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PubMedDate not supplied

[Arteriovenous malformation complicated by serious recurrent epistaxis].

Arteriovenous malformations in the region of the head and the neck are rarely manifested by epistaxis. These lesions are usually treated by the vascular surgeon, neurosurgeon, maxillofacial surgeon etc. Anyhow, the role of the specialist in otorhinolaryngology is indispensable when epistaxis gives morphological and functional modifications of the organs in the region of the head and neck. The paper reports on a particular case of severe, relapsing epistaxis, secondary to a geniomasseteric, right, invasive, cavernous hemangioma. The patient was admitted, for four times, in the period 1982-1984, into the O.R.L. clinic, Timişoara, and for two times into the clinic of maxillofacial surgery for severe, relapsing epistaxes in the right nasal pit. In 1983, the ligature of the external carotid artery and the partial ablation of the hemangioma were performed. In 1984, at a new right massive epistaxis, the nasal hemorrhage could not be arrested, and the patient died on November 10, 1984 due to a hemorrhagic shock.

Adult↗

PubMed1988

Epistaxis and leprosy.

Forty-four leprosy patients with epistaxis were analysed. Aetiopathogenesis of epistaxis in leprosy is discussed in the light of available literature. It has been suggested that epistaxis is more frequent and severe in leprosy patients and more liable to have complications. Epistaxis in leprosy with nasal lesions may alarm the physician that patient has some systemic disorder.

Epistaxis↗

PubMedDate not supplied

Protocol: pediatric epistaxis.

The central task in dealing with pediatric epistaxis is to differentiate between anterior and posterior origins of bleeding. An anterior bleed is usually of minor concern while a posterior bleed is usually life-threatening. A table of conditions causing epistaxis, a brief overview of anatomy and clinical tips for differentiating the two types during a physical exam are all designed to help the nurse practitioner make this important assessment. Emphasis is placed on treating anterior epistaxis with only a brief reference given to treatment of posterior epistaxis. Two teaching and counseling tables are provided for duplication and distribution to patients.

Child↗

PubMed1993

Endonasal endoscopy and posterior epistaxis.

The availability of a comprehensive range of endonasal telescopes facilitates systematic examination of the nasal cavity. Epistaxis is normally divided into anterior and posterior. Posterior epistaxis is diagnosed when anterior rhinoscopy fails to visualize anterior-located bleeding points. With the aid of endonasal endoscopy the exact location of bleeding points can be identified and diathermy applied under direct vision. Twenty-seven cases of the so-called posterior epistaxis were treated successfully by endonasal endoscopy. The technique is particularly useful during acute nose bleeds, it shortens hospital stay, and reduces the discomfort inflicted by the presence of nasal packing. The need for blood transfusion is reduced by using endonasal endoscopy in the acute stage of epistaxis.

Adult↗

PubMed1996

Acute epistaxis. How to spot the source and stop the flow.

The goals of epistaxis treatment are control of hemorrhage, prevention of cardiovascular and airway compromise, and determination of the cause and the source of bleeding. Distinguishing anterior from posterior epistaxis is important because therapeutic approaches differ. Epistaxis can usually be managed nonsurgically, but a surgical procedure is sometimes necessary. Cauterization, nasal packing, and use of an intranasal tampon or balloon catheter are effective nonsurgical interventions, but they may cause sinusitis, middle ear effusion, patient discomfort, and hypoxia. Surgical interventions include arterial ligation, endoscopic cauterization, and angiographic embolization. These highly effective methods incur the risks of general anesthesia and require technical expertise. A thorough and methodical approach to epistaxis is necessary, with otolaryngologic consultation when appropriate.

Acute Disease↗

PubMed1998

[The maxillary artery embolization in the management of recurrent epistaxis].

The management of recurrent epistaxis, especially posterior epistaxis, is difficult. Anterior and posterior nasal packing constitutes the initial treatment. Ligation of the ethmoid arteries and maxillary artery is the next step if the previous methods fails. We have described three cases with recurrent epistaxis; all underwent successful diagnostic angiography and therapeutic embolization of the maxillary artery. The role of embolization in the management of persistent epistaxis has been discussed.

Adult↗

PubMed1999

New modification of hot-water irrigation in the treatment of posterior epistaxis.

BACKGROUND: Tamponade treatment for epistaxis is painful and traumatic to the nasal mucosa, and may necessitate hospitalization for several days. Hot-water irrigation (HWI) was introduced as a treatment of epistaxis more than 100 years ago. In a previous study the treatment proved to be effective, less painful, and less traumatic, and required a shorter hospital stay than tamponade treatment. However, HWI has the risk of aspiration during treatment. To minimize this risk, a special catheter has been designed. OBJECTIVES: To evaluate the modified HWI and to compare the results with tamponade treatment, with respect to patient compliance, effectiveness, recurrence of bleeding, pain, complications, and length of hospital stay. PATIENTS: A total of 122 patients, hospitalized for posterior epistaxis, were randomized to receive either HWI or tamponade treatment. RESULTS: In the HWI group, 31 (55%) of the patients could be discharged from the hospital after the initial treatment only, compared with 29 (44%) of the patients treated with tamponade. Using a 10-cm visual analog scale, the mean pain score during treatment was 4.7 in the HWI group compared with 7.5 in the tamponade group. The mean hospital stay was 2.9 days for the HWI group vs. 4.0 days for the tamponade group. After discharge from the hospital, necrosis or synechia was found on rhinoscopy in 12 patients (40%) in the tamponade group compared with none in the HWI group. CONCLUSIONS: Compared with tamponade treatment, HWI is as effective, requires a significantly shorter hospital stay, is less traumatic to the nose, and is significantly less painful.

Adult↗

PubMed1977

Delayed epistaxis secondary to shotgun wound to maxillary artery. Report of a case.

Severe delayed epistaxis following open or closed trauma has been reported in the literature by many authors. We report a case of delayed epistaxis following a shotgun wound to the face. The evaluation of this type of patient, including the use of angiography to localize the bleeding, is illustrated. We review methods of conservative management of epistaxis and outline the surgical treatment of this patient.

Adult↗

PubMed1977

Management of epistaxis in hereditary hemorrhagic telangiectasia. Review of 80 cases.

Intranasal dermoplasty and estrogen therapy have been shown to be the most effective means of managing epistaxis in patients with hereditary hemorrhagic telangiectasia. In a series of 80 patients studied, the most effective treatment was by intranasal dermoplasty; of 22 patients so treated, 14 had improvement for more than six months after surgery and six had improvement for one to six months. Regrafting for recurrent epistaxis was successful in four of five patients (improvement for more than six months). Estrogen was administered for systemic effect to 16 patients and produced improvement of more than six months' duration in eight and of one to six months' duration in three. Other forms of management were less effective for the prolonged control of epistaxis.

Administration, Topical↗

PubMed1988

Factors associated with active, refractory epistaxis.

This study addresses the underlying causes responsible for the severity and persistence of active, refractory epistaxis. Seventy-five patients referred because of treatment failure by primary care physicians showed hypertension and aspirin and alcohol abuse to be major factors in the refractory nature of their epistaxis. The majority of bleeding was located near the posterior floor of the nasal cavity and just posterior to Kiesselbach's plexus and was only associated with septal deviation, spurring, or mucosal abnormalities in 16 of the 75 patients. Seventeen of 67 outpatients required hospitalization. Standard laboratory tests were often inadequate determinants of etiology. Intractable epistaxis should be a signal for a thorough investigation of factors that influence clotting.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed1990

Uncontrollable epistaxis. Angiographic localization and embolization.

The method of choice for uncontrollable epistaxis that is refractory to anterior and posterior nasal packing is controversial. In a retrospective study, the therapeutic results in 42 patients with uncontrollable epistaxis were reviewed, with special consideration of 11 cases in which the patients received angiography and embolization of branches of the internal maxillary artery. Out of this collective, only one patient received surgery, ie, transantral internal maxillary artery ligation. The results of primary embolization demonstrated the effectiveness and illustrated the potential role of embolizing procedures in uncontrollable epistaxis.

Adult↗

PubMed1993

Embolization for the treatment of posterior epistaxis. An analysis of 31 cases.

Thirty-one patients with posterior epistaxis refractory to nasal packing alone or in combination with surgical ligation (n = 8) underwent diagnostic angiography and therapeutic embolization of the internal maxillary artery. Embolization resulted in the cure of epistaxis in 22 cases (71.0%). Of the nine failures (29.0%), seven underwent successful surgical clipping of the ethmoid arteries, and two were treated conservatively and died of their primary hematologic disease within 33 days. Late rebleeding occurred in two patients: one underwent re-embolization and the other was treated surgically. No severe or permanent complications occurred. The results indicate that embolization is a feasible alternative to surgical intervention for patients with posterior epistaxis, and we recommend it as the treatment of choice in cases with high surgical risk or failure of prior arterial ligation.

Adolescent↗

PubMed1997

[Treatment of recurrent epistaxis in Rendu-Osler-Weber disease].

Rendu-Osler-Weber disease is an autosomally dominant inherited disease which affects the connective tissue of blood vessels. The major symptom is recurrent epistaxis for which still exists no generally recommended treatment. Treatment modalities discussed in the literature include bilateral closure of the nostrils, brachytherapy, vessel embolization, hormone therapy, dermoplasties, as well as different kinds of laser therapies. Advantages and disadvantages of single treatment modalities are discussed. Dermoplasty and laser therapy seem to be the most suitable treatment procedures currently available for recurrent epistaxis in affected patients. Treatment carried out with the argon, KTP or ND:YAG laser has proven to be suitable as initial therapy. In most cases the additional use of long-term applications of a soft nasal ointment allows a lasting successful treatment. Our experiences show that dermoplasty should be reserved for cases with continued bleeding despite laser treatment but only rarely offers a long-term cure in the sense of a total recovery from epistaxis.

Aged↗

PubMed1998

[Percutaneous therapeutic embolization in therapy refractory, non-traumatic epistaxis].

UNLABELLED: The records of 24 patients with severe intractable non-traumatic epistaxis were reviewed to evaluate the efficacy of embolism therapy. MATERIAL AND METHOD: The histories of 17 patients with idiopathic epistaxis, 6 patients with Osler-Rendu-Weber disease and 1 patient with a high-flow angioma were analyzed. All patients were treated by means of percutaneous embolization of the maxillary artery and its branches. RESULTS: In 5/17 patients with idiopathic epistaxis repeat embolization was necessary in 5 cases, while permanent hemostasis was achieved in 16/17 patients with embolism alone. Five of the 6 patients with Osler-Rendu-Weber disease labelled stage III before treatment were managed successfully with repeated embolizations, while all cases were reduced to stage I disease. The high-flow angioma was successfully ablated after embolization combined with direct injection of thrombosing material and laser resection.

Adult↗

PubMed2004

Massive recurrent epistaxis from non-traumatic bilateral intracavernous carotid artery aneurysms.

Recurrent epistaxis may rarely follow traumatic intracavernous carotid artery aneurysm. This occurs nearly always after head injury and is usually associated with fracture of the skull base. Severe torrential epistaxis due to non-traumatic intracavernous carotid artery aneurysm is extremely uncommon and potentially fatal, with only a few cases having been reported in the literature. We present the case of a 23-year-old female with a history of recurrent severe epistaxis and otalgia due to bilateral intracavernous carotid artery aneurysms, illustrating the diagnostic difficulties. The radiological investigations and the management of the patient are discussed and relevant literature is reviewed.

Adult↗

PubMed2005

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.

Epistaxis↗

PubMedDate not supplied

A comparison of cocaine, lidocaine with epinephrine, and oxymetazoline for prevention of epistaxis on nasotracheal intubation.

The alpha-adrenergic agonist oxymetazoline was compared to cocaine and to lidocaine with epinephrine with respect to prevention of epistaxis on nasotracheal intubation. The nares of three groups of 14 patients each were topically pretreated with 4% lidocaine with 1:100,000 epinephrine (group 1), 10% cocaine (group 2), or 0.05% oxymetazoline (group 3) prior to nasotracheal intubation. After intubation, epistaxis was estimated on a scale of 0 to 3, with 0 indicating no bleeding, 1 representing blood on the nasotracheal tube only, 2 indicating blood pooling in the pharynx, and 3 representing blood in the pharynx sufficient to impede intubation. Only 29% of the patients in group 1 displayed no bleeding, whereas 57% of those in group 2 and 86% of those in group 3 had no bleeding. Nonparametric analysis showed a statistically significant difference (p less than 0.013) between oxymetazoline and lidocaine with epinephrine. In addition, heart rate (HR) and blood pressure (BP) were examined prior to administration of the medications; at 5 minutes, 10 minutes, and 15 minutes after administration of the medications; and after intubation. No significant differences were noted (p greater than 0.05) between the medications except for a slightly higher systolic BP for cocaine than for lidocaine with epinephrine at 15 minutes. The results of this double-blind, randomized trial demonstrate that the alpha-adrenergic agonist oxymetazoline is as effective as cocaine, and more effective than lidocaine with epinephrine, for the prevention of epistaxis associated with nasotracheal intubation.

Administration, Topical↗

PubMed2004

Epistaxis in healthy children requiring hospital admission.

OBJECTIVES: To determine the outcomes for healthy children who require admission to hospital with acute epistaxis. METHODS: A 10-year retrospective review of admissions with acute epistaxis under the Otolaryngology Department in a tertiary pediatric centre was performed. RESULTS: There were 14 cases (11 males, 3 females), with mean age 7.8 years (1.9-18.3 years). Three patients had a history of recent aspirin ingestion, and one had sustained nasal trauma. Mean hemoglobin at presentation was 105g/L (75-150), and no patient was diagnosed with a bleeding disorder. Four patients underwent surgical intervention, and one patient received a blood transfusion or blood product. The mean length of hospital stay was 3.6 days (2-14 days). CONCLUSIONS: Acute epistaxis in healthy children that requires hospital admission is generally not a marker for an underlying bleeding disorder. It is associated with a short inpatient stay, and usually requires minimal intervention.

Acute Disease↗