloy JA, Kountakis SE. Doctor Google: Correlating internet search trends for epistaxis with metropolitan climates. Am J Otolaryngol 2019; 40:358-363. [PMID: 30819541 DOI: 10.1016/j.amjoto.2019.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/01/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Variation in weather patterns is often cited as a risk factor for epistaxis although robust studies investigating specific climate factors are lacking. As society is increasingly utilizing the Internet to learn more about their medical conditions, we explore whether Internet search activity related to epistaxis is influenced by fluctuations in climate. METHODS Internet search activity for epistaxis-related search terms during 2012-2017 were extracted from Google Trends and localized to six highly populated cities in the US: New York, New York; Los Angeles, California; Chicago, Illinois; Houston, Texas; Philadelphia, Pennsylvania; and Atlanta, Georgia. Data were compared to local average monthly climate data from the National Centers for Environmental Information for the same time period. RESULTS Spearmen correlations (r) were statistically strongest for dew point temperature (rNewYork = -0.82; rPhiladelphia = -0.74; rChicago = -0.65; rAtlanta = -0.49, rLosAngeles = -0.3). This was followed closely by relative humidity (rNewYork = -0.63; rPhiladelphia = -0.57; rLosAngeles = -0.44; rAtlanta = -0.42; rHouston = -0.40) and average temperature (rNewYork = -0.8; rPhiladelphia = -0.72; rChicago = -0.62; rAtlanta = -0.45). Overall, correlations were most significant and predictable for cities with the greatest seasonal climate shifts (New York, Philadelphia, and Chicago). The weakest environmental factor was barometric pressure, which was found to be moderately positive in Atlanta (rbarometric = 0.31), Philadelphia (rbarometric = 0.30) and New York (rbarometric = 0.27). CONCLUSIONS Google Trends data for epistaxis-related search activity responds closely to climate patterns in most cities studied, thus underscoring the potential utility of Internet search activity data as a resource for epidemiologic study and for the identification of at risk populations.
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HELLÍN-VALIENTE E, MERINO-GÁLVEZ E, HELLÍN-MESEGUER D. Estudio retrospectivo sobre la incidencia y tratamiento de epistaxis en un área de salud en el período 2011 a 2017. REVISTA ORL 2019. [DOI: 10.14201/orl.18642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hey SY, Koo Ng NKF, McGarry GW. Endoscopic Sphenopalatine Artery Ligation: General Applicability in a Teaching Unit. EAR, NOSE & THROAT JOURNAL 2019; 98:85-88. [PMID: 30884999 DOI: 10.1177/0145561319828675] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND: Endoscopic sphenopalatine artery ligation (ESPAL) is the intervention of choice for refractory epistaxis in specialist ear, nose and throat (ENT)units and should be within the repertoire of competencies for all ENT trainees. Following its recent incorporation within the United Kingdom competency-based training syllabus as an explicit outcome standard, the ESPAL is not uncommonly being delivered by trainees under appropriate supervision. We assessed the efficacy and outcome of ESPAL in epistaxis management within our teaching hospitals. METHODS: Retrospective, structured review of all ESPAL procedures performed for epistaxis between December 2005 and December 2013. The techniques of ligation, operator grade, and outcome were studied. RESULTS: Sixty-five patients (41 male:24 female; average age of 58.2 years) were identified in whom 67 artery ligations were performed (63 unilateral; 2 bilateral). Overall, success rate of ESPAL was 92.3% (60/65), with 5 rebleed cases recorded within 30 days of the primary procedure. Sixteen (24.6%) underwent "clipping," 26 (40.0%) had diathermy ligation, 18 (27.7%) had both clipping and diathermy, and in 5 (7.7%) patients, the ligation technique was not recorded. In 31 (47.7%) of 65 cases, a consultant was the principal surgeon. The remaining 34 (52.3%) of 65 cases were performed by trainees with (24, 70.6%) or without (10, 29.4%) supervision. There was no correlation between rebleed and operators' grade, level of supervision, or ligation technique. CONCLUSION: With appropriate training, ESPAL can achieve hemostasis in teams of varying grades of operators without significant reduction in outcome. To further enhance the technical learning curve, the utility of simulation-based training could offer continuous and longitudinal development of skills.
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Affiliation(s)
- Shi Ying Hey
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Nigel K F Koo Ng
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Gerald W McGarry
- 1 Department of Otolaryngology-Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Shorter hospital stays in epistaxis patients with atrial fibrillation when taking rivaroxaban or apixaban versus phenprocoumon. J Thromb Thrombolysis 2019; 47:384-391. [PMID: 30729376 DOI: 10.1007/s11239-019-01824-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Patients taking oral anticoagulants (OACs) currently represent one-third of all patients treated for epistaxis and an upward trend is expected. New direct oral anticoagulants (DOACs) have been on the market for approximately 10 years. DOACs are favoured over Vitamin K-Antagonists (VKAs) in the current guidelines. There are barely studies that investigate the impact of DOACs on patients with epistaxis. A retrospective study was performed analysing all patients who had stationary treatment for epistaxis from 01.01.2011 to 01.01.2018 in a tertiary care centre. In a total of 466 patients, 46.1% were on OACs. The main indication was atrial fibrillation (AF, 67.4%).The number of DOACs taken surpassed that of the VKAs during the past 2 years. The length of hospital stay was significantly longer in the phenprocoumon group (3 ± 0.2 days) in comparison to both the rivaroxaban (2.3 ± 0.1) and the apixaban (2.2 ± 0.1) groups (p = 0.005). Posterior epistaxis occurred more frequently in the phenprocoumon group (10.8%) than in the rivaroxaban (0%) and apixaban (0%) groups (p = 0.03). A correlation between CHA2DS2-VASc score (risk score for apoplexy in patients with AF, p = 0.01), HAS-BLED score (score for assessment of major bleeding in patients taking anticoagulants with AF, p = 0.006), and length of hospital stay (p = 0.002) with recurrence of epistaxis was found. Shorter hospital stays and exclusively anterior bleeding was noted in AF patients taking rivaroxaban and apixaban, whereas AF patients taking phenprocoumon stayed in hospital longer and had more posterior bleeding.
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Akdoğan MV, Hızal E, Semiz M, Topal Ö, Akkaş H, Kabataş A, Erbek SS. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis. EAR, NOSE & THROAT JOURNAL 2019; 97:E1-E5. [PMID: 30273433 DOI: 10.1177/014556131809700901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 μm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.
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Affiliation(s)
- M Volkan Akdoğan
- Department of Otorhinolaryngology, Baskent University Konya Research and Teaching Center, Saray Caddesi No:1 Selcuklu, Konya, 42080 Turkey.
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22
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Deng D, Du J, Liu F, Zhong B, Qiao Y, Liu Y. Clinical characteristics of internal carotid artery pseudoaneurysms in the sphenoid sinus. Am J Otolaryngol 2019; 40:106-109. [PMID: 30472125 DOI: 10.1016/j.amjoto.2018.09.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/17/2018] [Accepted: 09/19/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Internal carotid artery (ICA) pseudoaneurysms are associated with high mortality if lack of proper management. Patients with ICA pseudoaneurysms in the sphenoid sinus often visit a hospital's ear, nose and throat (ENT) department due to nasal bleeding. In such cases, simple examination and therapy will lead to misdiagnosis. OBJECTIVE This study sought to investigate the clinical characteristics, diagnostic methods and treatment of ICA pseudoaneurysms in the sphenoid sinus. METHODS Various data, including clinical features, imaging examination results, and treatment and prognosis information, were collected and analyzed for 8 patients who visited the Department of Otolaryngology, Head & Neck Surgery of West China Hospital from March 2008 to January 2017. RESULTS The patients included 6 males and 2 females (ages 16 to 56 years). Repeated epistaxis was a common symptom in six of the eight patients (6/8), whereas monocular blindness and binocular blindness were observed in the other two patients. Head trauma was found to play a role in the induction of ICA pseudoaneurysms, given that five patients (5/8) exhibited a specific history of head injury. CT examination tended to result in misdiagnosis, whereas MRI and digital subtraction angiography (DSA) were helpful for obtaining a definite diagnosis with all diagnoses were confirmed via DSA. Coated stent intervention was performed in five patients, while carotid artery ligation was performed in two patients in emergency situations: one of whom exhibited paraplegia, but recovery was ultimately observed after rehabilitation. Moreover, failure of coated stent intervention in one patient was resolved via additional unilateral common carotid artery ligation. Furthermore, one patient with vision loss experienced vision restoration. One patient discontinued treatment for personal reasons and was lost to follow-up. No recurrence was observed in the other 7 patients. CONCLUSION ICA pseudoaneurysms in the sphenoid sinus are uncommon. To accurately identify ICA pseudoaneurysms, collaboration between otolaryngologists and imaging specialists is essential. On the other hand, both surgical and interventional treatments can achieve good results; therefore, otolaryngologists should enhance their cooperation with neurosurgery and intervention departments. Accurate diagnosis and rapid treatment are keys to managing ICA pseudoaneurysms.
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Affiliation(s)
- Di Deng
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Jintao Du
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
| | - Feng Liu
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Bing Zhong
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yixin Qiao
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
| | - Yafeng Liu
- Department of Otorhinolaryngology Head & Neck surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China.
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Reis LR, Correia F, Castelhano L, Escada P. Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018. [DOI: 10.1016/j.otoeng.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Glikson E, Chavkin U, Madgar O, Sagiv D, Nakache G, Yakirevitch A, Wolf M, Alon EE. Epistaxis in the setting of antithrombotic therapy: A comparison between factor Xa inhibitors, warfarin, and antiplatelet agents. Laryngoscope 2018; 129:119-123. [DOI: 10.1002/lary.27400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Eran Glikson
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | | | - Ory Madgar
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Doron Sagiv
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
| | - Gabriel Nakache
- Department of Otolaryngology-Head and Neck Surgery; Rabin Medical Center; Petach Tikva Israel
| | - Arkadi Yakirevitch
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Michael Wolf
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Eran E. Alon
- Department of Otolaryngology-Head and Neck Surgery; Sheba Medical Center; Tel-Hashomer Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
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Zhou AH, Chung SY, Sylvester MJ, Zaki M, Svider PS, Hsueh WD, Baredes S, Eloy JA. To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly. Am J Rhinol Allergy 2018; 32:539-545. [PMID: 30270635 DOI: 10.1177/1945892418801259] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. METHODS The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. RESULTS A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). CONCLUSION Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.
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Affiliation(s)
- Albert H Zhou
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Sei Y Chung
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael J Sylvester
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Michael Zaki
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Peter S Svider
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Wayne D Hsueh
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Soly Baredes
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Jean Anderson Eloy
- 1 Department of Otolaryngology - Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 2 Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Rutgers New Jersey Medical School, Newark, New Jersey
- 3 Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
- 4 Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, New Jersey
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Abstract
AIM The goal of the present study was to analyze the seasonal variation of epistaxis in ear, nose, and throat (ENT) practices in Germany in 2016. METHODS The present study sample included patients who received a first epistaxis diagnosis from physicians in 114 ENT practices in Germany between January 2016 and December 2016. The number of epistaxis patients per practice was calculated for each month. A logistic regression model, adjusted for age and sex, was used to calculate the association between epistaxis diagnosis and the month. RESULTS The authors found a total of 15,523 patients with epistaxis in 114 ENT practices. Of these patients, 55.9% were men and the mean age was 47.8 ± 27.6 years. The highest number of epistaxis patients was found in February (14.89 patients per practice) and the lowest in August (7.22 patients per practice). The age- and sex-adjusted risk of epistaxis was significantly higher in the months of February (OR = 1.32), March (OR = 1.37), April (OR = 1.34), May (OR = 1.35), and December (OR = 1.33) compared with August. CONCLUSIONS The presentation of patients with epistaxis at German ENT practices shows a marked seasonal variation with a low in the summer, an increase in fall and winter, and a peak in February, March, and April.
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Is the occurrence of pediatric epistaxis related to climatic variables? Int J Pediatr Otorhinolaryngol 2018; 113:182-187. [PMID: 30173981 DOI: 10.1016/j.ijporl.2018.07.053] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/29/2018] [Accepted: 07/29/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the correlations between multiple meteorological variables and the frequency of epistaxis in the pediatric population. METHODS Children diagnosed with epistaxis in 2016 and 2017 were selected from the Outpatient Department of the Children's Hospital of Zhejiang University School of Medicine. The correlations between multiple meteorological factors and the incidence of pediatric epistaxis each month, were analyzed. A Poisson regression model was generated to predict the cases of pediatric epistaxis using both the 2-year study data and the 4-month new data. RESULTS There were 6805 cases of pediatric epistaxis (mean age 4.99 years). Contrary to previously reported inverse associations between ambient temperature and presentation rates for patients with epistaxis, a significant strong positive correlation was found between temperature and pediatric epistaxis rates (Pearson's r = 0.801 p < 0.001). A weak negative correlation between humidity and pediatric epistaxis was found, but it was not significant (Pearson's r = -0.225 p = 0.29). A very strong positive correlation between high air visibility and pediatric epistaxis was identified (Pearson's r = 0.909 p < 0.001). The predictions from the Poisson regression model have a mean error rate of 5.70% ± 22.71%. CONCLUSION A positive correlation between the frequency of pediatric epistaxis existed for both temperature and air visibility. No significant correlation was found for humidity.
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Moon S. Comprehensive understanding of vascular anatomy for endovascular treatment of intractable oronasal bleeding. Yeungnam Univ J Med 2018; 35:7-16. [PMID: 31620565 PMCID: PMC6784680 DOI: 10.12701/yujm.2018.35.1.7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 04/26/2018] [Accepted: 05/11/2018] [Indexed: 11/04/2022] Open
Abstract
Oronasal bleeding that continues despite oronasal packs or recurs after removal of the oronasal packs is referred to as intractable oronasal bleeding, which is refractory to conventional treatments. Severe craniofacial injury or tumor in the nasal or paranasal cavity may cause intractable oronasal bleeding. These intractable cases are subsequently treated with surgical ligation or endovascular embolization of the bleeding arteries. While endovascular embolization has several merits compared to surgical ligation, the procedure needs attention because severe complications such as visual disturbance or cerebral infarction can occur. Therefore, comprehensive understanding of the head and neck vascular anatomy is essential for a more effective and safer endovascular treatment of intractable oronasal bleeding.
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Affiliation(s)
- Sungjun Moon
- Department of Radiology, Kyungpook National University School of Medicine, Daegu, Korea
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Buchberger AMS, Baumann A, Johnson F, Peters N, Piontek G, Storck K, Pickhard A. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol 2018; 275:2035-2043. [PMID: 29936627 PMCID: PMC6060781 DOI: 10.1007/s00405-018-5043-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/16/2018] [Indexed: 01/13/2023]
Abstract
Purpose The purpose of this retrospective study was to identify the impact of oral anticoagulants on epistaxis with the focus on new oral anticoagulants. Methods The study was conducted at the Department for Ear- Nose- and Throat (ENT), Head and Neck Surgery, Technical University Munich, Germany. All patients presenting in 2014 with the diagnosis of epistaxis to a specialized ENT accident and emergency department were identified and analyzed in clinical data and medication. Results 600 adult cases, with a median age of 66.6 years were identified with active bleeding. 66.8% of all cases were anticoagulated. Classic oral anticoagulants (COAC) were three times more common in patients than new-generation oral anticoagulants (NOAC). Recurrent bleeding was significantly associated with oral anticoagulants (OAC) (p = 0.014) and bleeding location was most often anterior (p = 0.006). In contrast, severe cases, which required surgery or embolization were significantly more likely in non-anticoagulated middle-aged patients with posterior bleedings (p < 0.05). In our epistaxis cohort, OAC were highly overrepresented (40%) when compared to the general German population (1%) but COAC as well as NOAC played only a minor role in severe courses of epistaxis. Conclusion Oral anticoagulation, especially with new-generation drugs, is not associated with more complicated and severe courses of epistaxis, but rather with recurrent bleeding. One should keep this information in mind when triaging the patient in the emergency room and when planning further procedures.
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Affiliation(s)
- A M S Buchberger
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Baumann
- Department of Otolaryngology Head and Neck Surgery, Helios Amper-Klinikum Dachau, Krankenhausstraße 15, 85221, Dachau, Germany.
| | - F Johnson
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - N Peters
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - G Piontek
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - K Storck
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - A Pickhard
- Department for Ear- Nose- and Throat, Head and Neck Surgery, University hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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Reis LR, Correia F, Castelhano L, Escada P. Epidemiology of epistaxis in the emergency department of a southern European tertiary care hospital. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 69:331-338. [PMID: 29739664 DOI: 10.1016/j.otorri.2017.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 11/01/2017] [Accepted: 11/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Epistaxis is the most common rhinological emergency seen in the emergency department. The purpose of this study was to evaluate epidemiological data of epistaxis in a southern European tertiary care hospital. METHODS A retrospective study was conducted during the period between January 2009 and December 2015. We analyzed the distribution by cross-referencing the demographic variables, destination after medical discharge, inpatient characteristics (major comorbid diseases, medication, bleeding localization and treatment) and health-care costs with the disease. RESULTS Epistaxis accounted for approximately 1 in 30 visits to the ED and 77 out of a population of 100,000 was served by that ED. Overall, 71,624 patients were treated and 2371 patients presented with epistaxis (3.31%). One-thousand three-hundred and twenty-seven cases were male and 1044 female (p <.001). The mean age was 56 years (±26). Age distribution was bimodal, with peaks among those <10 years and >70 (p <.001). Epistaxis was more common in the winter months (p < 0.001). The main referral destinations (6.8%) included outpatient (2.9%) and inpatient (1.9%) services. Hospitalization was more frequent between the ages of 60 and 80 years (p =.029), and the major comorbidity was hypertension (47.8%). Medication interfering with haemostasis was documented in 30.4%. Most inpatient epistaxis was managed in a non-interventional manner and only. 5% of patients needed surgery. The mean total health-care cost was 69.8 € per episode. CONCLUSION Emergency epistaxis was more frequent in men, the elderly, patients with underlying comorbidities, during the winter months, and showed a higher risk of referral and hospitalization with increasing age (as a result of an aging population in western countries). The main hospital expenses for epistaxis are related to hospitalization and health care costs.
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Affiliation(s)
- Luis Roque Reis
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal.
| | - Filipe Correia
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Luis Castelhano
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
| | - Pedro Escada
- Department of Otolaryngology of Egas Moniz Hospital, Centro Hospitalar de Lisboa Ocidental (CHLO), NOVA Medical School - Faculdade de Ciências Médicas, Lisbon, Portugal
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Ording AG, Veres K, Farkas DK, Adelborg K, Sørensen HT. Risk of cancer in patients with epistaxis and haemoptysis. Br J Cancer 2018; 118:913-919. [PMID: 29462130 PMCID: PMC5886125 DOI: 10.1038/bjc.2017.494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022] Open
Abstract
This corrects the article DOI: 10.1038/bjc.2017.85.
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Affiliation(s)
- Anne G Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palme's Allé 43-45, Aarhus N 8200, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palme's Allé 43-45, Aarhus N 8200, Denmark
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palme's Allé 43-45, Aarhus N 8200, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palme's Allé 43-45, Aarhus N 8200, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palme's Allé 43-45, Aarhus N 8200, Denmark
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Beck* R, Sorge* M, Schneider A, Dietz A. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:12-22. [PMID: 29345234 PMCID: PMC5778404 DOI: 10.3238/arztebl.2018.0012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 05/15/2017] [Accepted: 10/17/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND The lifetime prevalence of epistaxis is approximately 60%, and 6-10% of the affected persons need medical care. In rare cases, severe bleeding calls for the rapid initiation of effective treatment. METHODS This review is based on pertinent articles that were retrieved by a selective search PubMed, and on the authors' clinical experience. RESULTS There are no German guidelines for the management of epistaxis. The available evidence consists mainly of retro spective analyses and expert opinions. 65-75% of the patients who require treatment can be adequately cared for by their primary care physician or by an emergency physician with baseline measures. If there is persistent anterior epistaxis, an otorhinolaryngologist can control the bleeding sastisfactorily in 78-88% of cases with chemical or electrical cauterization. Nasal packing is used if this treatment fails, or for posterior epistaxis. In a retrospective study, surgical treatment was found to be more effective than nasal packing in the treatment of posterior epistaxis (97% versus 62% treatment success). Percutaneous embolization is an alternative treatment for patients whom general anesthesia would put at high risk. CONCLUSION The treatment of severe or recurrent epistaxis requires the interdisciplinary collaboration of the primary care physician, the emergency physician, the practice-based otolaryngologist, and the hospital otolaryngology service. Uniform guidelines and epidemiological studies on this topic would be desirable.
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Affiliation(s)
- Rafael Beck*
- * Both authors contributed equally to this paper
- Department of Otolaryngology, University of Leipzig
| | - Martin Sorge*
- * Both authors contributed equally to this paper
- Department of Otolaryngology, University of Leipzig
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Masoudian P, McDonald JT, Lasso A, Kilty SJ. Socioeconomic status and anterior epistaxis in adult population. World J Otorhinolaryngol Head Neck Surg 2017; 4:263-267. [PMID: 30564789 PMCID: PMC6284191 DOI: 10.1016/j.wjorl.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/17/2017] [Accepted: 07/21/2017] [Indexed: 11/09/2022] Open
Abstract
Objective Little was known about the role of socioeconomic status as a risk factor for epistaxis in adult population. The objective of this study was to determine whether socioeconomic status influences the presentation to emergency department for anterior epistaxis in an adult population. Methods Retrospective review of emergency department visits from January 2012 to May 2014. The setting is in an emergency department of a Canadian tertiary care centre. Adult patients with primary diagnosis of anterior epistaxis in the emergency department were included in this study. The main outcome was emergency department visits for anterior epistaxis visits. Results A total of 351 cases of anterior epistaxis were included. The mean age was 70 years and 51% of patients were male. The patients were stratified into two groups based on whether their age was equal to and above, or below 75 years. Our analysis indicated that those 75 years or older in higher income quintiles have an increased risk of anterior epistaxis compared to the subjects in the lower income quintiles (P < 0.05). This association did not hold true for those younger than 75 years or for all age groups combined. Conclusion There is an association between higher socioeconomic status and the presentation to the emergency department with anterior epistaxis in the population older than 75 years but not in younger patients.
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Affiliation(s)
| | - J Ted McDonald
- Department of Economics, University of New Brunswick, Fredericton, NB, Canada
| | - Andrea Lasso
- The Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada
| | - Shaun J Kilty
- The Ottawa Hospital Research Institute (OHRI), Ottawa, ON, Canada.,Department of Otolaryngology-Head and Neck Surgery, The University of Ottawa, Ottawa, ON, Canada
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Sauter T, Hegazy K, Hautz W, Krummrey G, Ricklin M, Nagler M, Borner U, Exadaktylos A. Epistaxis in anticoagulated patients: Fewer hospital admissions and shorter hospital stays on rivaroxaban compared to phenprocoumon. Clin Otolaryngol 2017; 43:103-108. [DOI: 10.1111/coa.12904] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/30/2022]
Affiliation(s)
- T.C. Sauter
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
| | - K. Hegazy
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
| | - W.E. Hautz
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
| | - G. Krummrey
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
| | - M.E. Ricklin
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
| | - M. Nagler
- Department of Haematology and Central Haematology Laboratory; Inselspital University Hospital; Bern Switzerland
| | - U. Borner
- Department of Otorhinolaryngology; Head and Neck Surgery; Inselspital University Hospital; Bern Switzerland
| | - A.K. Exadaktylos
- Department of Emergency Medicine; Inselspital, University Hospital Bern; Bern Switzerland
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Cohen O, Shoffel-Havakuk H, Warman M, Tzelnick S, Haimovich Y, Kohlberg GD, Halperin D, Lahav Y. Early and Late Recurrent Epistaxis Admissions: Patterns of Incidence and Risk Factors. Otolaryngol Head Neck Surg 2017; 157:424-431. [PMID: 28463569 DOI: 10.1177/0194599817705619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Epistaxis is a common complaint, yet few studies have focused on the incidence and risk factors of recurrent epistaxis. Our objective was to determine the patterns of incidence and risk factors for recurrent epistaxis admission (REA). Study Design Case series with chart review. Settings Single academic center. Subjects and Methods The medical records of patients admitted for epistaxis between 1999 and 2015 were reviewed. The follow-up period was defined as 3 years following initial admission. REAs were categorized as early (30 days) and late (31 days to 3 years) following initial admission. Logistic regression was used to identify potential predictors of REAs. Results A total of 653 patients were included. Eighty-six patients (14%) had REAs: 48 (7.5%) early and 38 (6.5%) late. Nonlinear incidence curve was demonstrated for both early and late REAs. Based on logistic regression, prior nasal surgery and anemia were independent risk factors for early REAs. According to multivariate analysis, thrombocytopenia was significantly associated with late REAs. Conclusion Early and late REAs demonstrate different risk predictors. Knowledge of such risk factors may help in risk stratification for this selected group of patients. All patients at risk should be advised on possible preventive measures. Patients at risk for early REA may benefit from a more proactive approach.
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Affiliation(s)
- Oded Cohen
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Hagit Shoffel-Havakuk
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Meir Warman
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Sharon Tzelnick
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Yaara Haimovich
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Gavriel D Kohlberg
- 3 Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital-Columbia and Weill Cornell Campuses, New York, New York, USA
| | - Doron Halperin
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
| | - Yonatan Lahav
- 1 Department of Otolaryngology-Head and Neck Surgery, Kaplan Medical Center, Rehovot, Israel.,2 Hadassah Medical School, Hebrew University, Jerusalem, Israel
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Reinberg AE, Dejardin L, Smolensky MH, Touitou Y. Seven-day human biological rhythms: An expedition in search of their origin, synchronization, functional advantage, adaptive value and clinical relevance. Chronobiol Int 2016; 34:162-191. [DOI: 10.1080/07420528.2016.1236807] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Alain E. Reinberg
- Unité de Chronobiologie, Fondation Adolphe de Rothschild, Paris Cedex, France
| | - Laurence Dejardin
- Unité de Chronobiologie, Fondation Adolphe de Rothschild, Paris Cedex, France
- Hôpital Français Saint Louis, Jerusalem, Israel
| | - Michael H. Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
| | - Yvan Touitou
- Unité de Chronobiologie, Fondation Adolphe de Rothschild, Paris Cedex, France
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Mangussi-Gomes J, Enout MJR, Castro TCD, de Andrade JSC, Penido NDO, Kosugi EM. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study. Acta Otolaryngol 2016; 136:1184-1189. [PMID: 27295576 DOI: 10.1080/00016489.2016.1191673] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION Epistaxis has a bimodal age distribution. Anterior epistaxis of mild severity is more common in children; severe epistaxis occurs more often in adults and elderly patients. The occurrence of spontaneous epistaxis was shown to be weakly-to-moderately and inversely correlated to the mean monthly temperature, relative humidity and total rainfall. OBJECTIVES To describe the clinical and epidemiological profiles of patients diagnosed with spontaneous epistaxis; to correlate its monthly occurrence with meteorological variables. METHODS A retrospective cross-sectional study was performed in a referral ENT service in São Paulo, Brazil. The study assessed the clinical and epidemiological features of 508 patients with spontaneous epistaxis treated between February 2010 and January 2011. The occurrence of epistaxis was associated with weather variables for the same study period. RESULTS Spontaneous epistaxis presented two age peaks of higher incidence (11-20 and 51-70 years). Children more frequently had localized bleeding (p = 0.003), in the anterior region of the nasal cavity (p = 0.0001), of absent-mild severity (p = 0.0082). Diffuse bleeding (p = 0.005), of moderate-severe intensity (p = 0.003), was more common in adults and elderly patients. The total number of visits because of epistaxis was inversely correlated to mean temperature (R = -0.489; p = 0.011), mean relative humidity (R = -0.364; p = 0.038), and total rainfall (R = -0.512; p = 0.009) during each month of the analyzed period.
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Chaaban MR, Zhang D, Resto V, Goodwin JS. Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis. Otolaryngol Head Neck Surg 2016; 156:81-86. [DOI: 10.1177/0194599816667295] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To determine the demographics and seasonal and geographic variation of epistaxis in the United States. Study Design Retrospective cohort analysis based on data from Medicare claims. Setting Emergency department visits. Subjects and Methods We used a 5% sample of Medicare data from January 2012 to December 2012. Our cohort included patients with an incident diagnosis of epistaxis during a visit to the emergency department, excluding those with a diagnosis in the prior 12 months. Demographics included age, sex, race, and ethnicity. We compared the rate of emergency department visits for epistaxis by geographic division and individual states. Results In the 5% sample of Medicare data, 4120 emergency department visits for incident epistaxis were identified in 2012. Our results showed an increase in the emergency department visits for epistaxis with age. Compared with patients <65 years old, patients who were 66 to 76, 76 to 85, and >85 years old were 1.36 (95% confidence interval [95% CI], 1.23-1.50), 2.37 (95% CI, 2.14-2.62), and 3.24 (95% CI, 2.91-3.62) more likely to present with epistaxis, respectively. Men were 1.24 (95% CI, 1.17-1.32) times more likely to present with epistaxis than women. Blacks were 1.23 (95% CI, 1.10-1.36) times more likely to present with epistaxis when compared with non-Hispanic whites. Epistaxis emergency department visits were 40% lower in the summer months versus winter. The seasonal variation was more pronounced in the northern versus southern United States. Conclusion Emergency department visits for epistaxis increase with age and appear to be seasonal, with a more pronounced variation in the northern versus southern United States.
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Affiliation(s)
- Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Dong Zhang
- Sealy Center on Aging, Galveston, Texas, USA
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - James S. Goodwin
- Sealy Center on Aging, Galveston, Texas, USA
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA
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Comelli I, Vincenti V, Benatti M, Macri GF, Comelli D, Lippi G, Cervellin G. Influence of air temperature variations on incidence of epistaxis. Am J Rhinol Allergy 2016; 29:e175-81. [PMID: 26637565 DOI: 10.2500/ajra.2015.29.4239] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Epistaxis is the most common ear, nose, and throat emergency observed in the emergency department (ED). An increased frequency of this condition has been observed during cooler months, but the results of available studies are controversial. The aim of this study was to investigate the seasonality and association of epistaxis presentations to a large urban ED with variations of air temperature and humidity. METHODS This study was a retrospective case series. Information on all the patients who presented for epistaxis in the ED of the Academic Hospital of Parma during the years 2003-2012 and ages ≥ 14 years were retrieved from the hospital data base, excluding those attributable to trauma. The chronologic data of all visits were associated with climate data (air temperature and humidity) by univariate linear regression analysis. RESULTS Among the 819,596 ED patients seen throughout the observational period, 5404 were admitted for epistaxis. Of these, 5220 were discharged from the ED, whereas 184 (3.4%) needed hospital admission. A strong seasonality of epistaxis was observed, with a peak during winter. A strong negative correlation was also found between the daily number of epistaxes and the mean daily temperature in the whole population as well as in patient subgroups (those undergoing anticoagulant or antiplatelet therapy, or those with hypertension, inherited bleeding disorders, liver cirrhosis, or advanced malignancy). A weaker correlation was also found between air humidity and epistaxis but only in certain subgroups. CONCLUSIONS The results of this study provided a contribution to improve our understanding of the epidemiology of epistaxis and for specific health policies that should also be planned by considering the seasonality of nosebleed.
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Affiliation(s)
- Ivan Comelli
- Emergency Department, Academic Hospital of Parma, Italy
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Neurological involvement in hereditary hemorrhagic telangiectasia. J Neuroradiol 2016; 43:236-45. [PMID: 27059009 DOI: 10.1016/j.neurad.2016.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/06/2015] [Accepted: 02/11/2016] [Indexed: 11/22/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disorder characterized by epistaxis, telangiectases, and multi-organ vascular dysplasia. Head and neck localizations of HHT are recurrent, frequent associated with serious complications. The aim of this study was to describe the clinical and imaging patterns of neurological involvement in HHT and to discuss the role of interventional radiology in the management of HHT patients. Based on a multidisciplinary experience of twenty years at our center, we report here the different aspects of neurological involvement of HHT. Depending on the genetic type of the disease, vascular abnormalities may affect different organs. The knowledge of neurological involvement according to specific localization of HHT makes detection easier. As cerebral or spinal arteriovenous fistula may be present in patients with epistaxis or pulmonary arteriovenous malformations (PAVMs), radiologists should be able to detect high-risk lesions and prevent related complications. Finally, we review indications and techniques of embolization for hemorrhagic lesions and emphasize that endovascular therapies are very effective and safe in experienced hands. Head and neck imaging is commonly used for the diagnosis of HHT. Imaging plays also a key role for patient evaluation before treatment as pluridisciplinary management is needed.
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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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Kamble P, Saxena S, Kumar S. Nasal bacterial colonization in cases of idiopathic epistaxis in children. Int J Pediatr Otorhinolaryngol 2015; 79:1901-4. [PMID: 26384831 DOI: 10.1016/j.ijporl.2015.08.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 08/27/2015] [Accepted: 08/29/2015] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the role of nasal bacterial colonization in cases of idiopathic epistaxis in children. METHODS A descriptive, hospital based, observational study in our hospital was conducted on total 112 pediatric patients in the age group 4-16 years. Group A (control): 56 patients with no epistaxis; Group B (epistaxis): 56 patients with idiopathic epistaxis. A swab for microbiological evaluation was taken from the anterior nasal cavity of each child. RESULTS A highly significant association between nasal colonization with pathological Staphylococcus aureus and idiopathic epistaxis was found. The presence of pathological S. aureus colonization in the anterior nasal cavity was also associated with statistically significant number of crusting and presence of dilated blood vessels on the anterior nasal septum of children in epistaxis group. CONCLUSION Nasal bacterial colonization with S. aureus leads to a sequence of pathological events i.e. low grade inflammation, crusting and new vessel formation. This leads to irritation in nasal cavity resulting in digital trauma and subsequently epistaxis and thus it plays an important role in causing idiopathic epistaxis in children.
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Affiliation(s)
- Payal Kamble
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals Shaheed Bhagat Singh Marg, New Delhi 110001, India.
| | - Sonal Saxena
- Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals Shaheed Bhagat Singh MargNew Delhi 110001, India
| | - Sunil Kumar
- Department of Otorhinolaryngology-Head & Neck Surgery, Lady Hardinge Medical College & Associated Hospitals Shaheed Bhagat Singh Marg, New Delhi 110001, India
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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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Seidel DU, Remmert S, Brassel F, Schlunz-Hendann M, Meila D. Superselective microcoil embolization in severe intractable epistaxis: an analysis of 12 consecutive cases from an otorhinolaryngologic and an interventional neuroradiologic point of view. Eur Arch Otorhinolaryngol 2014; 272:3317-26. [PMID: 25502741 DOI: 10.1007/s00405-014-3427-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective microcoil embolization is a valuable addition to the therapeutic spectrum. From the interventional neuroradiologic point of view, superselective microcoil embolization is an effective, well tolerable and safe procedure and complications may be reduced in comparison to microparticle embolization. Modern supersoft microcoils with smallest diameters enable ideal superselectivity of the target vessels.
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Affiliation(s)
- D U Seidel
- Department of Otorhinolaryngology and Head and Neck Surgery, Malteser Hospital St. Anna, Albertus-Magnus-Straße 33, 47259, Duisburg, Germany.
| | - S Remmert
- Department of Otorhinolaryngology and Head and Neck Surgery, Malteser Hospital St. Anna, Albertus-Magnus-Straße 33, 47259, Duisburg, Germany
| | - F Brassel
- Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany
| | - M Schlunz-Hendann
- Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany
| | - D Meila
- Department of Radiology and Neuroradiology, Klinikum Duisburg-Sana Kliniken, Zu den Rehwiesen 9, D-47055, Duisburg, Germany. .,Department of Diagnostic and Interventional Neuroradiology, Medical School Hannover, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
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Szyszkowicz M, Shutt R, Kousha T, Rowe B. Air pollution and emergency department visits for epistaxis. Clin Otolaryngol 2014; 39:345-51. [DOI: 10.1111/coa.12296] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2014] [Indexed: 11/26/2022]
Affiliation(s)
- M. Szyszkowicz
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - R. Shutt
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - T. Kousha
- Population Studies Division; Health Canada; Ottawa ON Canada
| | - B.H. Rowe
- Department of Emergency Medicine and School of Public Health; University of Alberta; Edmonton AB Canada
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Abstract
Epistaxis, or nosebleed, is a common disorder that many patients will experience. Most patients go to the emergency room when they have an uncontrolled nosebleed, or they may present to an outpatient office. Most nosebleeds are not life-threatening and can be managed conservatively. Occasionally, hospital admission, referral to an otolaryngologist physician, and/or blood transfusion may be necessary. This article is an update on the latest information related to the prevention, causes, and treatment of epistaxis.
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Affiliation(s)
- Daniel J Morgan
- Wesley Medical Center, Wichita, KS, USA; Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214, USA.
| | - Rick Kellerman
- Department of Family and Community Medicine, University of Kansas School of Medicine-Wichita, 1010 North Kansas, Wichita, KS 67214, USA
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Duvdevani SI, Migirov L, Wolf M, Yakirevitch A. The rate of spontaneous epistaxis is not linked to the lunar cycle but shows seasonal variations. Chronobiol Int 2014; 31:851-4. [DOI: 10.3109/07420528.2014.916298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Sowerby LJ, DeSerres JJ, Rudmik L, Wright ED. Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada. J Otolaryngol Head Neck Surg 2014; 43:10. [PMID: 24755112 PMCID: PMC4026858 DOI: 10.1186/1916-0216-43-10] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/05/2014] [Indexed: 11/30/2022] Open
Abstract
Background Classical dogma holds that epistaxis is more common in winter months but there is significant variability reported in the literature. No study has yet examined the effect of season, humidity and temperature on epistaxis in a location with as severe weather extremes as seen in Alberta, Canada. The objective of the study is to evaluate for an effect of these meteorological factors on the incidence of epistaxis in Alberta. Method A retrospective review of consecutive adult patients presenting to the Emergency room (ER) in Edmonton and Calgary, Alberta over a three-year period was performed. Daily temperature and humidity data was recorded from the respective airports. Statistical analysis with Pearson’s correlation coefficient was performed. Results 4315 patients presented during the study period. Mean daily temperatures ranged from a low of -40°C to a high of +23°C. A significant negative correlation was found for mean monthly temperature with epistaxis (Pearson’s r = -0.835, p = 0.001). A significant correlation was also present for daily temperature and epistaxis presentation (Pearson’s r = -0.55, p = 0.018, range 1.8 to 2.2 events/day). No correlation was identified with humidity and no significant seasonal variation was present. Conclusions A negative correlation was found to exist for both daily and mean monthly temperature with rates of epistaxis. A seasonal variation was seen in Edmonton but not in Calgary. No correlation was found for humidity when compared to both presentation rates and admissions.
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Affiliation(s)
| | | | | | - Erin D Wright
- Division of Otolaryngology-Head & Neck Surgery, University of Alberta, Edmonton, AB, Canada.
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Spielmann PM, Barnes ML, White PS. Controversies in the specialist management of adult epistaxis: an evidence-based review. Clin Otolaryngol 2013; 37:382-9. [PMID: 23164264 DOI: 10.1111/coa.12024] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2012] [Indexed: 11/27/2022]
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