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: 1.61). 06/2005; 81(955):309-14. DOI:10.1136/pgmj.2004.025007
Source: PubMed

ABSTRACT 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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    ABSTRACT: Iron deficiency anemia remains a major global health problem. Higher iron demands provide the potential for a targeted preventative approach before anemia develops. The primary study objective was to develop and validate a metric that stratifies recommended dietary iron intake to compensate for patient-specific non-menstrual hemorrhagic losses. The secondary objective was to examine whether iron deficiency can be attributed to under-replacement of epistaxis (nosebleed) hemorrhagic iron losses in hereditary hemorrhagic telangiectasia (HHT). The hemorrhage adjusted iron requirement (HAIR) sums the recommended dietary allowance, and iron required to replace additional quantified hemorrhagic losses, based on the pre-menopausal increment to compensate for menstrual losses (formula provided). In a study population of 50 HHT patients completing concurrent dietary and nosebleed questionnaires, 43/50 (86%) met their recommended dietary allowance, but only 10/50 (20%) met their HAIR. Higher HAIR was a powerful predictor of lower hemoglobin (p = 0.009), lower mean corpuscular hemoglobin content (p<0.001), lower log-transformed serum iron (p = 0.009), and higher log-transformed red cell distribution width (p<0.001). There was no evidence of generalised abnormalities in iron handling Ferritin and ferritin(2) explained 60% of the hepcidin variance (p<0.001), and the mean hepcidinferritin ratio was similar to reported controls. Iron supplement use increased the proportion of individuals meeting their HAIR, and blunted associations between HAIR and hematinic indices. Once adjusted for supplement use however, reciprocal relationships between HAIR and hemoglobin/serum iron persisted. Of 568 individuals using iron tablets, most reported problems completing the course. For patients with hereditary hemorrhagic telangiectasia, persistent anemia was reported three-times more frequently if iron tablets caused diarrhea or needed to be stopped. HAIR values, providing an indication of individuals' iron requirements, may be a useful tool in prevention, assessment and management of iron deficiency. Iron deficiency in HHT can be explained by under-replacement of nosebleed hemorrhagic iron losses.
    PLoS ONE 01/2013; 8(10):e76516. · 3.73 Impact Factor
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    ABSTRACT: Objectives To evaluate the efficacy of radiofrequency coagulation and to compare it with that of liquid paraffin plus antiseptic cream in the management of recurrent anterior epistaxis. Design Prospective clinical trial. Between February 2011 and July 2012, one hundred consecutive patients with histories of recurrent anterior epistaxis were randomly assigned to receive treatment consisting of either a combination of liquid paraffin plus antiseptic cream (group 1) or radiofrequency coagulation (group 2). Setting Benha University Hospital. Main outcome measures The Epistaxis Severity Score; before treatment, at 4, 12weeks, 6 and 12months after treatment, participant’s perception of discomfort during the management and complications. Results The severity score of the 94 patients who had full data at 4weeks after treatment shows no statistically significant differences between the two groups. However, at 12weeks; 85% of the radiofrequency group versus 40% of paraffin-antiseptic group patients had reported no bleeding. At 6months; 74% of the radiofrequency group versus 25% of the paraffin-antiseptic group patients reported no bleeding. At 12months, 70% of the radiofrequency group versus 23% of the paraffin-antiseptic group patients reported no bleeding. Both groups had no complications. The level of pain associated with the procedure was tolerable. Mean duration of the radiofrequency procedure was 14.2min. Conclusions It can be concluded that radiofrequency coagulation is a safe, convenient rapid and simple procedure that is associated with a significant improvement in epistaxis severity in cases of recurrent anterior epistaxis. This therapy could be performed in office settings. Keywords: Radiofrequency, Antiseptic, Cream, Recurrent, Epistaxis
    Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 03/2013;
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    ABSTRACT: Introduction. 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.
    Case reports in otolaryngology. 01/2013; 2013:851270.


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