Epistaxis: An update on current management

Department of Otolaryngology and Head and Neck Surgery, St Michael's Hospital, Bristol, UK.
Postgraduate Medical Journal (Impact Factor: 1.45). 06/2005; 81(955):309-14. DOI: 10.1136/pgmj.2004.025007
Source: PubMed


Epistaxis is one of the commonest ENT emergencies. Although most patients can be treated within an accident and emergency setting, some are complex and may require specialist intervention. There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population with their associated morbidity who often require more intensive treatment and subsequent admission. Treatment strategies have been broadly similar for decades. However, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Recent evidence suggests that this, combined with the use of stepwise management plans, should limit patient complications and the need for admission. This review discusses the various treatment options and integrates the traditional methods with modern techniques.

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Available from: Christopher Geoffrey Laurence Hobbs, May 30, 2014
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    • "Epistaxis is common and generally self-limited, but can quickly become an otolaryngic emergency. The etiology of epistaxis is vast and includes causes from digital manipulation, inflammation and neoplasia to coagulopathies and systemic disease [1]. Intractable epistaxis can become life-threatening, as hypotension and hypoxia can easily occur. "
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    ABSTRACT: Epistaxis is most commonly an easily treated ENT entity with a relatively simple algorithm. Occasionally, however, it is encountered as a devastating disease process that can humble the otolaryngologist. In the setting of comorbidities that exacerbate bleeding, in this case vasculitis due to systemic lupus erythematosus (SLE), epistaxis can be life-threatening and refractory to conservative management. This case report describes the hospital course of a patient with severe SLE and intractable epistaxis. We discuss classic management options for epistaxis and offer a novel treatment option for patients with SLE-related vasculitides-goal-directed medical therapy with high-dose intravenous pulse steroid therapy. To our knowledge, this report not only is the first description of targeted treatment options for intractable epistaxis in patients with SLE, but also serves to augment the traditional algorithm with the addition of a goal-directed medical therapy-control of epistaxis through high-dose intravenous pulse steroid therapy. We demonstrated that 6mg of intravenous dexamethasone given every 6hours can be highly effective in controlling epistaxis in patients with uncontrolled SLE. The presumed mechanism is through control of associated vasculitides.
    American journal of otolaryngology 12/2013; 35(2). DOI:10.1016/j.amjoto.2013.12.003 · 0.98 Impact Factor
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    • "Epistaxes are frequent in adults [1]. Local (e.g., trauma, cancer, etc.), general (e.g., hypertension, anticoagulants; etc.), and idiopathic causes are distinguished [2], and these causes must always be managed. Stopping the blood flow is sequential , applying direct pressure to the nose, followed by anterior packing, then anterior and posterior packing, and finally performing surgical cautery under general anesthesia [3] or endovascular treatment [4]. "
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    ABSTRACT: . In case of thrombopenia and/or thrombopathy, epistaxes are very difficult to manage. Case Series . Two patients, one with a thrombocytopenia, the other with a thrombopathy, were hospitalized because of repeated active epistaxes after failure of packing. Both patients were successfully treated with an application of Surgiflo without side effects and left the hospital without recurrence of epistaxis. Discussion . Being a subject of many studies dealing with epistaxis, Surgiflo is a simple treatment that seems to be very effective and without side effects to treat acute epistaxis in fragile patients with coagulation disorders. Prospective studies of tolerance and efficiency in such situations should be performed.
    05/2013; 2013(3):851270. DOI:10.1155/2013/851270
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    • "The etiological profile of epistaxis has been reported to vary with age and anatomical location [4-8]. Traumatic epistaxis is more common in younger individuals (under age 35 years) and is most often due to digital trauma, facial injury, or a foreign body in the nasal cavity [6-8]. Non-traumatic epistaxis is more characteristic of older patients (over age 50 years) and may be due to organ failure, neoplastic conditions, inflammation, or environmental factors (temperature, humidity, altitude) [7,8]. "
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    ABSTRACT: Epistaxis is the commonest otolaryngological emergency affecting up to 60% of the population in their lifetime, with 6% requiring medical attention. There is paucity of published data regarding the management of epistaxis in Tanzania, especially the study area. This study was conducted to describe the etiological profile and treatment outcome of epistaxis at Bugando Medical Centre, a tertiary care hospital in Northwestern Tanzania. This was a prospective descriptive study of the cases of epistaxis managed at Bugando Medical Centre from January 2008 to December 2010. Data collected were analyzed using SPSS computer software version 15. A total of 104 patients with epistaxis were studied. Males were affected twice more than the females (2.7:1). Their mean age was 32.24 ± 12.54 years (range 4 to 82 years). The modal age group was 31-40 years. The commonest cause of epistaxis was trauma (30.8%) followed by idiopathic (26.9%) and hypertension (17.3%). Anterior nasal bleeding was noted in majority of the patients (88.7%). Non surgical measures such as observation alone (40.4%) and anterior nasal packing (38.5%) were the main intervention methods in 98.1% of cases. Surgical measures mainly intranasal tumor resection was carried out in 1.9% of cases. Arterial ligation and endovascular embolization were not performed. Complication rate was 3.8%. The overall mean of hospital stay was 7.2 ± 1.6 days (range 1 to 24 days). Five patients died giving a mortality rate of 4.8%. Trauma resulting from road traffic crush (RTC) remains the most common etiological factor for epistaxis in our setting. Most cases were successfully managed with conservative (non-surgical) treatment alone and surgical intervention with its potential complications may not be necessary in most cases and should be the last resort. Reducing the incidence of trauma from RTC will reduce the incidence of emergency epistaxis in our centre.
    BMC Ear Nose and Throat Disorders 09/2011; 11(1):8. DOI:10.1186/1472-6815-11-8
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