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PubMed2006

Kaposiform hemangioendothelioma arising in the ethmoid sinus of an 8-year-old girl with severe epistaxis.

BACKGROUND: Epistaxis is very common during childhood. It occurs primarily in boys and is usually self-limiting. Trauma and nose picking are among the most common causes. In general, epistaxis can be easily treated with anterior nasal packing or electrocoagulation. METHODS: We report a case of an 8-year-old girl with severe unilateral epistaxis. RESULTS: The bleeding originated from a kaposiform hemangioendothelioma arising in the left nasal cavity and ethmoid sinus. The feeding vessels originating from the maxillary artery were first embolized. The tumor was then surgically removed through a combined external ethmoidectomy and endonasal approach. The postoperative course was uneventful. MRI at 6 months after surgery showed no tumor recurrence. CONCLUSIONS: We report a previously undescribed cause of epistaxis in children, namely, a kaposiform hemangioendothelioma. To our knowledge, this is the first such case in the English-language literature. The differential diagnosis of severe unilateral nasal bleeding among the pediatric population should include the possibility of a kaposiform hemangioendothelioma.

Child↗
PubMed1990

Traumatic intracavernous aneurysm in children: massive epistaxis without ophthalmic signs.

Traumatic intracavernous aneurysms are a distinctly uncommon lesion in children. They usually present with compressive symptoms of the III, IV, V, or VI cranial nerves rather than epistaxis. Epistaxis is rare and usually minor and brief in duration. A child with severe head injury and basal skull fracture, who did not have any preceding symptoms or signs of ophthalmoplegia or exophthalmus, developed massive epistaxis as a leading symptom of the ruptured intracavernous aneurysm. Since there are no reported pediatric cases with fatal epistaxis as a presenting sign, we would like to share our experience.

Adolescent↗
PubMed1993

Management of epistaxis in Rendu-Osler disease: is brachytherapy effective?

PURPOSE: This paper reviews the results of intranasal brachytherapy for epistaxis in 43 patients with Rendu-Osler disease treated between 1971-1991 at Henri Mondor Hospital. METHODS AND MATERIALS: 2-3 intranasal catheters were afterloaded with 192Ir sources. Computer dosimetry was performed and then the dose was prescribed to an isodose thought to cover the nasal mucosa. The dose rate ranged from 0.16 Gy/h-0.63 Gy/h with a median of 0.34 Gy/h. Dose at one application ranged from 15-35 Gy with a median of 30 Gy. The severity of epistaxis was graded 1 to 5. RESULTS: The time to recurrence of significant epistaxis ranged from 6-178 months with a median of 24 months. The dose prescribed did not correlate with control rate. The only brachytherapy complication was septal perforation in 4 patients; in one this was a result of repeated nasal coagulation. CONCLUSION: We suggest that intranasal brachytherapy is a useful modality in the management of epistaxis in Rendu-Osler disease.

Adult↗
PubMed1996

[Epistaxis in children].

Most epistaxis in children come from the anterior part of the nasal septum. The bleeding is usually under control by manual compression or vestibular packing with a piece of cotton or calcium alginate. In case of severe or recurrent epistaxis, one must look for a bleeding disorder or a nasal/nasopharyngeal tumour, especially juvenile nasopharyngeal angiofibroma in adolescent males. Chemical or electrical cautery of the septum should be suggested in case of recurrent idiopathic epistaxis. When bleeding continues despite such treatments, anterior nasal packing is recommended; life-threatening epistaxis usually requires posterior packing. Embolisation can be used to reduce blood supply before surgery in case of haemorragic tumours or vascular malformations.

Cautery↗
PubMed2004

Intractable epistaxis related to cavernous carotid artery pseudoaneurysm: treatment of a case with covered stent.

Although epistaxis is commonly seen in otorhinolaryngologic practice, it may rarely become a severe and life-threatening problem. Pseudoaneurysm of internal carotid artery (PICA) is an uncommon, but potentially fatal cause of epistaxis. Optimal management demands rapid recognition and treatment to give the best functional outcome. High suspicion and carotid arteriography is essential for diagnosis. In this article, a 28-year-old male case with post-traumatic cavernous PICA localized to sphenoid sinus and presenting with intractable epistaxis was reported. The patient was managed by endovascular covered stent application successfully. In differential diagnosis of patients with intractable epistaxis and isolated sphenoid sinus lesions, PICA should be considered. Early treatment with covered stent of aneurysm can be a life saving therapeutic approach.

Adult↗
PubMedDate not supplied

[Selective therapeutic embolization in intractable epistaxis].

Epistaxis is a common otolaryngologic emergency that is controlled frequently with conservative measures. On the other hand, more aggressive treatments are required in refractory or severe epistaxis, which may have systematical impact. About intractable posterior epistaxis, selective embolization of external carotid territory is an effective option for managing. Three patients with severe epistaxis successfully treated with selective embolization and a review of literature are exposed.

Aged↗
PubMedDate not supplied

[Statistical study regarding anemia in patients admitted with epistaxis. Importance of its control and the associated risk factors].

OBJECTIVE: To emphasize the importance of hemodinamic control and risk factors in the patients hospitalized due to epistaxis. MATERIAL AND METHODS: Retrospective study of 200 consecutive patients admitted by such cause between 1997 and 2004 of whom 46 (23%) developed some degree of anemia. Among other clinical variables we analyze the present risk factors, age, sex, levels of hematocrit and hemoglobin, origin of the nasal hemorrhage, number of transfusions that were required and type of nasal packing used. RESULTS: We prove a significant statistical association (p<0,01)) between epistaxis with anemia and risk factors. About 39% of the anemizing epistaxis needed a transfusion, generally red cell concentrates. CONCLUSIONS: Every admitted epistaxis needs a good hemodinamic study and control of the patient and the treatment of the base pathology associated.

Adult↗
PubMed2003

Atrial natriuretic peptide levels in children with habitual epistaxis.

OBJECTIVE: By virtue of no identifiable causes in the majority of children with habitual epistaxis, it continues to be problematic in pediatric clinical practice. The purpose of this study is to explore the possible change of atrial natriuretic peptide (ANP) levels in the children with epistaxis. METHODS: Both the plasma and nasal mucus ANP levels have been determined in 30 sick children by a sensitive radioimmunoassay (RIA) technique. RESULTS: Our results revealed that the plasma and nasal mucus ANP levels were considerably decreased in 24 children with habitual epistaxis when compared with control group (P<0.05), making up 80%, and amongst the interest of these are the nasal mucus ANP levels changing inversely as the times bled from the nose. CONCLUSION: Although the plasma and nasal mucus ANP levels will not establish the diagnosis of its etiology, it is helpful for us to know the cardiovascular status compensating for chronic blood loss in the children with habitual epistaxis.

Adolescent↗
PubMed1999

Management paradigms for posterior epistaxis: A comparison of costs and complications.

OBJECTIVES: Posterior epistaxis is a common otolaryngologic emergency. Management is controversial because of the many treatment options available. These options vary in efficacy, rates of complications, and cost. Posterior nasal packing is the medical management most frequently used to control posterior epistaxis. It is associated with major complications, including stroke, myocardial infarction, arrhythmias, and death. Because of these potential complications, many otolaryngologists monitor patients with posterior nasal packing in the intensive care unit (ICU). However, the level of care used to monitor these patients is variable, and standards have not been established. METHODS: From 1991 to 1997, 46 patients had posterior nasal packing placed to control epistaxis. Management, complications, and hospital charges were analyzed. RESULTS: Six patients (13%) were admitted to the ICU, 2 (4%) were admitted for telemetry monitoring, and 38 (83%) were sent to the ENT ward for continuous pulse oximetry. Four major complications occurred (1 episode of syncope [emergency department], 2 arrhythmias [ICU], and 1 death [hospice]). Twenty-six patients were treated with posterior packing in the ENT ward, at a mean cost of $2988. Fourteen patients underwent intervention (5 ligations, 6 endoscopic cauterizations, and 3 angiograms), with a mean cost of $5482. Six patients spent time in the ICU, with a mean cost of $8242. Patients treated in the ENT ward had significantly lower costs than those undergoing intervention (P = 0.017) or those admitted to the ICU (P = 0.020). CONCLUSION: We propose that most patients with posterior epistaxis can be treated in specialized ENT wards. This can be done without increasing complications and with significantly decreased costs.

Adult↗
PubMed1995

Intractable epistaxis: transantral ligation vs. embolization: efficacy review and cost analysis.

After posterior nasal packing, the two most common therapies for intractable epistaxis are transantral ligation of the internal maxillary artery and percutaneous embolization of the distal internal maxillary artery. However, optimal management of intractable posterior epistaxis remains controversial. We retrospectively reviewed the charts of 21 patients treated for intractable epistaxis and obtained data on presentation, risk factors, treatment, success rates, complications, and cost. Twelve patients received percutaneous embolization, five underwent transantral ligation, and four required both. The success rates for transantral ligation and percutaneous embolization were 89% and 94%, respectively. No mortality or serious morbidity occurred with either technique. A cost comparison revealed that transantral ligation was moderately less expensive than percutaneous embolization ($5941 vs. $6783). Although some authors advocate transantral ligation or percutaneous embolization as the procedure of choice for intractable epistaxis, a direct comparison of efficacy and cost reveals that they are comparable procedures with specific strengths and weaknesses. We present our experience and a review of the literature, highlighting the indications and advantages of each technique. We conclude that the choice of treatment modality should be based on the benefits of each procedure as it pertains to the specific needs of the individual patient.

Adult↗
PubMed2006

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.

Adolescent↗
PubMed1999

A new bipolar diathermy probe for the outpatient management of adult acute epistaxis.

The findings of a prospective evaluation of the use of a newly-designed bipolar diathermy probe in the outpatient management of adult acute epistaxis are presented. Forty-four adult patients with acute epistaxis were treated with bipolar diathermy after identification of the bleeding point using a rod lens endoscope. The use of the nasal endoscope allowed diagnosis of the source of the bleeding point in all patients. In all 44 patients immediate control of the bleeding was achieved. The use of the bipolar probe obviated the need for hospital admission in 31 patients (70%). Three patients had recurrence of their epistaxis after treatment (7%). The number of patients requiring admission to hospital with epistaxis was significantly reduced using the new bipolar strategy. (4.4/month versus 1.2/month, P < 0.002)

Acute Disease↗
PubMed2002

The influence of meteorological factors on the frequency of epistaxis.

This retrospective study aims to search out the influence of temperature, atmospheric pressure and humidity on the frequency of epistaxis. The study includes 701 patients who have suffered from epistaxis and have been treated in the ENT department of the University of Ioannina Hospital, during the years 1995 and 1996. The statistical methods used are simple linear correlation and linear stepwise regression analysis. The results of simple correlation analysis showed that the daily number of epistaxes depends mainly on mean, maximum and minimum temperature and water vapour pressure. The corresponding correlation coefficients are statistically significant, indicating an influence of weather on epistaxis up to 9% of its total variance. By applying stepwise regression analysis, we managed to increase the linear correlation coefficient and the corresponding amount of variance of epistaxis explained by meteorological factors. This percentage was found to approach 20% for the cold period and 10% for the warm period of the year.

Atmospheric Pressure↗
PubMed1997

[Endovascular embolization treatment for intractable epistaxis].

BACKGROUND: Intractable epistaxis has been treated with surgical intervention for many years, including ligation of the internal maxillary artery. As an alternative approach, endovascular therapy has gained increased acceptance. The purpose of our study was to evaluate the efficacy and safety of endovascular treatment of untractable epistaxis. METHODS: Embolotherapy was performed in 26 patients. The indication for embolization was persistent epistaxis even after anterior and posterior nasal packing. In all but two patients, who required general anesthesia, the procedure was performed in local anesthesia. Endovascular embolization of the internal maxillary artery was performed by using microcatheters, which were introduced intraarterially. Particulate embolic agents were used in all but one patient, who was treated by means of minicoils. RESULTS: The embolization of the territory of the internal maxillary artery was possible in all cases, the technical success rate was 96%, the clinical success rate was 100%. No complications were encountered. Because of an acute recurrent bleeding in one case, a second embolization was performed. No delayed hemorrhages were noted. CONCLUSIONS: Endovascular embolotherapy seems to be an excellent, safe, and less invasive alternative to surgery in patients with intractable epistaxis.

Adolescent↗
PubMed2003

Management of epistaxis in the oral and maxillofacial surgery setting: An update on current practice.

Epistaxis is a common and, in most cases, benign event. Although most nosebleeds resolve spontaneously, some may be profuse and life-threatening. Severe or recurrent epistaxis can be a challenging management problem. In otolaryngologic practice, it is the most commonly seen emergency. Oral and maxillofacial surgeons will also encounter this clinical problem in varied settings. It is our aim to present an update on the contemporary management of epistaxis in maxillofacial practice. The etiology and relevant surgical anatomy are discussed. This is followed by an update on current treatment regimens in different scenarios. A stepwise algorithm for the management of epistaxis is presented.

Algorithms↗
PubMed2004

Moyamoya disease complicated by life-threatening epistaxis: first report of a case.

OBJECTIVE: Subacute haemorrhage is a common emergency in otorhinolaryngology. Rapid evaluation of the aetiology and localization is a precondition for suitable treatment. We demonstrate a rare case of primarily intractable epistaxis associated with occlusion of the circle of Willis (moyamoya disease). PATIENT: A 38-year-old man presented with a 24-h history of recurrent epistaxis. Anamnesis revealed long-term anticoagulation after heart valve transplantation and arterial hypertension. RESULTS: As a result of several re-bleedings after anterior nasal packing, a re-packing was followed by surgical treatment under general anaesthesia. Four days after discharge the patient presented to the intensive care unit with severe re-bleeding. After removal of a temporary Bellocq packing, interdisciplinary treatment was necessary. Emergency angiography revealed advanced moyamoya disease, with occlusion of both internal carotid arteries. The cerebral blood supply was sustained by an excessive collateral network originating from external carotid anastomoses. This complicated the endovascular treatment, which consisted of embolization of the infraorbital and maxillar arteries with liquid material and coils flanked by Bellocq packing. The patient was doing well at follow-up after 12 months. CONCLUSION: Epistaxis complicating moyamoya disease is rare, and endovascular treatment is difficult due to the high risk of cerebral embolism. Malformations of the cerebral arteries should be considered in the differential diagnosis of intractable epistaxis.

Adult↗
PubMed2005

Recurrent epistaxis after treatment with tadalafil (Cialis).

A 66-year-old male presented to our department with recurrent epistaxis. On examination it was not possible to identify the source of the bleeding, despite various measures. The bleeding stopped spontaneously each time and advice on nose bleeds was given to the patient. During a consultation the patient volunteered that the trigger for the epistaxis appeared to have been energetic sexual activity. To enhance his sexual performance he had taken Viagra; however, on stopping the Viagra and changing to the newer drug Cialis, the episodes of epistaxis continued. We document what we believe to be the first case of epistaxis caused by Cialis.

Aged↗