Role of season, temperature and humidity on the incidence of epistaxis in Alberta, Canada

Nasal Disorders

Nasal obstruction, rhinorrhea, and epistaxis are common presenting concerns in primary care clinics. Nasal disorders affect the quality of life for many children and families. Rarely, these complaints may represent a life-threatening condition among infant obligate nasal breathers or cases of unusual pathology. The most common causes of rhinorrhea and nasal obstruction vary by age and include physiologic, infectious, allergic, foreign body, irritant, and traumatic causes. Less commonly, children may have congenital malformations, sinonasal masses, or autoimmune disease. The most common causes of epistaxis are inflammatory, environmental, and traumatic causes and medication misuse, but rarely, children may have predisposing anatomic, hematologic, or vascular abnormalities or even sinonasal tumors. In this article, we provide a thorough review of the common nasal disorders treated every day in primary care clinics and mention briefly some of the rare but serious cases that may be overlooked without considering a full differential diagnosis.

Influence of meteorological variables on the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate (Lorca, Spain)

BACKGROUND AND OBJECTIVES

Epistaxis is a common emergency for otorhinolaryngologists. Although the aetiological factors have been widely studied, they remain subject to debate. The role of meteorological variables has been discussed in recent years, but results have been inconsistent. Given a lack of prior data, the aim of our study was to identify the meteorological variables that influence the frequency of visits and hospital admission for epistaxis in a city with a cold semi-arid climate in Spain.

METHODS

Case-control study.

CASES

patients who attended the accident and emergency department of a secondary level hospital for epistaxis over a 9-year period (2011-2019). Controls were established by simple random sampling among emergency rooms visits in general (patients who attended the same centre over the same period of time). Sociodemographic, clinical and meteorological variables were all taken into account.

RESULTS

2749 patients in the epistaxis group and 2764 in the control group. There were significant differences in the epistaxis group, with a higher proportion of male (62.85%) and older patients. Univariate and multivariate analysis revealed that the daily minimum temperature and maximum wind speed were factors significantly associated with the onset of epistaxis. In addition, logistic regression analysis showed that decreases in minimum temperature and increases in maximum wind speed were associated with an increase in epistaxis (p < 0.01). No association was found between hospital admission and the weather conditions.

CONCLUSION

Our findings suggest that low minimum temperatures and high wind speeds are associated with the number of visits to hospital accident and emergency departments for epistaxis, but not with hospital admission.

Environmental Risk Factors for Pediatric Epistaxis vary by Climate Zone

INTRODUCTION AND OBJECTIVE

Prior studies have provided variable results regarding environmental risk factors for epistaxis. These studies were conducted in varying climate zones, which may explain discrepancies in results. The objective of this study is to investigate correlations between season, temperature, and humidity on frequency of pediatric epistaxis across climate zones.

METHODS

Children seen in the outpatient setting for epistaxis were identified from the 2007-2010 IBM MarketScan database. Climate zones were assigned according to International Energy Conservation Code (IECC) classification, where temperature zones in the United States and territories were assigned on an ordinal scale from 1 (tropical) to 8 (subarctic), and humidity zones were categorized as moist, dry, or marine. The control population was a sample of all well-child visits matched by age and county.

RESULTS

We identified 184,846 unique children seen for epistaxis and 1,897,012 matched controls. Moderate temperature zones were associated with lower odds of epistaxis compared with the hottest and coldest zones. Humidity was associated inversely with epistaxis rates in moderate temperature zones but was not a significant predictor of epistaxis in climates with extreme heat. Additionally, summer was associated with lower odds of epistaxis compared to winter. Interestingly, however, there were significantly higher rates of cautery procedures during summer months, driven largely by increased procedures performed in clinic, as opposed to the operating room or emergency room.

CONCLUSIONS

Environmental risk factors for epistaxis vary by climate zone. The model presented reconciles prior reports and may allow for more personalized clinical management based on regional climate.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:1450-1456, 2024.

Environmental factors differentially affect epistaxis among preschool and school-aged children

Introduction

Environmental factors are closely associated with pediatric epistaxis. Whether this association differs according to age has not been previously reported. Therefore, we tried to evaluate the differences in associations between environmental factors and epistaxis in children of different ages.

Methods

A total of 20,234 patients with epistaxis who visited the hospital between January 1, 2002, and December 31, 2015, were enrolled in this study. The patients were divided into two groups according to their ages: preschool-aged (<6 years) and school-aged children (6-18 years). Daily, monthly, and yearly data on environmental factors were collected. We performed a stepwise logistic regression to identify the potential environmental risk factors for epistaxis in each age group.

Results

The mean number of epistaxis cases per month in both groups was highest in September. The cases were lowest in February in preschool-aged children and in November in school-aged children. Temperature, humidity, maximum wind speed, and sunshine duration were associated with epistaxis in preschool-aged children. Average wind speed, particulate matter (>10 μm diameter), temperature, humidity, sunshine duration, and sulfur dioxide concentration were associated with epistaxis in school-aged children.

Conclusion

This study indicates that the differences in environmental risk factors for epistaxis are associated with the patient's age.

Effect of Average Relative Humidity on Epistaxis

Background Epistaxis is a very common symptom. The occurrence of epistaxis may be affected by dry environments, but there are some differences among previous reports and this view is controversial. Objective We investigated the relationship between the number of epistaxes and daily average relative humidity. Methods Data on patients with epistaxis between March 2011 and February 2021 were collected from two hospitals. The daily average relative humidity was examined, and the change in the number of patients with epistaxis due to humidity was investigated using a generalized linear mixed model. Results A total of 4184 cases of epistaxis were identified. The number of epistaxis cases per day was significantly associated with the daily average relative humidity (p < 0.001). One percent increment in average relative humidity decreases the number of epistaxis cases per day by 1.1%. Conclusion A negative correlation was found to exist between daily average relative humidity and occurrences of epistaxis.

Epistaxis in a Pediatric Outpatient Clinic: Could It be an Alarming Sign?

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.

Minimal temperature, mean wind speed, and mean relative humidity are associated with spontaneous epistaxis in Seoul, Korea

OBJECTIVE

Epistaxis is a commonly encountered condition; however, factors that have been associated with epistaxis are controversial. Although several previous studies have evaluated the relationship between meteorological factors and epistaxis, studies conducted in Korea has been nearly reported. We attempted to evaluate the meteorological factors associated with the frequency of patients presenting with epistaxis in a tertiary hospital.

METHODS

We retrospectively reviewed the medical records of patients presenting with spontaneous epistaxis in an urban tertiary medical center, during one year. Patients with a clear etiology for epistaxis (such as trauma, previous surgery) were regarded as cases of secondary epistaxis and were excluded from this study. Daily climatic data were collected from the website of Korea Meteorological Administration. Meteorological factors affecting the frequency of patients presenting with epistaxis were statistically analyzed.

RESULTS

Among 350 enrolled subjects, 219 were males and 131 were females, and the mean age was 44.94 ± 26.02 years. Univariate and multivariate regression analyses revealed that minimal temperature and mean wind speed were significant factors that affected the presence of patients presenting with epistaxis to the hospital. Furthermore, ordinal logistic regression analysis showed that decreases in minimal temperature and mean relative humidity were associated with a increase in the number of patients presenting with epistaxis.

CONCLUSION

Minimal temperature and mean wind speed were significantly different between days with epistaxis and days without epistaxis patients presenting with epistaxis, and minimal temperature and mean relative humidity were associated with number of patients presenting with epistaxis. Our findings suggested that these meteorological factors might affect the spontaneous epistaxis in Seoul, Korea.

Geographic Variation in Epistaxis Interventions Among Medicare Beneficiaries

OBJECTIVES

To quantify the utilization of epistaxis procedures in the elderly population and assess whether the geographic variability of these procedures is associated with hypertension and direct oral anticoagulant (DOAC) use.

METHODS

A cross-sectional study was performed on publicly available Medicare procedure and beneficiary data from 2013 to 2016 for all epistaxis procedures categorized by Common Procedural Terminology (CPT). Epistaxis procedures were analyzed by state, complexity, and provider type. Pearson's correlation coefficient was calculated.

RESULTS

Over 4 years, 2 19 827 epistaxis procedures were performed on Medicare patients, 44.3% of which were categorized as simple (control of nasal hemorrhage: anterior simple or posterior primary). Otolaryngologists performed 92.6% of all epistaxis procedures. The frequency of epistaxis procedures performed by state ranged from 0.99 procedures per 10 000 Medicare beneficiaries (PP10K) in Hawaii to 25.7 PP10K in New Jersey. The percentage of epistaxis interventions categorized as complex (anterior complex, posterior subsequent, with nasal endoscopy, or open procedures) in each state varied from 0% in North Dakota to 72.6% in Hawaii. Epistaxis procedure utilization was weakly correlated with the prevalence of hypertension (R² = 0.08, P = .04) and higher percentage of DOAC among all anticoagulants prescribed (R² = 0.08, P = .04) in a state's Medicare population. Utilization of complex epistaxis interventions was not correlated with the prevalence of hypertension or DOAC use.

CONCLUSIONS

Otolaryngologists perform the vast majority of epistaxis procedures in the Medicare population. However, practice patterns vary across the United States. Hypertension and DOAC use are weakly associated with the utilization of epistaxis interventions.

Winter peaks in web-based public inquiry into epistaxis

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.

Examining seasonal variation in epistaxis in a maritime climate

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.

Characteristics and treatment of patients with epistaxis over the last 5 years in Guangzhou

Background:

Epistaxis is one of the most common emergencies in the department of otolaryngology, which gives a burden to the health care system.

Objectives:

This study aimed to investigate the patients’ characteristics of hospital admission with epistaxis and provide an optimized protocol.

Methods:

This study was a retrospective analysis of patients with epistaxis admitted to The Third Affiliated Hospital of Sun Yat-sen University in Guangzhou, China. The data were analyzed in terms of gender, age, seasonal differences, length and expenses of hospitalization, pathogenesis of epistaxis, primary medical management before hospital admission, bleeding sites, and treatment.

Results:

A total of 387 patients were included, which consisted of 270 males and 117 females with an average of 43 years. Most patients could be identified with underlying diseases, and the most commonly observed bleeding site was Little area (n = 164). Most patients received electrocauterization as a precision medical treatment (n = 288). The duration of hospitalization length ranged from a mean of 5.17–4.48 days, and the expenses of hospitalization ranged from a mean of RMB 4881–4951 yuan over the last 5 years.

Conclusion:

Most patients with epistaxis could be treated as outpatients by endoscopic electrocauterization, and hospitalization is indicated when patients need improvement of poor general condition, posterior packing, embolization, or surgery. This study enables to provide an optimized protocol for patient with epistaxis.

Doctor Google: Correlating internet search trends for epistaxis with metropolitan climates

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 (r_NewYork = -0.82; r_Philadelphia = -0.74; r_Chicago = -0.65; r_Atlanta = -0.49, r_LosAngeles = -0.3). This was followed closely by relative humidity (r_NewYork = -0.63; r_Philadelphia = -0.57; r_LosAngeles = -0.44; r_Atlanta = -0.42; r_Houston = -0.40) and average temperature (r_NewYork = -0.8; r_Philadelphia = -0.72; r_Chicago = -0.62; r_Atlanta = -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 (r_barometric = 0.31), Philadelphia (r_barometric = 0.30) and New York (r_barometric = 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.

The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis

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.

Seasonal Variation of Epistaxis in Germany

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.

Is the occurrence of pediatric epistaxis related to climatic variables?

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.

Epidemiological characteristics of pediatric epistaxis presenting to the emergency department

OBJECTIVE

Investigate the epidemiological characteristics of pediatric epistaxis in the emergency department setting.

STUDY DESIGN

Cross-sectional study using national databases.

METHODS

Children (age <18 years) presenting with a diagnosis of epistaxis were extracted from the State Emergency Department Databases for New York, Florida, Iowa, and California for the calendar year 2010. Associated diagnoses, procedures, encounter characteristics, and demographic data were examined.

RESULTS

There were 18,745 cases of pediatric epistaxis (mean age 7.54 years, 57.4% male). Overall, 6.9% of patients underwent procedures to control epistaxis, of which 93.5% had simple anterior epistaxis control. The distribution of pediatric epistaxis was highest in spring and summer months (p < 0.001). Children from the lowest income quartile comprised a higher proportion of epistaxis presentations (38.8%, p < 0.001), yet were least likely to have an epistaxis control procedure performed (p < 0.001). Most patients had either Medicaid (43.8%) or private insurance (41.3%). Patients with Medicaid and those without healthcare coverage were least likely to undergo an epistaxis control procedure (p < 0.001). White children were more likely to undergo an epistaxis control procedure compared to those of minority backgrounds (p < 0.001).

CONCLUSIONS

Most emergency department presentations of pediatric epistaxis are uninvolved cases that do not require procedural intervention. The overrepresentation of low socioeconomic status patients may suggest an overutilization of emergency services for minor cases of epistaxis, and perhaps a lack of access to primary care providers. This is the first study to evaluate racial and socioeconomic factors in relationship to pediatric epistaxis. Further investigation is needed to better elucidate these potential disparities.

Socioeconomic status and anterior epistaxis in adult population

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.

Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study

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.

Demographic, Seasonal, and Geographic Differences in Emergency Department Visits for Epistaxis

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.

Influence of air temperature variations on incidence of epistaxis

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.

Clinical Study of 1,515 Patients Presenting with Epistaxis Over the Last 6 Years

AIM

This study reviews our clinical experience of patients with epistaxis and discusses proper management.

PATIENTS AND METHODS

We retrospectively investigated 1,515 patients with epistaxis treated in our department between 2005 and 2010.

RESULTS

Men over 50 years old predominated. More than half of the patients (n = 828) first visited after consultation hours, and 40% (n = 606) were brought by ambulance. The most common underlying diseases were circulatory diseases (69%, n = 1,047). Antithrombotics were being administered to 23% (n = 345). Kiesselbach's plexus was the most commonly observed bleeding site (51%, n = 769). In 20% (n = 297), no bleeding point was confirmed because hemostasis had been achieved on arrival. Anterior packing was the most common primary treatment, followed by electrocauterization. Hospitalization was required in 2% (n = 30). Re-bleeding occurred within 14 days after primary treatment in 14% (n = 206). Surgical treatment was performed for 5% (n = 11).

CONCLUSIONS

Patients showing repeated pulsatile arterial bleeding require hospitalization for surgical therapy, although outpatient therapy is sufficient in most cases. A risk of re-bleeding should be considered if patients show unclarified bleeding points and circulatory diseases.

(Ton)silly seasons? Do atmospheric conditions actually affect post-tonsillectomy secondary haemorrhage rates?

Background:

Tonsillectomy is a common procedure, with potentially life-threatening complications. Previous investigations into post-tonsillectomy secondary haemorrhage rates suggest an influence of climactic and atmospheric conditions on haemorrhage rate, particularly temperature and water vapour pressure. With a single emergency department and a large variance in atmospheric conditions, Darwin, Australia, is ideal for investigating the effects of local climate on rates of post-operative haemorrhage.

Methods:

A five-year retrospective review was conducted of all tonsillectomy procedures performed between 2008 and 2013. Effects of atmospheric variables were examined using Pearson's correlation coefficient and analysis of variance.

Results:

A total of 941 patients underwent tonsillectomy in the study period. The bleeding rate was 7.7 per cent. No variation was found between wet and dry season tonsillectomies (p= 0.4). Temperature (p= 0.74), water vapour pressure (p= 0.94) and humidity (p= 0.66) had no effect on bleeding.

Conclusion:

The findings revealed no correlation between humidity, season, water vapour pressure and haemorrhage rates. Further research should use multi-site data to investigate the effect of air conditioning, humidification and climactic conditions between different regions in Australia.