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PubMed1991

[A case of bilateral nontraumatic internal carotid aneurysms presenting with recurrent massive epistaxis].

A case of bilateral nontraumatic internal carotid aneurysms presenting with recurrent massive epistaxis was reported. A 37-year-old female complaining of massive epistaxis from the left nostril was admitted to our hospital. After admission, she experienced recurrent massive epistaxis, but had no cranial nerve palsies. Carotid angiography demonstrated an aneurysm of the cavernous portion of the left internal carotid artery partially protruding into the sphenoid sinus. Neck clipping of the aneurysm was unsuccessful, therefore the left internal carotid ligation in the neck was performed with a Selverstone clamp. After the ligation, no rebleeding and neurological deficits occurred. Postoperative carotid angiography showed an aneurysm of the right internal carotid artery at the same site. The carotid angiography of 3 months later and 1 year and 3 months later revealed that the left aneurysm decreased in size and the right one remained unchanged. Twenty-one cases including ours that presented nontraumatic internal carotid aneurysm of the cavernous portion were reviewed. Twelve cases had no cranial nerve palsies, and 7 cases including ours had no other symptoms than massive epistaxis. Because massiveness of epistaxis from an internal carotid aneurysm often threatens one's life, diagnosis should be made by carotid angiography as soon as possible. There are several surgical procedures for such aneurysms. Clipping is the ideal method which can interrupt the blood flow to the aneurysm completely, but it is very difficult to be performed anatomically. Carotid ligation in the neck with little surgical invasion was an excellent method in 7 cases without rebleeding and neurological deficits. Bilateral intracavernous internal carotid aneurysms were found in our case and another case.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2004

The inheritance of liability to epistaxis in the southern African Thoroughbred.

This study was carried out to estimate the heritability of liability to epistaxis in the southern African Thoroughbred population. Data of all horses that suffered epistaxis while racing in southern Africa and Mauritius from 1986 to 2002 and involving 1252 bleeders were analysed. Pedigree data covering the period 1960-1986 was used as required to calculate the incidence of bleeding amongst ancestors of the post-1986 era. Only pedigrees of horses that raced were included in this study as it was not possible to predict whether non-runners would have bled had they raced. Consequently all non-runners and also those that raced overseas in countries where bleeding occurrence was not recorded, were excluded. The heritability of liability method as described by Falconer (1989) was used to estimate the relative importance of heredity and environment. For the period investigated, the population incidence for epistaxis in southern African horses was 2.1%. The estimation of heritability of liability showed that 1st-degree relatives had a figure of 55.4%. Second-degree relatives had a heritability of 41.3% and 3rd-degree relatives came in at 30.4%. The heritability of liability shown in this study could be regarded as being at the lower end of the range but could be appreciably higher. The data depict horses that bled almost exclusively on race days, as only a small percentage (approximately 5%) was reported as having bled during exercise. Accordingly, the full extent of epistaxis amongst racing Thoroughbreds in southern Africa is difficult to gauge. It is clear that epistaxis in the racing Thoroughbred has a strong genetic basis. It is suggested that horses showing frankbleeding from the nostrils after racing or exercise be suspended, and not used for breeding purposes. This should result in relatively fast progress being made towards eradicating this costly scourge of the modern Thoroughbred racehorse.

Animals↗
PubMedDate not supplied

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.

Adolescent↗
PubMedDate not supplied

[Epistaxis: prospective study on emergency care at the hospital level].

We prospectively studied 279 patients with epistaxis referred to ENT specialist from emergency room in our hospital in one year. Masculine sex (62%), medium or old ages (median 56 year), and associated diseases (HBP 22.9%, anticoagulants or antiplatelet drugs 11.1%), were the most common. Predominant local etiologic factors were trauma (12.9%) and inflammation (14%). Epistaxis had been essential in 36.9%. The most frequent location in all ages was the anterior one, especially located in the Kiesselbach's area, although the incidence of the posterior epistaxis increases in characteristic way from fourth decade, affecting more to men. Most of epistaxis (> 99%) were treated successfully by conservative approach and only two patients required surgical or interventional therapy. Patients between 30-59 year and the posterior epistaxis was the most refractory to the treatment. Hospitalized patients were older than ambulatory ones and had more associated diseases. Their average hospital stay was 9.2 days.

Adolescent↗
PubMed2002

Transnasal sphenopalatine artery electrocautery for posterior epistaxis.

BACKGROUND: To evaluate the effects of sphenopalatine artery electrocautery for the treatment of recurrent posterior epistaxis. METHODS: Nine patients were enrolled in the study. Seven patients had hypertension, two had diabetes, two received irradiation for nasopharyngeal carcinoma, one had congestive heart failure and one was a heavy drinker. Three patients needed blood transfusion for profound blood loss. The sphenopalatine artery electrocautery was performed transnasally with endoscope. After the sphenopalatine foramen was identified through dissecting the mucosa of middle meatus posteriorly one centimeter from the choana, the neurovascular bundle in the sphenopalatine foramen was cauterized. RESULTS: Most operations can be performed within fifty minutes with minimal blood loss under local anesthesia. One patient developed minor epistaxis 2 months after surgery, and the bleeding was controlled with medical treatment. The other patients had no recurrent epistaxis after surgery. Thus, epistaxis was well controlled in all patients without complications. The follow-up duration was 2 to 14 months after surgery, with a mean duration of 10 months. CONCLUSIONS: Transnasal sphenopalatine artery electrocautery is a simple, effective and safe method for the treatment of posterior epistaxis.

Adult↗
PubMed2004

Treatment of severe epistaxis by superselective embolization: a review of 22 cases.

OBJECTIVES: Epistaxis represents one of the most common ENT emergencies. In this paper, the authors report their experience in treating some cases of severe epistaxis by super-selective embolization of the afferent vessels of the nasal fossae. PATIENTS AND METHODS: A retrospective study of 22 patients with severe recurrent epistaxis (1 anterior and 21 posterior). All patients had been treated unsuccessfully with repeated anteroposterior nasal packing, and presented significant secondary anaemia. Selective embolization procedures were performed under local anaesthesia. An arterial introducer is inserted into the femoral artery -generally the right one- and diagnosis as well as treatment are performed with the same guide catheter. In all cases, the terminal branches of the facial artery and of the internal maxillary artery on the side on which the haemorrhage occurred were embolized. Moreover the contralateral internal maxillary artery was always embolized as well, in order to prevent immediate recurrence of hypervascularisation of the mucosa through anastomotic paths. RESULTS: In all patients, complete devascularisation was achieved in the areas of the embolized arteries at the nasal mucous membranes, arresting the epistaxis. None of the cases experienced complications attributable to treatment. DISCUSSION AND CONCLUSION: Superselective arteriography with embolization can be considered as the method of choice in treating severe epistaxis because it can be performed under local anaesthesia and can easily be repeated if the first procedure is not successful. Moreover, it is at least as effective as ligation of the internal maxillary artery, if not more so, but it has a significantly lower complication rate which is destined to fall as the quality of the materials being used continues to improve.

Adult↗
PubMed2005

Epistaxis in Chiang Mai University Hospital.

OBJECTIVES: Epistaxis is a common otolaryngologic emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. The aim of this study was to review and analyze the general and specific data causes, management and results of epistaxis in patients admitted in Chiang Mai University Hospital. MATERIAL AND METHOD: A retrospective study by reviewing charts of new epistaxis inpatients, admitted to Chiang Mai University Hospital between January 2001 and July 2004, was done. RESULTS: From 55 cases reviewed, 41 were males (74.5%) and 14 females (25.5%). The mean age was 46.98 +/- 17 years (12-87 years). The peak of prevalence was between January and April. The average length of hospital stay was 6.2 +/- 3.8 days, (1-17 days). The most common cause of epistaxis was hypertension (32.72%) followed by tumor, local trauma and coagulopathy, subsequently. About 18 per cent of the patients had more than one cause of the illness. According to the bleeding site, 33 patients (60%) had anterior bleeding, 14 (25.45%) had posterior bleeding, and the rest had non-identifiable bleeding sites. There were 5 abnormalities from 52 patients (9.6%) tested for clotting profile. A bout one third of the patients received more than one type of procedure, while 2 patients (3.6%) treated by a local hospital before being transfered, were observed with successful outcome. CONCLUSION: The most common and preventable causes of epistaxis in this review are hypertension and facial and paranasal sinus injuries. The other common curable cause is tumor Otolaryngologists and general physicians should find out the causes and know characteristics of the patients and diseases, especially in their own area of practice in order to be able to perform optimal management.

Adolescent↗
PubMed2006

Non-invasive treatment of intractable posterior epistaxis with hot-water irrigation.

Posterior nose bleeding is a frequent and challenging emergency. The authors report their experience using hot water irrigation as a non-invasive treatment option for posterior epistaxis. Between January 2003 and January 2005 a group of 103 patients were enrolled in this prospective study evaluating the effectiveness of a "hot water irrigation" technique to control acute posterior nose bleeding. All patients with posterior epistaxis were included, whereas anterior epistaxis was controlled using conventional methods. The patient's nose was initially anaesthetized with topical Tetracain 4% (without vasoconstriction) and a modified epistaxis-balloon-catheter was introduced into the bleeding nasal cavity obstructing the choana. The bleeding nasal cavity was continuously irrigated using 500 ml of 50 degrees C hot water. In a total of 84 patients (82%) the bleeding was successfully and permanently stopped. Forty-seven of these patients (56%) regularly took antiplatelet agents or anticoagulants. The method failed in 19 of 103 patients (18%). In the group with unsuccessful irrigation, 11 patients (58%) were receiving treatment with antiplatelet agents or anticoagulants. Their proportion was not different from the successfully treated group. The success rate of hot water irrigation as non-invasive treatment of posterior epistaxis appears at least as effective as conventional methods. However it avoids painful packing, hospitalizations, or immediate surgery, and allows the patient to breath normally through his open nasal cavities.

Adolescent↗
PubMed1996

[Hot water irrigation in the treatment of posterior epistaxis].

Tamponade treatment in epistaxis is painful and the patient needs hospitalisation. Irrigation with hot water was introduced as a treatment of epistaxis 100 years ago. This study compares the two treatments with respect to effect, recurrence, pain, and length of hospital stay. Forty-four consecutive patients with posterior epistaxis were randomized to receive treatment with either hot water (HWI) or tamponade. In the group of patients treated with HWI, the treatment had to be stopped in seven patients (33%) because of lack of cooperation; nine patients (43%) could be discharged from hospital with no need for further treatment, whereas five patients (24%) had recurrent epistaxis requiring additional tamponade treatment. Among patients treated with tamponade, 14 patients (61%) could be discharged from hospital with no need for further treatment, while nine patients (39%) had recurrent epistaxis requiring additional tamponade treatment. Compared with the tamponade treatment, HWI is almost as effective, the hospital stay is shorter, and the treatment is significantly less painful.

Adult↗
PubMed1996

Hot-water irrigation as a treatment of posterior epistaxis.

The commonly-used tamponade treatment for posterior epistaxis is painful and the patient may need hospitalization for several days. Irrigation with water of 50 degrees C was introduced as a treatment for posterior epistaxis more than 100 years ago. This study compares the two treatment modalities with respect to effect, recurrence, pain, and length of hospital stay. Forty-four consecutive patients with posterior epistaxis were randomized to receive treatment with either hot water (21 patients) or tamponade (23 patients). In the group of patients treated with hot water, the treatment had to be stopped in seven patients (33%) because of lack of cooperation; nine patients (43%) could be dismissed from hospital with no need for further treatment, whereas five patients (24%) had recurrent epistaxis requiring additional tamponade treatment. Among the patients treated with tamponade, 14 patients (61%) could be dismissed from hospital with no need for further treatment, while nine patients (39%) had recurrent epistaxis requiring additional tamponade treatment. The median stay in hospital was five days for the group treated with hot water, and six days for the group treated with tamponade. Compared to the tamponade treatment, hot-water irrigation is almost as effective, the hospital stay is shorter, and the treatment is significantly less painful.

Balloon Occlusion↗
PubMed1996

Management of epistaxis: a national survey.

A survey to assess variations in management and outcome of patients admitted with epistaxis was conducted. A questionnaire was sent to all consultant otolaryngologists working at NHS hospitals in England and Wales requesting information about management of patients admitted with epistaxis over a 3 month period. Data analysis of information provided by 102 consultants for a total of 933 patients was performed. The average number of patients admitted with epistaxis over a period of 3 months per consultant was 10.2. More than 70% of the patients were aged 60 years or over. Approximately 75% of the patients required nasal packing; the most common pack used was BIPP (Bismuth Iodine Paraffin Paste). Of the patients, 5.6% required general anaesthesia, with less than 1% requiring formal arterial ligation. The mean duration of stay in hospital was 2.9 days. Few complications were reported. Patients admitted with epistaxis were generally managed conservatively, with very few requiring surgical intervention. There was remarkable consensus in various aspects of management of patients admitted with epistaxis.

Adult↗
PubMed1995

[Relapsing epistaxis: embolization as treatment of choice].

Epistaxis is a very common disease. Fortunately it occurs most commonly in the anterior septal network of blood vessel and is therefore readily controlled with simple local measures. Severe posterior epistaxis is less frequent but is still a common and much more serious clinical problem and usually requires hospitalization. The classic treatment of these epistaxis is combined anterior-posterior nasal packing. Occasionally, however, this treatment does not control bleeding. The most popular alternative for these patient is arterial ligation. Initially only carotid ligation was performed. Later further advances in surgical technique and instrumentation, permitted internal maxillary and etmoid artery ligation to be carried out. However often arterial ligation cannot be easily performed in some ent departments and furthermore, surgical failure rate is not exceptionally high if one consider the numerous hypsilateral-contralateral arterial anastomoses present in the etmoid-nasal region. Fifteen patients with recurring nasal bleeding were treated with embolization between 1991 and 1993. Ten of them suffered of essential epistaxis while the other five had chronic local and/or systemic diseases (hereditary haemorrhagic teleangectasia and angiomas). Analysis of the results show a good control of bleeding in the first group of patients (90% after one embolization) and a satisfactory control in patients with haemorrhagic teleangectasia. In conclusion, owing to its efficacy, speed and safety therapeutic embolization with PVA particles may be considered treatment of choice in recurrent persistent epistaxis.

Adult↗
PubMed1996

Epistaxis in hereditary haemorrhagic telangiectasia.

Hereditary haemorrhagic telangiectasia (HHT) is characterized by easily bleeding telangiectases of the skin and mucosa. Epistaxis is the most common symptom of HHT. Larger arteriovenous malformations (AVM) occur in the lungs (in up to 33% of the patients), brain (in up to 11% of patients), and liver. These may cause severe complications which can be prevented by early therapy. To gain insight in the characteristics of epistaxis in HHT, 171 persons were investigated, who either had HHT or participated in a screening programme for relatives of HHT patients. Of these, 58 persons had HHT. Epistaxis without signs of HHT was present in 12 persons, whereas 10% of HHT patients did not have epistaxis. Seventeen HHT patients with epistaxis had visited an otorhinolaryngologist before, without a correct diagnosis of HHT being made. Telangiectases were most common on lips, tongue, the nasal septum, and the turbinates. In view of the prevalence of visceral AVM and the associated complications, HHT patients presenting to an otorhinolaryngologist should be encouraged to engage in a screening programme for these AVM.

Adult↗
PubMed1996

Recurrent epistaxis following nasotracheal intubation--a case report.

Epistaxis is one of the common complications of nasotracheal intubation. Clinical patterns of all nasal bleeding are mild and may stop spontaneously in most patients. Serious nasal bleeding requiring hospitalization are rare. Nasal bleeding occurs more frequently in children than in adults. Among adults, men have a higher incidence than women. Although numerous publications have reported the cases of initial epistaxis caused by nasotracheal intubation, recurrent epistaxis was reported rarely. We experienced a case of recurrent epistaxis occurring in the 6th, 8th, 15th and 18th day after nasotracheal intubation. Herein, we describe the clinical events and discuss the causes of epistaxis.

Adult↗
PubMed1997

Warfarin and epistaxis: should warfarin always be discontinued?

The object of this study was to determine whether warfarin could be safely continued in patients with epistaxis if the International Normalized Ratio (INR) was within the suggested therapeutic range. Twenty patients on warfarin treatment were compared with controls, matched for age and sex. Local measures for the control of epistaxis were undertaken appropriately in all the patients. In the warfarin group 17 patients (85%) did not discontinue warfarin as the INR was within the suggested range. There were no additional bleeding complications or failure of epistaxis control due to continuation of warfarin. There was no significant difference in the mean hospital stay between the warfarin and non-warfarin groups. It is concluded that warfarin can be continued safely in patients with epistaxis, in appropriate circumstances, and that the policy of stopping warfarin routinely in all patients with epistaxis should be reconsidered.

Aged↗
PubMed1976

Percutaneous embolization to control epistaxis in Rendu-Osler-Weber disease.

Recurrent epistaxis is the most common manifestation of hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease), a disorder characterized by widely scattered visceral, dermal, and mucosal vascular lesions. Emergency measures applied locally may control acute hemorrhage, but seldom result in long-term benefit. Recently, we have had the opportunity of performing bilateral carotid angiographic examination on a patient with hereditary hemorrhagic telangiectasia who was suffereing from severe intractable epistaxis. At the time of angiographic examination, embolization of both internal maxillary arteries was accomplished, and control of the epistaxis was achieved. In the patient with severe epistaxis that is unresponsive to local measures, percutaneous embolization offers substantial advantages over surgical intervention.

Carotid Artery, External↗
PubMed2004

Interventions for recurrent idiopathic epistaxis (nosebleeds) in children.

BACKGROUND: Recurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self-limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition. OBJECTIVES: To assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children. SEARCH STRATEGY: We searched the Cochrane ENT Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 3, 2003), MEDLINE (January 1966 to August 2003), EMBASE (January 1980 to August 2003), CINAHL (January 1982 to August 2003), and reference lists of relevant articles. SELECTION CRITERIA: We identified all randomised controlled trials (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo, or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The full text articles of all the retrieved trials of possible relevance were reviewed by the two reviewers and the inclusion criteria applied independently. DATA COLLECTION AND ANALYSIS: Trials were graded for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner by one reviewer and rechecked by the other, and where necessary investigators were contacted to obtain missing information. A meta-analysis was not undertaken because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented. MAIN RESULTS: Three studies - two randomised controlled trials (RCTs) and one controlled clinical trial (CCT) - involving 256 participants satisfied the inclusion criteria. One RCT compared Naseptin antiseptic cream with no treatment, the second RCT compared Vaseline(R) petroleum jelly with no treatment, and the CCT compared Naseptin antiseptic cream with silver nitrate cautery. Overall, results were inconclusive, with no statistically significant difference found between the compared treatments. No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic). REVIEWER'S CONCLUSIONS: The optimal management of children with recurrent idiopathic epistaxis is unknown. High quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.

Administration, Intranasal↗
PubMed2003

Giant intracavernous internal carotid artery aneurysm with fatal epistaxis.

The case history and autopsy findings of a 32-year-old male, who suffered a mild closed-head injury and then had repeated epistaxis beginning 5 months later, is presented. The condition culminated in an episode of fatal epistaxis 1 year after the injury. At one time during the course of his work-up, the etiology of his repeated epistaxis was thought to be a vascular nasopharyngeal neoplasm. The diagnosis of an intracavernous internal carotid artery aneurysm was made only at autopsy. The principles of management of traumatic intracavernous internal carotid artery aneurysm presenting with epistaxis are discussed.

Accidents, Traffic↗