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PubMed1991

The natural history of epistaxis in hereditary hemorrhagic telangiectasia.

The purpose of this retrospective study is to document the natural history of epistaxis in patients with hereditary hemorrhagic telangiectasia. A telephone questionnaire was administered to 73 patients who had been previously screened for pulmonary arteriovenous malformations (PAVMs). The incidence of epistaxis in this population was 93%, with a mean onset age of epistaxis of 12 years, a mean frequency of bleeding of 18 episodes per month, and a mean duration of bleeding of 7.5 minutes. More than 90% of patients experienced the onset of epistaxis before the age of 21 and symptoms were progressive with age. There were no differences in the age of onset, frequency of epistaxis, or duration of epistaxis between patients with PAVMs versus those without PAVMs. Although the natural history of epistaxis does not predict the presence or absence of pulmonary arteriovenous malformations, epistaxis is an early marker of the disease, hereditary hemorrhagic telangiectasia, and might guide screening for pulmonary and cerebral arteriovenous malformations in children of affected parents.

Adolescent↗
PubMed2001

Frequency of and risk factors for epistaxis associated with exercise-induced pulmonary hemorrhage in horses: 251,609 race starts (1992-1997).

OBJECTIVE: To determine the frequency of epistaxis during or after racing among racehorses and identify factors associated with development of epistaxis. DESIGN: Retrospective study. SAMPLE POPULATION: 247,564 Thoroughbred and 4,045 Anglo-Arab race starts. PROCEDURE: Race start information (breed, age, sex, racing distance, and race type) was obtained for Thoroughbred and Anglo-Arab horses racing in Japan Racing Association-sanctioned races between 1992 and 1997. All horses that raced were examined by a veterinarian within 30 minutes of the conclusion of the race; any horse that had blood at the nostrils was examined with an endoscope. If blood was observed in the trachea, epistaxis related to exercise-induced pulmonary hemorrhage (EIPH) was diagnosed. RESULTS: Epistaxis related to EIPH was identified following 369 race starts (0.15%). Frequency of EIPH-related epistaxis was significantly associated with race type, age, distance, and sex. Epistaxis was more common following steeplechase races than following flat races, in older horses than in horses that were 2 years old, following races < or =1,600 m long than following races between 1,601 and 2,000 m long, and in females than in sexually intact males. For horses that had an episode of epistaxis, the recurrence rate was 4.64%. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that frequency of EIPH-related epistaxis in racehorses is associated with the horse's age and sex, the type of race, and the distance raced. The higher frequency in shorter races suggests that higher intensity exercise of shorter duration may increase the probability of EIPH.

Age Factors↗
PubMedDate not supplied

Embolization for the treatment of idiopathic posterior epistaxis.

BACKGROUND: The goal of this study was to examine safety and efficacy of transarterial embolization for the treatment of idiopathic posterior epistaxis. METHODS: A retrospective chart review was conducted to characterize the underlying conditions of eighty-one consecutive patients for whom complete records were available presenting with posterior epistaxis, the associated risk factors for patients with idiopathic posterior epistaxis, and the success rate of embolization in this patient population. RESULTS: One hundred consecutive patients undergoing embolization for epistaxis were identified and 81 patients were included in the analysis. Nineteen patients did not have sufficient and retrievable medical records to be included in the study. Idiopathic posterior epistaxis was the most common underlying etiology of patients with refractory posterior epistaxis (34%). Hypertension, vascular disease, and diabetes were frequently detected comorbid diseases. Patients were equally as likely to be hypertensive as normotensive at the time of presentation (45 and 55%, respectively). Most patients (83%) had failed at least one prior treatment modality. Few patients had a recurrence of epistaxis within 72 hours (three patients [12%]) or had an adverse effect associated with embolization (three patients [12%]). CONCLUSION: Embolization for the treatment of posterior epistaxis is a safe and effective treatment modality.

Adult↗
PubMed1993

[Occurrence of epistaxis in relation to seasonal factors].

A retrospective study of the occurrence of epistaxis in relation to seasonal factors--mean monthly air temperature and atmospheric pressure is presented. During three consecutive years a total of 18 625 patients were seen in the ENT Clinic: 1,357 (7.3%) were suffering from epistaxis (about 38 patients with epistaxis per month). The epistaxis appeared more frequently in men (60.1%), aged from 41 to 60 years (41.3%) The Increased occurrence of epistaxis was related to the low temperature period. The highest occurrence of epistaxis was observed during the cold season--between December and April (from 9.2 to 13.36% of all patients seen per month), suggesting the relationship between epistaxis and infections of the upper respiratory tract. No relation between epistaxis and mean monthly atmospheric pressure was observed.

Adult↗
PubMed1997

Epistaxis: a retrospective review of hospitalized patients.

A 2-year retrospective study (August 1, 1992, to July 31, 1994) reviews medical records of 249 hospitalized epistaxis patients at seven Baltimore-area hospitals. This review represents the first multihospital study of patients hospitalized with epistaxis. The study evaluates multiple factors associated with epistaxis: demographics, underlying medical diseases, use of anticoagulation medication, site of epistaxis, and month of hospital admission. Blood transfusion requirement, hematocrit level, length of stay, treatment, and local/systemic complications are studied as well. The month of hospital admission was evenly distributed without a wintertime predominance, and the mean length of stay was 4 days. Treatment and outcome were similar in all hospitals, and more than 83% of patients responded to packing, balloon placement, local cautery, or a combination thereof. Of the 249 patients reviewed, 30 underwent surgical endoscopic cautery, 3 required formal surgical arterial ligation, and 1 underwent arterial embolization. All 30 endoscopic cauterizations successfully stopped the epistaxis, and this technique proved to be a useful adjunct for patients who required multiple interventions. The review identified a 3% complication rate of epistaxis and its treatment, including synechiae, aspiration, angina, myocardial infarction, and hypovolemia. No deaths were directly attributable to epistaxis or its treatment.

Adolescent↗
PubMed2001

A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood.

Epistaxis is common in children. Trials show antiseptic cream is as effective as cautery, but it is not known whether either is better than no treatment. We wished to know the efficacy of cream in children with recurrent epistaxis. The design was a single-blind, prospective, randomized controlled trial set in the Otolaryngology clinic in a children's hospital. The participants were 103 children referred by their general practitioner for recurrent epistaxis. Excluded were those with suspected tumours, bleeding disorders or allergies to constituents of the cream. Referral letters were randomized to treatment and no treatment groups. Treatment was antiseptic cream to the nose twice daily for 4 weeks, which was prescribed by the general practitioner before clinic attendance. All children were given an appointment for 8 weeks after randomization. The main outcome measures were the proportion of children in each group with no epistaxis in the 4 weeks preceding clinic review. Complete data were available for 88 (85%) of the children. Of the treatment group, 26/47 (55%) had no epistaxis in the 4 weeks before the clinic appointment. Of the controls, 12/41 (29%) had no epistaxis over the 4 weeks. This is a relative risk reduction of 47% for persistent bleeding (95% CI 9-69%) and an absolute risk reduction of 26% (95% CI 12-40%), giving a number needed to treat of 3.8 (95% CI 2.5-8.5). We conclude that antiseptic cream is an effective treatment for recurrent epistaxis in children.

Administration, Topical↗
PubMed2000

Delayed epistaxis resulting from external carotid artery injury requiring embolization: a rare complication of transsphenoidal surgery: case report.

OBJECTIVE AND IMPORTANCE: Delayed epistaxis resulting from trauma to branches of the external carotid artery is an infrequent but potentially serious complication of transsphenoidal surgery. We report two cases of severe, delayed epistaxis in patients who had undergone transsphenoidal surgery. In both cases, noninvasive treatment failed, necessitating endovascular intervention. CLINICAL PRESENTATION: The first patient, a 52-year-old woman with a prolactinoma, underwent a second transsphenoidal resection 18 months after the first surgery. She was readmitted on postoperative Day 15 with massive epistaxis. The second patient, a 40-year-old woman, had undergone two transsphenoidal surgeries, 14 years apart, for an adrenocorticotropic hormone-secreting adenoma. She was readmitted with massive epistaxis on postoperative Day 17. INTERVENTION: Both patients were initially treated with nasal balloon packing but experienced recurrent hemorrhage when the balloon was deflated, necessitating referral to the interventional radiology department for embolization. At arteriography, the first patient was found to have a pseudoaneurysm of the medial branch of the left internal maxillary artery, which was subsequently embolized. Arteriography in the second patient revealed an abnormally dilated midline branch of the right internal maxillary artery in the nasal septum; this vessel was occluded at arteriography. CONCLUSION: Delayed massive epistaxis is a rare but significant complication of transsphenoidal surgery. Injury to branches of the external carotid artery, along with injury to the internal carotid artery, should be suspected in patients who present with delayed epistaxis after transsphenoidal surgery. Angiography performed in patients with refractory bleeding should include selective external carotid injections. Epistaxis that is refractory to anterior and posterior nasal packing may be effectively treated with endovascular embolization.

Adult↗
PubMedDate not supplied

A study of the association between epistaxis and the severity of hypertension.

Hypertension (HTN) has frequently been cited as a general risk factor for epistaxis. However, studies dealing with this association have yielded equivocal results. In this study, a sample of 121 hypertensives (blood pressure > or = 140/90 mmHg) was selected to evaluate the association between the severity of HTN and a previous history of epistaxis. Patients with an average blood pressure > or = 160/100 mmHg were classified as suffering from a more severe form of HTN and were compared with those with a less severe form of the disease (160/100 mm Hg < or = blood pressure > or = 140/90 mm Hg). The frequency of epistaxis did not differ among patients categorized by the severity of HTN. Users of aspirin were found to be twice as likely to have a history of epistaxis. In addition, there was a statistical tendency for an association between a history of epistaxis and the duration of hypertension. We conclude that the severity of HTN and a history of epistaxis were not associated in a cohort of hypertensive patients. The identification of other risk factors for epistaxis, including the duration of HTN, deserves further study.

Adult↗
PubMed1976

[Massive epistaxis from intracranial extradural aneurysm of the internal carotid artery associated with head injury (author's transl)].

Severe epistaxis following head injury occur from damage to the anterior ethmoidal or sphenopalatine arteries. However, the more massive, life-threatening posttraumatic epistaxis is that arising from ruptured aneurysm, arteriovenous fistula, or tear of the intracranial extradural portion of the internal carotid artery. The authors had opportunities to treat successfully 3 cases of massive delayed epistaxis from the aneurysm of this site following closed head injury. Case 1. A 23-year-old man was injured in a motorcycle accident on April 19, 1968 and taken to an emergency hospital, where the findings were semicomatose state, profuse bleeding from the left nostril and oral cavity, and laceration above the left eye associated with fracture of the left sphenoid. Since regaining consciousness he was blind in the left. Slight localized protrusion of the cavernous portion of the left internal carotid was shown by angiography, which was performed on the next day (Fig. 1). Three days later, he was transfered to Toyokogyo Hospital. On April 29, he had sudden severe epistaxis. The nasal bleeding recurred massively 6 times over 2 months, requiring the replacement of more than 8000 cc of blood. Sixty days after the trauma, carotid angiography demonstrated an large aneurysm arising from the left internal carotid (Fig. 2). The authors were consulted on this occasion. Intra- and extracranial trapping of the internal carotid artery associated with muscle embolization (Jaeger's operation) was performed (Fig. 3). Postoperative course was uneventful except occurrence of temporary diabetes insipidus. Case 2. This 59-year-old man was admitted to our clinic on November 7, 1970, Because of posttraumatic recurrent massive epistaxis. Thirty-seven days before admisstion, he was hitted by a car and lost consciousness. Profuse nasal bleeding occurred immediately after the accident. Despite skin lacereation above the right eye, visual acuity was not distrubed and no fracture line was found. Two weeks after the injury, he had sudden massive bleeding from the right nostril. The epistaxis recurred 5 times over 3 weeks. Carotid angiography revealed an aneurysm arising from the right internal carotid (Fig. 4). The internal carotid was gradually occluded at the cervical level without any neurological complication. Case 3. A 33-year-old man was referred to our department on October 7, 1974, complaining of recurrent profuse bleeding from the oral cavity. About 2 months prior to admission, he fell from the fourth floor on the street and became comatose. Several fracture lines of the frontal bones were found on skull film. Thirty-six days after the accident, sudden severe epistaxis occurred. Massive bleeding from the oral cavity repeated every 7 to 10 days. Visual acuity was lost within 10 weeks. III and VI cranial nerves palsy was found on the both sides. Carotid angiography demonstrated a small aneurysm of the left internal carotid (Fig. 5). Occlusion of the internal carotid at the cervical level stopped bleeding without further neurological deficit...

Adult↗
PubMed2000

Endovascular embolization of intractable epistaxis.

BACKGROUND: We undertook this study to define the role of angiography and endovascular embolization in the treatment of patients with intractable epistaxis. METHODS: A series of 19 patients with massive intractable epistaxis, all treated with endovascular embolization were reviewed. There were 15 males and four females ranging in age from 18 to 70 years, with a mean age of 38 years. The predisposing factors of intractable epistaxis were head and neck tumors (n = 11), idiopathic symptoms (n = 3), surgical complications (n = 2), arteriovenous malformation of the face (n = 1), thrombocytopenia (n = 1) and trauma (n = 1). Polyvinyl alcohol (PVA) particles and gelfoam plugs were used as embolic agents in 11 patients for devascularization; detachable balloons with N-butyl-2-cyanoacrylate (NBCA) were used in four patients for vascular occlusion; NBCA and/or coils were used in four patients in the carotid and subclavian arteries for obliteration of pseudoaneurysms. RESULTS: Complete cessation of epistaxis was achieved in all 19 patients immediately after embolization. Seven patients had also undergone surgical tumor removal at two to five days after embolization. Two patients experienced mild to moderate facial pain on the first day after the procedure, but the symptoms later subsided. No significant complication or recurrence was observed in 18 patients. One patient with advanced hypopharyngeal carcinoma died two weeks after embolization due to another episode of massive epistaxis. Clinical follow-up for these patients was 15 days to eight years, with a mean of 41 months. CONCLUSIONS: Therapeutic endovascular embolization of intractable epistaxis is both efficient and safe. It should be considered as the primary treatment modality in intractable epistaxis.

Adolescent↗
PubMed2000

[The determination of activated partial thromboplastin time, coagulate time and thrombin time in patients with epistaxis of indeterminate cause].

OBJECTIVE: To explore the coagulation mechanism of indeterminate epistaxis. METHOD: 36 cases with epistaxis of indeterminate cause were studies by mean of detecting activated partial thromboplastin time (APTT), coagulate time (CT) and thrombin time. The results of first APTT, APTT after 8 min and CT were observed. RESULT: 1. The first APTT in epistaxis and normal group didn't show statistical difference (P > 0.05). But the APTT after 8 min in epistaxis were significantly different compared with the first APTT and that in normal group (P < 0.01). 2. The CT prolonged in 33.3% patients with epistaxis, which was higher significantly than that in the normal group (P < 0.01). (3) The epistaxis thrombin time (TT) was longer than that in normal group. CONCLUSION: The result suggest that during blood coagulation in indeterminate epistaxis, the activated factors in internal coagulating system may decompose more quickly than that in normal group. Antiagglutinating factors increase in blood.

Adolescent↗
PubMed2006

[A clinical analysis of intractable spontaneous epistaxis with 289 cases reviewed].

OBJECTIVE: To explore the clinical characteristics and the prevention strategy of intractable spontaneous epistaxis. METHOD: Two hundred and eighty-nine patients with intractable spontaneous epistaxis were retrospectively analyzed. RESULT: Intractable spontaneous epistaxis was characterized by the onset season, age, sex, and the associated disease. Nasal septums were the most common sites of bleeding. Recurrent epistaxis was mainly associated with the failure of locating the bleeding sites. CONCLUSION: Control of elevated blood pressure is essential for the prevention of intractable spontaneous epistaxis. Once epistaxis occurs, the importance of the first treatment for the haemostasis should be emphasized. For the uncontrollable epistaxis, multiple interventions are necessary.

Adolescent↗
PubMed1999

Percutaneous embolization to control intractable epistaxis in nasopharyngeal carcinoma.

BACKGROUND: Epistaxis in patients with nasopharyngeal carcinoma (NPC) who have received radiotherapy can be difficult to control by conventional methods. The use of angiography and embolization to control problematic epistaxis has been well documented in other situations, but its use in severe or recurrent epistaxis following irradiation for NPC has not been described. METHODS: We retrospectively reviewed case notes of all patients with NPC initially seen with epistaxis over a 4-year period. Those patients with refractory epistaxis which could not be controlled by conventional methods and required angiography and embolization were assessed. RESULTS: Eight patients who underwent angiography were identified. Five patients showed hypervascularization and three patients had pseudoaneurysms or an aneurysm of the internal carotid artery seen on the angiogram. All these patients were successfully embolized. There were no significant complications after the procedure. CONCLUSION: We conclude that embolization is a safe and effective method of controlling refractory epistaxis in patients irradiated for NPC.

Adult↗
PubMed2006

Assessment of safety and efficacy of arterial embolisation in the management of intractable epistaxis.

To evaluate outcomes of intractable epistaxis managed with arterial embolisation. Fourteen sequential cases of intractable epistaxis that underwent embolisation in our centre were evaluated retrospectively and interviewed over the phone. All patients had several failed treatment modalities prior to embolisation. Patients' follow up ranged from 1 to 57 months with median of 26 months. All 14 cases underwent a single embolisation procedure with successful arrest of epistaxis. Four cases (29%) developed recurrent epistaxis at a later date. One (7%) required re-embolisation 19 months after his first procedure. One bled 17 days after embolisation, but this settled with hospital admission and Bismuth Iodoform Paraffin Paste packing. The other two developed minor episodes of epistaxis, which did not require hospital admission. Two patients developed local ischaemic complications following arterial embolisation. Of those, one developed necrosis of the left alar skin and cartilage that healed reasonably well after 5 months. The other case developed mucosal necrosis of the right side of the hard palate; this patient was the one who bled 17 days post-embolisation. The palatal necrosis healed in a satisfactory manner without causing any functional impairment of the oral cavity. Embolisation is a successful intervention in management of persistent epistaxis, when other interventions fail. The risks of major complications such as stroke are well known, and discussed with patients prior to the procedure. It is also important to discuss the risks of ischaemic damage to the face and oral cavity. In our experience, these complications have been minor and the benefits still outweigh the complications.

Adolescent↗
PubMed2006

Epistaxis: diagnosis and treatment.

Oral and maxillofacial surgeons are called on to evaluate and treat various emergencies, including acute epistaxis. Epistaxis is relatively benign in nature, but it can produce a serious, life-threatening situation. It has been estimated that up to 60% of the population has had at least 1 episode of epistaxis throughout their lifetime. Of this group, 6% seek medical care to treat epistaxis, with 1.6 in 10,000 requiring hospitalization. With fewer and fewer otorhinolaryngologists participating on hospital call schedules, it is critical for the oral and maxillofacial surgeon to be familiar with the anatomy, diagnosis, and treatment of acute epistaxis and associated medical concerns. Considerations concerning mechanism of injury, coagulopathies, and potential treatment options need to be assessed quickly and accurately to ensure the most appropriate treatment and positive outcome for the patient. The need to treat epistaxis in an emergent setting will often require the involvement of an oral and maxillofacial surgeon. By reviewing the anatomy, potential complications arising from associated medical conditions, and treatment options, patients can be accurately assessed and treated appropriately.

Cautery↗
PubMed2004

[Does clustering exist in non-traumatic epistaxis?].

OBJECTIVE: Non traumatic epistaxis seems to be clustering in different periods. This paper tries to find out if there is any relationship between incidence of epistaxis and the year season, month, week, day, hour and/or lunar phase. METHODS: We have retrospectively studied 754 episodes seen between May 2001 and April 2002 in our Hospital. The following parameters were registered in each patient: age, sex, number of episodes, season, month, week, day, hour and lunar phase. RESULTS: Epistaxis represented 12.1% of the total otolaryngological emergencies. That means an incidence of 0.1% of non traumatic epistaxis which needed hospital specialized attention. We found statistical differences (p = 0.003) in the number of epistaxis per day and the different months (greater in june and november). No differences were found in the remaining periods studied. CONCLUSIONS: This paper shows monthly clustering of epistaxis episodes.

Adolescent↗
PubMed1992

Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis.

Whilst it is generally accepted that the standard management for anterior or benign epistaxis is either cautery or anterior nasal packing, that of posterior or intractable epistaxis remains controversial. Various modalities of treatment, ranging from posterior nasal packing to arterial ligation and embolization, have been advocated but none have been unanimously accepted as the treatment of choice. The purpose of this paper was to determine the efficacy of internal maxillary arterial ligation versus combined internal maxillary arterial ligation and anterior ethmoid arterial coagulation in intractable epistaxis. Over a six year period, from 1985 to 1990, 454 patients were admitted and treated for epistaxis. Forty-seven patients were diagnosed as having intractable epistaxis on the basis that the epistaxis failed to settle on anterior nasal packing. They were moved to the next step in management, which was combined anterior and posterior nasal packing. There were 30 failures, one was found to have choriocarcinoma of the maxilla, and was treated with cytotoxics, and the other 29 were moved to the next step, which was arterial ligation. Fifteen patients had internal maxillary arterial ligation, and 14 combined internal maxillary arterial ligation and anterior ethmoidal arterial coagulation. Large windows were created in both the anterior and posterior walls of the maxillary sinuses and all identifiable branches of the internal maxillary artery were dissected out carefully and two medium size ligating clips were placed over the main trunk, the sphenopalatine and the descending palatine branches. Single clips were placed on all other identifiable branches. Coagulation of the anterior ethmoidal artery was performed with a bipolar cautery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2007

Endoscopic control of the sphenopalatine artery for epistaxis: long-term results.

The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.

Adult↗