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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 morbidit...
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... Traumatic epistaxis is more common in younger individual(under age 15years) and is most often due to digital trauma , facial injury, or a foreign body in the nasal cavity. 6,7 Non traumatic epistaxis more characteristic of older patients (over age 50years) and may be due to organ failure, neoplastic conditions, inflammation or environmental factors (temperature, humidity, altitude) 7 . Epistaxis that occurs in children younger than 10 years usually is mild and originates in the anterior nose, whereas epistaxis that occurs in individuals older than 50 years is more likely to be severe and originate posteriorly 8 . ...
... Majority of the patients in this study were in above 5th decade (55%) followed by 2 nd to5th decade (25%) According to another study, the maximum number of patient were in 3rd decade (26.61) 12 , followed by 4th and 2nd decade. 6 There is a pronounced bimodal distribution in the age of onset of epistaxis were reported from north America 19 , and in this subcontinent. 20,21 The study, Shaheen et al shows an increase frequency between the age of 15-25 years and later from 45 to 65 years with no evidence of sex predilection 22 . ...
Background: Epistaxis is a common otolaryngological emergency worldwide. Many of the population suffer from it in their lifetime. This study was conducted to describe the demography of epistaxis among the patients who came to Pabna Medical College Hospital and Dhaka Medical College Hospital. Objective: To evaluate the frequency of epistaxis among populations of different groups of age, sex, habitat, and circadian variation. Methods: This cross-sectional study was conducted among 100 patients who came with epistaxis at Pabna Medical College Hospital and Dhaka Medical College Hospital of Bangladesh from January 2021 to December 2021. Results: Male was found to be affected more than female with male to female ratio of 3:1. Eighty percent of the patients were from 5th to 7th decade, 60% were from urban and 40% were from rural habitat. Regarding etiology and sex, there were no significant differences between rural and urban habitats. The frequency of epistaxis showed circadian variation, 40% reported to the hospital in the evening, 35% in the morning, and the remaining 25% at late night. The frequency (55%) of epistaxis was more from November to March. Conclusion: A high incidence in young adults was reported with the preponderance of male over female. The occurrence of epistaxis was strongly related to certain demographic factors. These are the age, sex, and habitat of the patient. This study supports the credibility of management procedure by finding some factors that make a difference in the frequency of epistaxis. J Shaheed Suhrawardy Med Coll 2022; 14(1): 8-11
... Among the systemic causes are elevated arterial blood pressure, blood disorders, coagulopathy, and the use of anticoagulants [4]. From a clinical perspective, epistaxis is classified as either anterior or posterior based on the anatomy of the blood supply of the nose [5]. Anterior epistaxis is more commonly observed during the early stages of life. ...
Epistaxis, commonly known as nasal bleeding, ranks among the most prevalent emergencies encountered in otorhinolaryngology. The etiology of epistaxis is multifaceted, arising from both local and systemic factors. In Saudi Arabia, a country with a relatively high prevalence of epistaxis, understanding the level of awareness and attitudes toward first aid management of epistaxis is of paramount importance. This systematic review aims to bridge this knowledge gap by evaluating the awareness of and attitudes toward epistaxis first aid in Saudi Arabia.
This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A comprehensive electronic search was executed across PubMed, Google Scholar, and Web of Science databases, encompassing studies published between January 2015 and July 2023. The study included exclusively cross-sectional studies, assessing awareness and attitude toward epistaxis first aid in Saudi Arabia across all populations and studies in English.
The 17 selected studies were all published after October 2017, with three published in the year of this systematic review (2023). Sample sizes exhibited substantial variability, ranging from 57 to 2,441 individuals. Despite widespread awareness of epistaxis, the general population often disregards it as a minor health issue. This discrepancy highlights the importance of addressing epistaxis seriously, given the potential for severe bleeding as a medical emergency. The review of 17 studies revealed significant variations in epistaxis awareness levels, influenced by factors such as age, gender, and varying sample sizes. Notably, higher awareness levels were observed in studies involving the general Saudi population and those employing self-administered questionnaires.
The average awareness and knowledge of epistaxis and its management among Saudi residents were moderate, with an estimated awareness level of 63%. A large-scale epidemiological survey, considering sociodemographic factors, is recommended to provide a more comprehensive understanding of epistaxis awareness.
... Trauma to the nose, such as from picking, blowing the nose forcefully, or facial injury, is a frequent cause of epistaxis. 6 The delicate blood vessels in the nasal mucosa can be easily disrupted, leading to bleeding. Dry air, especially in arid climates or heated indoor environments, can cause the nasal mucosa to become dry and prone to bleeding. ...
... If bleeding persists or worsens, or if the patient's condition deteriorates, it may be necessary to escalate the level of care, involve specialists, or consider admission to the hospital for more intensive management and evaluation. 6 Assessing the severity of bleeding in cases of acute epistaxis involves evaluating the duration, volume, impact on hemodynamic stability, patient symptoms, and overall clinical condition. This assessment guides the urgency and intensity of further management interventions, ensuring timely and appropriate care for patients presenting with acute epistaxis in the ED. ...
Acute epistaxis, or nosebleed, is a common presentation in the emergency department (ED) that requires a systematic evaluation and prompt management. The assessment involves considering the severity of bleeding, identifying underlying causes, and implementing appropriate interventions. Modifiable risk factors, such as medication review, nasal hygiene, avoidance of nasal trauma, and humidification, should be addressed to prevent recurrence. Referral to specialists is necessary for cases of recurrent or severe bleeding, suspected underlying causes, or inadequate response to initial management. Collaboration between ED healthcare providers and specialists ensures comprehensive evaluation, specialized interventions, and long-term management. Regular follow-up appointments and patient education are essential for monitoring progress, adjusting treatment, and preventing complications. By employing a comprehensive approach, healthcare providers aim to alleviate distress, achieve hemostasis, identify underlying etiologies, and optimize patient outcomes in the ED.
... Uncontrolled epistaxis is a common reason for presentation to the emergency department in Australia. Vasoconstrictive topical measures in conjunction with silver nitrate cautery are often successful in arresting the bleeding, allowing the patient to be discharged home (1,2). In our health service if these initial measures fail, insertion of a non-dissolving carboxymethylcellulose balloon pack (Rapid Rhino TM ) to tamponade the bleeding, additionally acting as a platelet aggregator and lubricator, is frequently performed (1). ...
... Vasoconstrictive topical measures in conjunction with silver nitrate cautery are often successful in arresting the bleeding, allowing the patient to be discharged home (1,2). In our health service if these initial measures fail, insertion of a non-dissolving carboxymethylcellulose balloon pack (Rapid Rhino TM ) to tamponade the bleeding, additionally acting as a platelet aggregator and lubricator, is frequently performed (1). The literature advocates for the removal of the pack 24-72 hours after insertion (2)(3)(4)(5), therefore once it has been inserted patients are routinely admitted to hospital for observation and pack removal (6). ...
Background: Epistaxis is an ear nose and throat (ENT) emergency accounting for a significant number of emergency department presentations. Traditionally patients requiring non-dissolving nasal balloon packing (Rapid Rhino TM) have required hospital admission with the packing left in situ for 24-48 hours. This research explores which patients are likely to require inpatient management, with an attempt to define a subgroup who are safe to be managed in the outpatient setting. Methods: Observational study with retrospective review of epistaxis ENT admissions between 1 st January 2019 and 31 st December 2020 at Flinders Medical Centre, South Australia. Data extracted include patient demographics, co-morbidities, recent nasal surgery, anti-platelet/anti-coagulant use and if surgical management or interventional radiology/embolisation was required. The primary outcome was whether the patient required unplanned review by a medical officer, used as a proxy to identify those patients less suitable for outpatient management. Results: A total of 207 admissions coded with epistaxis were identified, 171 patients required the insertion of at least one nasal balloon pack to control bleeding. Significant risk factors for requiring unplanned medical review were abnormal systolic blood pressure (SBP) (>170 or <90 mmHg) (P=0.002) and dementia/ cognitive impairment (P=0.04). Recent nasal surgery (P=0.03) and ≥1 recent presentation with epistaxis (P=0.009) were risk factors for requiring a surgical procedure to control epistaxis. One hundred and eighteen epistaxis patients requiring packing were found to require unplanned medical review, surgical management or interventional radiology/embolisation. The remaining 53 patients (31%) were identified as not having factors requiring active inpatient management. Conclusions: This retrospective study has identified that approximately 31% of patients could potentially be discharged home with a nasal balloon pack in situ with follow-up in outpatient clinic within 48 hours for packing removal. This hospital avoidance will reduce pressure on public hospital system.
... Epistaxis in childhood is twice as common as in the adult age group, and when considering the children's age group, more than half of people experience epistaxis at least once in years 5,19 . However, epistaxis in the childhood group usually does not require treatment; cases aged 50 years and over need treatment 20 . In this study, the mean age of the patients was 56.6 ± 17.8 years. ...
Aim: This study aimed to present technical details and outcomes of endovascular treatment of patients who underwent endovascular embolization due to resistant and recurrent epistaxis in our center. Methods: In this study, between January 2014 and January 2020, the patients who underwent endovascular treatment due to epistaxis in the interventional radiology unit at our hospital were evaluated retrospectively. Results: In this study, 4 (25%) female and 12 (75%) male patients were included in 16 patients. The mean age of the patients was 56.6 ± 17.8 years. The etiologies of epistaxis of the patients were as follows; 4 (25%) patients had nasal angiofibroma, 1 (6.2%) patient had larynx carcinoma, 1 (6.2%) patient had nasopharynx carcinoma, 1 (6.2%) patient had aneurysm rupture, 1 (6.2%) patient had epistaxis due to anticoagulant use, 8 (50%) patients had idiopathic epistaxis. In total, endovascular embolization was performed in all 18 procedures performed. In all 16 patients who underwent embolization, 100% technical success was achieved during the procedure, and no complications developed in the follow-up. However, in 2 (12.5%) procedures, embolization therapy was performed for the second time due to recurrent epistaxis after embolization. Conclusions: In resistance and recurrent epistaxis cases, endovascular embolization is an alternative to surgical methods, a treatment method with a low risk of complications and a high success rate.
... Therefore, epistaxis may continue despite unilateral arterial embolization. In addition, pre-existing anastomoses can be opened due to increased pressure during embolization and undesirable embolization of the internal carotid artery or ophthalmic artery may occur [4,5]. Therefore, embolization is contraindicated in the presence of an anastomosis between the external and internal carotid artery or in cases of bleeding in the ethmoid artery, a branch of the ophthalmic artery, due to the risk of blindness [1,2,6]. ...
A majority of the population will experience epistaxis at some time in their life. Most cases will be from an anterior source and can be treated with pressure, anterior nasal packing, or cautery. Intractable epistaxis is generally posterior in origin and may require endoscopic cauterization, posterior packing, ligation of external carotid artery or embolization. Here we report a case of bilateral posterior epistaxis in a 41 year old male patient with c/o spontaneous epistaxis from bilateral nostril. Digital Subtraction Angiography followed by Angioembolisation was done.
... Depending on the site of origin (and flow), epistaxis is divided into anterior and posterior epistaxis. Anterior epistaxis occurs as result of damage to the Kiesselbach plexus (near Little's area), where the vessels supplying the mucosa anastomose with each other [2,8]. Posterior epistaxis occurs because of damage to the posterior nasal septal artery [8]. ...
... Anterior epistaxis occurs as result of damage to the Kiesselbach plexus (near Little's area), where the vessels supplying the mucosa anastomose with each other [2,8]. Posterior epistaxis occurs because of damage to the posterior nasal septal artery [8]. Anterior nosebleeds are far more prevalent than posterior ones, and account for 80% of the cases [7,8]. ...
... Posterior epistaxis occurs because of damage to the posterior nasal septal artery [8]. Anterior nosebleeds are far more prevalent than posterior ones, and account for 80% of the cases [7,8]. However, posterior nosebleeds generally require medical attention as blood loss usually occurs through throat [7]. ...
Background: Epistaxis is one of the most common medical emergencies worldwide,with almost 60% of the population experiencing it at some point in their life.Our study aimed to understand the etiology and management in OPD and nonsurgical IPD settings. Methods: Our study consisted of 60 patients presenting with epistaxis over a period of one year in tertiary care setting. Detailed history was taken, followed by formulation, and putting into practice the management methodology. Results: Our results showed a male (63.3%) predominance over females (36.7%).Majority of our patients were more than 40 years in age,with 51-60 years (28.4%) being the most common age group. Hypertension, idiopathy, and trauma were the most common etiologies.All the cases were resolved with conservative (non-surgical) methods of treatment.Blood transfusion was required in only one case.Conclusions:Epistaxis,although seen at any age,is largely a geriatric problem. Hypertension, idiopathy, and trauma are the most common etiologies. Etiologies vary with age and their understanding leads to better management plans. Conservative methods remain successful in cases without any complications.
... 6 If these do not work, anterior nasal packing may be needed; it is an effective treatment, and it controls bleeding in up to 85% of cases. 7 Anterior nasal packing is used with or without a topical vasoconstrictor or a local anesthetic and may be associated with a number of complications, including irritation of the posterior nasal mucosa when the pack is inserted and removed, rebleeding after the pack is removed, infection, and tissue necrosis. 8,9 As a result, the search for a more efficient approach continues. ...
Study objective:
To determine the effectiveness of intranasal topical application of tranexamic acid in reducing the need for anterior nasal packing and determine the number of episodes of rebleeding in adult patients presenting with spontaneous atraumatic anterior epistaxis.
Methods:
This study was a double-blind randomized trial conducted from September to November 2021 in the ears, nose, and throat (ENT) emergency department (ED), Khalili Hospital, Shiraz, Iran. Cotton pledgets soaked in either phenylephrine and lidocaine (control group) or tranexamic acid with phenylephrine and lidocaine (intervention group) were inserted into the patients' nostrils for 15 minutes. The primary outcome was the need for anterior nasal packing. The secondary outcomes were staying in the ED for more than 2 hours, needing electrical cauterization, and rebleeding within 24 hours and 1 to 7 days of the first referral to the ED. The trial was registered with the Iranian Registry of Clinical Trials (IRCT20210403050815N1).
Results:
A total of 240 patients (120 in each group) were enrolled in this study. Tranexamic acid was associated with a lower rate of need for anterior nasal packing (50.0% versus 64.2%; odds ratio [OR], 0.56; 95% confidence interval [CI], 0.33 to 0.94). There were no significant differences between the 2 groups in terms of the need for electrical cauterization and the rate of rebleeding within 1 to 7 days. Tranexamic acid was associated with a lower rate of stay in the ED for more than 2 hours (9.2% versus 20.8%; OR, 0.38; 95% CI, 0.18 to 0.82) and rebleeding in 24 hours (15.0% versus 30%; OR, 0.41; 95% CI, 0.22 to 0.78) compared with the rates in the control group.
Conclusion:
Intranasal topical application of tranexamic acid is associated with a lower rate of need for anterior nasal packing and a shortened stay in the ED; it may be considered a part of the treatment for atraumatic anterior epistaxis.
... Trials have shown that symptoms of allergic rhinitis are reduced within 7 hours, and maximum efficacy is attained within 1-2 weeks using intranasal corticosteroids (Bryson and Faulds, 1992;Pope and Hobbs, 2005;Akkaş et al, 2018). ...
Allergic rhinitis affects 20% of the population of the UK. It confers a significant health burden upon the individual as it affects the patient's quality of life and is associated with serious comorbidities including asthma, sinusitis and conjunctivitis. Owing to its prevalence, it has a significant economic impact through its effects on education, productivity and use of healthcare resources. This review focuses on the management of allergic rhinitis and potential future treatments, because of the lack of clear national guidelines and because this illness is often misdiagnosed and mismanaged. The article provides a comprehensive overview of allergic rhinitis and illustrates the assessment criteria for various subcategories.
... Anterior epistaxis accounts for the majority of cases [49] and is usually self-limiting, occurring as an isolated event [46]. It is frequently idiopathic but may be attributable to a local cause such as trauma, digital manipulation, or deviated septum, to systemic conditions that require anticoagulation, or environmental causes such as a dry atmosphere [39]. Posterior epistaxis accounts for only 5-10% of cases and is commonly associated with a systemic condition such as hypertension [43]. ...
... In the years that ensued, reference to Woodruff's plexus has emerged within the literature, however, the details of its precise anatomy and its vascular nature in particular have become blurred. Contradictions between sources are apparent with some authors describing WP as venous [46,50], as was classically depicted in 1949, whereas others describe WP as an arterial network [32,35,39,40]. As it is frequently considered as the most common site of origin for posterior epistaxis, a better understanding of its anatomy is essential. ...
... Despite the relative paucity of anatomical dissection studies, there appears to be a multitude of articles that define the morphology of WP vascular network (Fig. 3). The majority of authors (78.26%) describe the SPA as the main supply to the plexus [13,35,37,38], whereas other authors (8.7%) such as Bastianpillai et al. and Pope and Hobbs identify the posterior nasal (septal) artery as a main component [4,39]. The ascending pharyngeal artery is cited in 34.78% of papers as forming the WP, either mentioned specifically by itself or in the context of anastomoses with other vessels. ...
PurposeWoodruff’s plexus is a vascular network located on the posterior lateral wall of the inferior meatus of the nasal cavity and it is generally considered to be responsible for posterior epistaxis. Despite being initially identified in 1949 as a venous plexus, discrepancies exist within literature regarding this anatomical structure, particularly its arterial or venous nature and its association with posterior epistaxis. This systematic review aims to collate information pertaining to Woodruff’s plexus and evaluate our current understanding of this vascular area.Methods
The systematic review was performed using published data in PubMed, Google Scholar, Scopus, EBSCO and Web of Science platforms using keywords such as ‘Woodruff’, ‘posterior’ and ‘plexus’. Articles referring to Woodruff’s plexus were collected and analysed by independent reviewers.ResultsThe search revealed 154 papers, out of which only 40 were included in the review. Out of this number only two papers were anatomical dissection studies, both of which identify the plexus as venous in nature. Seventeen studies describe the plexus as venous by citing these two papers. The remainder of the articles (23) consider Woodruff’s plexus as arterial with variability in the reported arteries that supply it.Conclusion
Woodruff’s original description of a venous plexus is supported by modern anatomical studies. There are a multitude of reports that Woodruff’s plexus is arterial in nature, despite the absence of existing anatomical studies to support this notion. This misconception has likely arisen due to clinical associations in relation to posterior epistaxis.
