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Mylonas S, Skoulakis C, Nikolaidis V, Hajiioannou J. Epistaxis Treatment Options: Literature Review. Indian J Otolaryngol Head Neck Surg 2023; 75:2235-2244. [PMID: 37636777 PMCID: PMC10447774 DOI: 10.1007/s12070-023-03824-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 04/20/2023] [Indexed: 08/29/2023] Open
Abstract
Epistaxis means bleeding from nostrils, nasal cavity or nasopharynx. To summarize the available epistaxis treatment options. Methods: 61 articles published in the last 20 years were included. Duplicate records, irrelevant and inaccessible ones were excluded. Epistaxis can be treated with first aid measures such as external pressure and ice packing and applying topical agents, e.g. oxymetazoline that stops 65-75% of nosebleeds in A&E. Also, with electrocautery which is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization and applying tranexamic acid that promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing. Furthermore, nasal packing can be applied with non-absorbable materials, e.g. petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino), absorbable materials, e.g. nasal tampon (Nasopore), and with newer hemostatic materials which are more effective and with fewer complications, e.g. hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan) and fibrin glue. Moreover, epistaxis can be achieved with endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing (97% vs. 62%), and with endoscopic cauterization which is more effective than ligation. Finally, for intractable cases embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate and comparable efficacy and complications to surgical methods. Epistaxis can be dealt with various methods depending on patient's history and available resources. Newer hemostatic agents in combination with endoscopic methods have advantages over traditional methods.
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Jones JM, Gannett C, Jones M, Winata E, Zhu M, Buckley L, Lazar J, Hedges JC, McCarthy SJ, Xie H. Development of a Hemostatic Urinary Catheter for Transurethral Prostatic Surgical Applications. Urology 2022; 165:359-365. [PMID: 35461919 PMCID: PMC10860670 DOI: 10.1016/j.urology.2022.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate a novel transurethral hemostatic catheter device with an integrated chitosan endoluminal hemostatic dressing (CEHD). Development and implementation of this technology may help address bleeding following surgery such as transurethral resection of prostate (TURP). Bleeding remains the most common complication following TURP, leading to increased morbidity and hospitalization. METHODS Investigation of hemostasis, delivery, safety and efficacy of the CEHD device is conducted using Female Yorkshire swine (N = 23). Hemostatic efficacy of the CEHD (N = 12) is investigated against a control of gauze (N = 12) in a splenic injury model (3 swine). The delivery, safety, and efficacy of the CEHD device (N = 10) are investigated against Foley-catheter control (N = 10) for 7 days using a swine bladder-neck-injury model. RESULTS In the splenic injury study, 9/12 CEHD dressings successfully achieved hemostasis within 150 seconds (mean 83 seconds) vs success of 6/12 (mean 150 seconds) for gauze (P = .04). In the 7-day study, the CEHD was successfully deployed in 10/10 animals and all dressings were tolerated without histologic or clinical adverse effect. Hemostasis of the CEHD device was found to be noninferior to control catheters. Noninferiority is attributed to low bleeding rates in the swine bladder neck injury model. CONCLUSION This investigation successfully demonstrated the feasibility of transurethral deployment of the CEHD in vivo. Routine use of safe and slowly dissolvable CEHDs could reduce the rate of complications and hospitalizations associated with bleeding and blood loss in TURP procedures. Further investigation is warranted.
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Affiliation(s)
- James M Jones
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | | | | | | | - Meihua Zhu
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Lisa Buckley
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jack Lazar
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR
| | - Jason C Hedges
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Urology, Oregon Health & Science University, Portland, OR
| | | | - Hua Xie
- The Center for Regenerative Medicine, Oregon Health & Science University, Portland, OR; Department of Surgery, Oregon Health & Science University, Portland, OR.
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Bui R, Doan N, Chaaban MR. Epidemiologic and Outcome Analysis of Epistaxis in a Tertiary Care Center Emergency Department. Am J Rhinol Allergy 2019; 34:100-107. [DOI: 10.1177/1945892419876740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The association between hypertension and recurrent epistaxis is controversial. The objective of this study is to examine the factors associated with recurrent epistaxis visits to the emergency department (ED) and establish an otolaryngology (ENT [ear, nose, and throat]) consult algorithm to optimize treatment and minimize unnecessary consultation. Methods A retrospective review of 100 patients presenting to the ED for epistaxis requiring ENT consult from 2013 to 2018 was conducted. Patient demographics, comorbidities, epistaxis etiology, blood pressure measurements during admission, and treatment methods were analyzed. Patient charts were reviewed for ED admissions, complications, and procedures. A consult algorithm was subsequently devised and retrospectively applied to our cohort. Results Patients who required more than one ED visit for epistaxis were more often males (77.8% vs 49.3%, P = .01), required posterior packing (51.9% vs 17 .8%, P < .001), and had more comorbid hypertension (66.7% vs 38.4%, P = .01) compared to patients who had 1 visit. Compared to patients presenting during summer and fall (May–October), patients presenting during winter and spring (November–April) were more often treated for anterior epistaxis with Surgicel®/Surgifoam® rather than posterior nasal packing (57.4% vs 37.0%, P = .04). Application of our consult algorithm decreased consultation by 78% and liberated 58.5 hours of ENT resident time. Conclusion Patients with recurrent epistaxis tended to be male and had more comorbid hypertension. Further prospective studies are warranted to ascertain the factors associated with recurrent epistaxis. Our consult algorithm for epistaxis helped reduce unnecessary ENT consultation and facilitated reallocation of valuable resident work hours.
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Affiliation(s)
- Roger Bui
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Nicolette Doan
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, Texas
| | - Mohamad R. Chaaban
- Department of Otolaryngology, University of Texas Medical Branch at Galveston, Galveston, Texas
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Intranasal packs and haemostatic agents for the management of adult epistaxis: systematic review. The Journal of Laryngology & Otology 2017; 131:1065-1092. [DOI: 10.1017/s0022215117002055] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:The mainstay of management of epistaxis refractory to first aid and cautery is intranasal packing. This review aimed to identify evidence surrounding nasal pack use.Method:A systematic review of the literature was performed using standardised methodology.Results:Twenty-seven eligible articles were identified relating to non-dissolvable packs and nine to dissolvable packs. Nasal packing appears to be more effective when applied by trained professionals. For non-dissolvable packs, the re-bleed rates for Rapid Rhino and Merocel were similar, but were higher with bismuth iodoform paraffin paste packing. Rapid Rhino packs were the most tolerated non-dissolvable packs. Evidence indicates that 96 per cent of re-bleeding occurs within the first 4 hours after nasal pack removal. Limited evidence suggests that dissolvable packs are effective and well tolerated by patients. There was a lack of evidence relating to: the duration of pack use, the economic effects of pack choice and the appropriate care setting for non-dissolvable packs.Conclusion:Rapid Rhino packs are the best tolerated, with efficacy equivalent to nasal tampons. FloSeal is easy to use, causes less discomfort and may be superior to Merocel in anterior epistaxis cases. There is no strong evidence to support prophylactic antibiotic use.
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Chaaban MR, Zhang D, Resto V, Goodwin JS. Factors influencing recurrent emergency department visits for epistaxis in the elderly. Auris Nasus Larynx 2017; 45:760-764. [PMID: 29208334 DOI: 10.1016/j.anl.2017.11.010] [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] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 11/14/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Our objective is to determine the risk factors associated with recurrent epistaxis requiring emergency department (ED) visits in the elderly. METHODS We used a 5% national sample of Medicare data from January 2012 through December 2013. Our cohort included patients with a new diagnosis of epistaxis in the ED, defined as no epistaxis in the prior 12 months. We assessed the rates of ED visits for recurrent epistaxis in the 12 months following the incident visit. Our variables included demographics, geographic location, procedures performed during the incident visit and comorbidities. RESULTS Out of the 4120 patients with incident epistaxis, 775 were readmitted with recurrent epistaxis within 12 months. 60% presented in the first 30days and 75% within 90 days. There was a significant increase in ED visits for patients over 75 years of age and in men compared to women. Recurrent ED visits for epistaxis was higher in patients with congestive heart failure, diabetes mellitus, and obstructive sleep apnea compared to those without these comorbidities. CONCLUSION Additional ED visits for epistaxis are more common in the elderly and in males. Congestive heart failure, diabetes mellitus and obstructive sleep apnea were found to be independent risk factors.
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Affiliation(s)
- Mohamad R Chaaban
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, United States.
| | - Dong Zhang
- Sealy Center on Aging, Galveston, TX, United States
| | - Vicente Resto
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, United States
| | - James S Goodwin
- Sealy Center on Aging, Galveston, TX, United States; Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, United States
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Zheng XL, Zhao YX, Xu M. Efficacy and Safety of 3 Nasal Packing Materials Used After Functional Endoscopic Sinus Surgery for Chronic Rhinosinusitis: A Comparative Study in China. Med Sci Monit 2017; 23:1992-1998. [PMID: 28441365 PMCID: PMC5412971 DOI: 10.12659/msm.899553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to investigate the efficacy and safety of 3 nasal packing products (silicone tube, Beschitin-F, and Aquacel1-Ag) after functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS) patients in China. Material/Methods Sixty-six CRS patients undergoing FESS surgery were randomly divided into 3 groups (22 patients in each group): the silicone tube group, the Beschitin-F group, and the Aquacel1-Ag group. Postoperative headache, nasal pain, nasal bleeding, and swelling of the nasal mucosa were observed at 1 month after FESS surgery. Bacteriology of chronic rhinosinusitis was conducted by culturing the removed nasal packing. Results The VAS scores of nasal pain in the silicone tube group were lower than in the Beschitin-F and the Aquacel1-Ag groups. The volume of nasal bleeding in the Beschitin-F group was higher than in the silicone tube and Aquacel1-Ag groups. The adhesion rate of the nasal cavity in the Beschitin-F1 group (2/22, 9.1%) was also higher than in the silicone tube group (0/22, 0%) and the Aquacel1-Ag group (0/22, 0%). The results of bacterial culture from removed nasal packing showed that coagulase-negative staphylococci (CNS) was more frequent in the silicone tube group than in the Beschitin-F and Aquacel1-Ag groups, but Streptococcus pneumonia, Haemophilus influenza, and Gram-negative rods were more common in the Aquacel1-Ag group than in the silicone tube and Beschitin-F groups. Conclusions These results indicate that the silicone tube may be more effective and safe than Beschitin-F and Aquacel1-Ag as nasal packing after FES surgery for CRS.
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Affiliation(s)
- Xi-Ling Zheng
- Department of Otorhinolaryngology, Medical School of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland).,Department of Otorhinolaryngology, The Affiliated Hospital of Yan'an University, Yan'an, Shaanxi, China (mainland)
| | - Yu-Xiang Zhao
- Department of Otorhinolaryngology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China (mainland)
| | - Min Xu
- Department of Otolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Odat H, Al-Qudah M. Endoscopic monopolar cauterization of the sphenopalatine artery: a single surgeons experience. Ann Saudi Med 2016; 36:422-426. [PMID: 27920415 PMCID: PMC6074210 DOI: 10.5144/0256-4947.2016.422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Epistaxis is one of the most common otolaryngology emergency conditions, and is usually treated conservatively by different types of nasal packs. A limited number of patients continue to bleed even with tightly fitted anterior and posterior packs in the nose. Such intractable epistaxis is managed by surgery or embolization. OBJECTIVES We reviewed the use and outcomes of endoscopic suction monopolar cauterization of the sphenopalatine artery. DESIGN Retrospective study. SETTING Tertiary academic center. PATIENTS AND METHODS Subjects who underwent consecutive monopolar sphenopalatine artery ligation for intractable epistaxis performed by a senior author from August 2010 to December 2014. MAIN OUTCOME MEASURE(S) Successful management of refractory epistaxis. RESULTS In 15 subjects (mean age 45 years; 10 men and 5 women) idiopathic epistaxis was the most common indication for surgery. Six patients had hypertension and three were on anticoagulation. One patient required bilateral cauterization and another had anterior ethmoid artery cauterization. The average operative time was 57 minutes. There was no major intra- or postoperative complications. Two patients underwent endoscopic sinus surgery to treat pathologies that were found during the procedure. All patients had healthy nasal and sinus mucosa during the follow-up period (average 17 months, range 1-70 months), and none suffered recurrent epistaxis. CONCLUSIONS Endoscopic monopolar cauterization of sphenopalatine artery is safe and effective for management of refractory epistaxis with minimal complications. It should be considered earlier in the algo- rithmic treatment of intractable epistaxis. LIMITATIONS Retrospective study, small number of patients, and no controls.
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Affiliation(s)
- Haitham Odat
- Haitham Odat, Department of Special Surgery,, Jordan University of Science and Technology,, Irbid 22110, Jordan, T: +962798201825, , ORCID: http://orcid.org/0000-0002-5148-7600
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Paramasivan S, Jones D, Baker L, Hanton L, Robinson S, Wormald PJ, Tan L. The Use of Chitosan–Dextran Gel Shows Anti-Inflammatory, Antibiofilm, and Antiproliferative Properties in Fibroblast Cell Culture. Am J Rhinol Allergy 2014; 28:361-5. [DOI: 10.2500/ajra.2014.28.4069] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Chitosan-dextran gel has been used as an antihemostatic agent and antiadhesive agent after endoscopic sinus surgery. Because Staphylococcus aureus biofilms have been implicated in recalcitrant chronic rhinosinusitis, this study aimed to further investigate the (i) anti-inflammatory, (ii) bacterial biofilm inhibition, (iii) antiproliferative effects, and (iv) wound-healing properties of chitosan and chitosan-dextran gel. Methods Fibroblasts were isolated from human nasal tissue and were used to determine the effects of chitosan and chitosan-dextran gel on (i) cell proliferation, (ii) wound healing, (iii) inflammation in fibroblast cultures challenged with superantigens S. aureus enterotoxin B (SEB) and toxic shock syndrome toxin (TSST), and (iv) on S. aureus biofilms. Results Chitosan was highly effective at reducing IL-8 expression after TSST and SEB challenge. Chitosan was also effective at reducing IL-8 expression of nonchallenged fibroblasts showing its anti-inflammatory effects on fibroblasts in a diseased state. Chitosan-dextran gel showed strong antibiofilm properties at 50% (v/v) concentration in vitro. Dextran, on its own, showed antibiofilm properties at 1.25% (w/v) concentration. Chitosan, on its own, reduced proliferation of fibroblasts to 82% of control proliferation and chitosan-dextran gel reduced proliferation of the fibroblasts to 0.04% of control proliferation. Relative to the no treatment controls, chitosan-dextran gel significantly delayed the wound-healing rate over the first 48 hours of the experiment. Conclusion Chitosan-dextran gel reduced fibroblast proliferation and wound-healing time, showing a possible mechanism of reducing adhesions in the postsurgical period. Chitosan reduced IL-8 levels, showing its anti-inflammatory properties. Chitosan-dextran gel and dextran treatment showed antibiofilm properties in our model.
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Affiliation(s)
- Sathish Paramasivan
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Damien Jones
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Leonie Baker
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Lyall Hanton
- Department of Polymer and Supra-molecular Chemistry, University of Otago, Dunedin, New Zealand
| | - Simon Robinson
- Department of Polymer and Supra-molecular Chemistry, University of Otago, Dunedin, New Zealand
| | - Peter J. Wormald
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
| | - Lorwai Tan
- Department of Surgery–Otorhinolaryngology, Head and Neck Surgery, University of Adelaide, Adelaide, Australia
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