Epistaxis in Port Harcourt

BACKGROUND

Epistaxis often causes significant anxiety in both patients and clinicians. Various methods of treatment have been advocated. The aim of this paper is to document the pattern of epistaxis in Port Harcourt, determine the etiologies and advocate the best treatment option.

METHODS

This is a 6-year retrospective study of patients that were managed for epistaxis in the department of Otorhinolaryngology of the University of Port Harcourt Teaching Hospital, Port Harcourt, from January 2000 to December, 2005. The material resources were the records of the Otorhinolaryngology outpatient clinic and Accident & Emergency department of the hospital. These were updated with records from the ward admissions and theatre. The diagnosis of epistaxis was based on clinical history, physical findings, laboratory and radiological investigations with examination under anaestheasia of the nose, nasopharynx and biopsy.

RESULTS

There were 30 patients, 16 males and 14 females with a mean age of 30.48 years +/- 15.14 [range 1-70 years]. The most commonly affected age group was 31-40 years. Idiopathic causes accounted for 66.67%, trauma 13.33%, nasopharyngeal carcinoma 10%, chronic maxillary sinusitis 6.67%, and vicarious menstruation 3.33%. The right nasal cavity was more affected than the left. The most commonly used method of treatment was anterior nasal packing (50%). Posterior nasal packing accounted for 26.67% while chemical cauterization was done in 13.3% of cases.

CONCLUSION

The pattern of epistaxis in our study agrees with the pattern found elsewhere. Anterior and posterior nasal packing were cost effective methods of treatment.

A prospective comparative study to examine the effects of oral diazepam on blood pressure and anxiety levels in patients with acute epistaxis

Objective: To examine the effects of oral diazepam on blood pressure and anxiety in patients with acute epistaxis.

Study design and setting: A prospective comparative study in an otorhinolaryngology tertiary referral centre.

Participants: Patients with acute epistaxis requiring hospital admission.

Intervention: Oral diazepam.

Main outcome measures: Anxiety and blood pressure levels.

Results: 32 patients received diazepam and 45 did not (control). On average, patients were hypertensive on admission (mean [standard deviation (SD)] systolic blood pressure diazepam group=157 mmHg [26], control=152 mmHg [23]; diastolic blood pressure diazepam group=87 mmHg [16], control=87 mmHg [18]). Both groups showed significant blood pressure reduction on discharge (p<0.0001) but the difference in mean blood pressure reduction between the two groups was insignificant (systolic blood pressure p=0.16, 95% confidence interval [CI]=–5 to +19 mmHg; diastolic blood pressure p=0.43, 95% CI=–8 to +10 mmHg). Anxiety was significantly lower on discharge (p<0.0001) but the difference in mean fall in anxiety scores between the two groups was insignificant (p=0.08, 95% CI=0 to +2). There was no significant correlation between total diazepam and changes in blood pressure (systolic blood pressure p=0.32; diastolic blood pressure p=0.65) or anxiety (p=0.73), nor between blood pressure and anxiety on admission (systolic blood pressure p=0.45; diastolic blood pressure p=0.72).

Conclusions: Elevated blood pressure and anxiety in acute epistaxis patients reduced on epistaxis resolution irrespective of oral diazepam use. The elevated blood pressure does not appear to be directly related to anxiety.

Rezidivierende Epistaxis bei hereditärer hämorrhagischer Teleangiektasie

BACKGROUND AND OBJECTIVE

Hereditary hemorrhagic telangiectasia (HHT) is an inherited autosomal dominant vascular disease, which can cause multiple symptoms, the cardinal one being chronic recurrent nosebleeds. The aim of this study was to determine, whether these chronic recurrent episodes are felt by the patients to be merely isolated episodes or affect their quality of life (QoL). Also assessed was the extent to which QoL is more impaired in patients with HHT than in those with other chronic diseases.

PATIENTS AND METHODS

This prospective cross-sectional study was based on a German questionnaire, "Profile of Quality of Life of Chronically Ill Patients"(PLC) together with a newly formulated questionnaire dealing with HHT-specific symptoms. Comparisons were made with German normative reference data, as well as with data from randomly selected patients with various chronic diseases.

RESULTS

90% of patients with HHT considered their recurrent nosebleeds to be the most disturbing symptom, interfering with hobbies and leisure time in 63% of them. Those with HHT had worse results in 5 of 6 PLC scales than those with other chronic diseases such as cardiomyopathy or rheumatic disease. 73% of the patients stated that they would appreciate new ways of treating these nosebleeds.

CONCLUSION

There is a great need for optimizing the treatment of chronic recurrent nosebleeds. Lasting reduction of such bleeds by new therapeutic methods seems unlikely to happen in the near future. For this reason multimodal treatment options, including psychological and relaxation techniques, should be considered. Such an approach may reduce the stress on patients (and subsequent nosebleeds) and result in a direct improvement of their quality of life.

Management of epistaxis in hereditary hemorrhagic telangiectasia by Nd:YAG laser and quality of life assessment using the HR-QoL questionnaire

The purpose of this study was to describe the results of Nd:YAG laser application in hereditary hemorrhagic telangiectasia (HHT) patients and to measure the Health-Related Quality of Life (HR-QoL) in patients with HHT before and after Nd:YAG laser application in a prospective, clinical trial at a university hospital. Twenty-seven consecutive patients with HHT and mild to moderate degrees of epistaxis were followed-up for 2 years after Nd:YAG laser treatments. Recurrence of epistaxis after Nd:YAG laser application and measurement of HR-QoL using the International Quality of Life Assessment questionnaire, version 1.1 (IQOLA 1.1), was found. Eight patients (30%) received only one Nd:YAG laser treatment, 15 (56%) had a recurrence and received a second treatment and 4 (14%) had two recurrences and received three Nd:YAG laser treatments. HR-QoL was improved 2 years after the first Nd:YAG laser application in both its Physical Health Dimension (47.5+/-2.9 vs. 38.1+/-2.3 before treatment, P <0.05) and Mental Health Dimension (45.1+/-2.7 vs. 39.6+/-2.4 before treatment, P <0.05). Although no curative treatment for HHT exists, Nd:YAG laser treatment seems to constitute a simple and efficient method of epistaxis control, resulting in a significant improvement in quality of life.

Management of life-threatening epistaxis in a Jehovah's Witness

The religious beliefs of Jehovah's Witnesses forbid them to receive blood or blood products. We report a case of life-threatening epistaxis in a Jehovah's Witness, causing severe anaemia (Hb 2.7 g/dl). The successful management of this case and literature relating to this are discussed.

Epistaxis: efficacy of arterial ligation and long-term outcome

Epistaxis is the most common otolaryngologic emergency requiring hospital admission. Patients with this disorder are usually managed conservatively beginning with the simplest mode of treatment with surgical arterial ligation being reserved for cases of failed nasal packing. The purpose of this retrospective review was to evaluate the efficacy of arterial ligation and document all of the complications secondary to these procedures, especially the minor complications secondary to transantral internal maxillary artery (IMAX) ligation. A total of 402 patients admitted to the Vancouver General Hospital between 1980-1990 with a primary diagnosis of epistaxis were the basis for this review. The hospital charts of those patients who underwent arterial ligation were reviewed. A phone questionnaire was directed to this group. External carotid artery (ECA) ligation was associated with a high rate of rebleeding (9/20-45%) during the 10 year follow-up period. IMAX ligation was an effective procedure for controlling epistaxis with a small number of rebleeds (3/29-10%). Although few major complications were noted in the IMAX ligation group, frequent minor complications were noted on prolonged follow-up. Despite this, patient satisfaction was very good in the IMAX ligation group.

Epistaxis

Epistaxis is discussed. Three unusual cases are reported. The first was a patient with a basal skull fracture due to a motor vehicle accident. He developed a carotid-cavernous fistula causing epistaxis severe enough to cause a cardiac arrest on one of his bouts of severe bleeding. The second was an unusual complication of a rhinoplasty due to damage to the anterior ethmoidal artery from the medial osteotomy. The third was due to psychopathology causing an adult female to traumatize her nose as an attention-getting or defence mechanism causing epistaxis with anemia requiring bi-annual blood transfusions of more than 175 units of blood over a 20 year period. Management is described.

Life threatening self-mutilation of the nose

Potentially life threatening self-mutilation of the nose in a patient with a severe passive aggressive character disorder is described. The phenomenological and psychodynamic features of this case are contrasted with those of schizophrenia and factitious dermatoses with similar excoriations.