phenylephrine-hydrochloride and Epistaxis

Patients with hereditary haemorrhagic telangiectasia can present with a multitude of symptoms caused by telangiectasia and arteriovenous malformations in the nose, brain, gastrointestinal tract, liver and spinal cord. Clinicians should be aware of the potential diagnosis of hereditary haemorrhagic telangiectasia and how to manage these patients both in the acute and chronic setting. Identifying these patients and optimising their management can help reverse the reduced life expectancy back to that of the normal population. The management of these patients is complex and often requires a multidisciplinary approach, with difficult discussions to be had around screening for arteriovenous malformations and genetic testing. The stepwise management ladder can be used in both the medical and surgical strategies; there are multiple pharmacological and surgical options available, all with their own side effects and risks. Patient education is key to help informed decision making. This article outlines the clinical characteristics of the disease and management options available.

Topics: Arteriovenous Malformations; Epistaxis; Genetic Testing; Humans; Nose; Telangiectasia, Hereditary Hemorrhagic

Massive and severe epistaxis is an uncommon event in pregnancy. It could be life threatening and could affect the normal pregnancy course. The best management is still on debate; it could be medical, conservative or surgical. Pregnancy termination often is problem solving. Hormonal changes during pregnancy affects nasal physiology. Vaginal delivery, labour induction or cesarean section are all suitable, after hemodynamic stabilization of pregnant woman. We report a case and review the available literature.

Topics: Adult; Epistaxis; Female; Humans; Nose; Pregnancy; Pregnancy Complications; Recurrence; Severity of Illness Index

It has been proposed that fibrin tissue adhesive (FTA) can act as an effective alternative to nasal packing in managing the postoperative symptoms of endoscopic nasal surgery.. MEDLINE, Embase, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and ClinicalTrials.gov were searched for randomised controlled trials comparing FTA with nasal packing in endoscopic nasal surgery. The primary outcome of interest was bleeding; secondary outcomes included pain, nasal obstruction, infection, adhesions and the formation of granulation tissue. All trials underwent a risk of bias assessment, and a meta-analysis was performed using a random effects model.. 315 studies were found, of which four were eligible for inclusion (n = 152). Bleeding was reported in all, with the meta-analysis favouring the packing group, although this was not significant. Nasal obstruction and granulation severity were significantly lower in the FTA group, however, no difference was noted for the outcomes of pain, infection or adhesions.. Our results indicate minor advantages for using FTA over nasal packing. Unfortunately, the included studies show significant heterogeneity and risk of bias. Based on the available evidence, clinicians must balance the higher cost of FTA against the limited advantages for the patient.

Topics: Endoscopy; Epistaxis; Fibrin Tissue Adhesive; Humans; Nasal Surgical Procedures; Nose

Epistaxis is a common emergency encountered by primary care physicians. Up to 60% of the general population experience epistaxis, and 6% seek medical attention for it. More than 90% of cases arise from the anterior nasal circulation, and most treatments can be easily performed in the outpatient setting. Evaluation of a patient presenting with epistaxis should begin with assessment of vital signs, mental status, and airway patency. When examining the nose, a nasal speculum and a good light source, such as a headlamp, can be useful. Compressive therapy is the first step to controlling anterior epistaxis. Oxymetazoline nasal spray or application of cotton soaked in oxymetazoline or epinephrine 1: 1,000 may be useful adjuncts to compressive therapy. Directive nasal cautery, most commonly using silver nitrate, can be used to control localized continued bleeding or prominent vessels that are the suspected bleeding source. Finally, topical therapy and nasal packing can be used if other methods are unsuccessful. Compared with anterior epistaxis, posterior epistaxis is more likely to require hospitalization and twice as likely to need nasal packing. Posterior nasal packing is often associated with pain and a risk of aspiration if it is dislodged. After stabilization, patients with posterior packing often require referral to otolaryngology or the emergency department for definitive treatments.

Topics: Ambulatory Care; Epistaxis; Humans; Nose; Patient Care Management

Topics: Chronic Disease; Diagnosis, Differential; Emergency Medical Services; Epistaxis; Follow-Up Studies; Humans; Hypertension; Nose; Recurrence

There is variation regarding the use of surgery and interventional radiological techniques in the management of epistaxis. This review evaluates the effectiveness of surgical artery ligation compared to direct treatments (nasal packing, cautery), and that of embolisation compared to direct treatments and surgery.. A systematic review of the literature was performed using a standardised published methodology and custom database search strategy.. Thirty-seven studies were identified relating to surgery, and 34 articles relating to interventional radiology. For patients with refractory epistaxis, endoscopic sphenopalatine artery ligation had the most favourable adverse effect profile and success rate compared to other forms of surgical artery ligation. Endoscopic sphenopalatine artery ligation and embolisation had similar success rates (73-100 per cent and 75-92 per cent, respectively), although embolisation was associated with more serious adverse effects (risk of stroke, 1.1-1.5 per cent). No articles directly compared the two techniques.. Trials comparing endoscopic sphenopalatine artery ligation to embolisation are required to better evaluate the clinical and economic effects of intervention in epistaxis.

Topics: Adult; Arteries; Cautery; Embolization, Therapeutic; Epistaxis; Humans; Ligation; Nose; Radiology, Interventional; Treatment Outcome

Epistaxis, or nosebleed, is a common disorder that many patients will experience. Most patients go to the emergency room when they have an uncontrolled nosebleed, or they may present to an outpatient office. Most nosebleeds are not life-threatening and can be managed conservatively. Occasionally, hospital admission, referral to an otolaryngologist physician, and/or blood transfusion may be necessary. This article is an update on the latest information related to the prevention, causes, and treatment of epistaxis.

Topics: Epistaxis; Humans; Nose; Tampons, Surgical

To introduce pseudoaneurysm of the sphenopalatine artery as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.. Case report and literature review.. This paper reports a case of acute life-threatening epistaxis following Le Fort I osteotomy. Computed tomography and angiography showed a pseudoaneurysm of the sphenopalatine artery, which was successfully treated by endovascular embolisation.. Although a pseudoaneurysm of the sphenopalatine artery following Le Fort I osteotomy is extremely rare, it should be considered as the possible aetiology of acute massive epistaxis in patients with a history of orthognathic surgery accompanied by Le Fort I osteotomy.

Topics: Adult; Aneurysm, False; Epistaxis; Humans; Male; Mandibular Osteotomy; Maxillary Artery; Nose; Orthognathic Surgical Procedures; Postoperative Complications; Tomography, X-Ray Computed

Otolaryngology (ear, nose, and throat) emergencies are a common complaint in the emergency department. These can present as a result of infection, trauma, foreign bodies, or postprocedure complications. The emergency department physician is called on to offer initial if not definitive management of these patients. This article discusses common ear, nose, and throat emergencies presenting to the emergency department.

Topics: Child; Ear Canal; Emergencies; Epistaxis; Eye Foreign Bodies; Foreign Bodies; Humans; Mouth; Nose; Otorhinolaryngologic Diseases; Respiratory System; Retropharyngeal Abscess

The nose counteracts chemical, biological and mechanical insults from the outside word. Mechanical injuries to the nose are usually managed within few days. Fracture of the nasal septum and possible hematoma should be managed within one day. Nasal or paranasal infection will in most cases heal by symptomatic treatment or antibiotic medication. Sometimes the condition gets rapidly complicated, resulting even in a life-threatening infection. Nose-bleeding originates in most cases from the frontal part of the nose, whereby treatment with silver nitrate is simple and effective. Gauze packing or anterior-posterior tamponade with a balloon serve as first aid for bleeding of the posterior part.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Emergency Treatment; Epistaxis; Hemostatic Techniques; Humans; Nose; Nose Diseases; Silver Nitrate

Topics: Adult; Algorithms; Anticoagulants; Blood Transfusion; Combined Modality Therapy; Electrocoagulation; Embolization, Therapeutic; Emergency Service, Hospital; Endoscopy; Epistaxis; Evidence-Based Medicine; Gelatin Sponge, Absorbable; Hemostatics; Humans; Ligation; Nose; Patient Admission; Platelet Aggregation Inhibitors; Retreatment; Tampons, Surgical; Utilization Review

Topics: Aged, 80 and over; Embolization, Therapeutic; Enbucrilate; Epistaxis; Humans; Male; Nose; Telangiectasia, Hereditary Hemorrhagic; Tissue Adhesives; Vascular Malformations

Epistaxis is a common clinical problem often seen by primary care physicians. This can be caused by multiple factors, each of which should be explored to treat the epistaxis and prevent recurrences. In this article, etiologies and methods of evaluation for the patient with epistaxis are discussed. Treatment strategies are outlined in a stepwise fashion, as are recommendations for situations requiring referral to an otolaryngologist.

Topics: Cautery; Epistaxis; Hemostatics; Humans; Ligation; Nose; Referral and Consultation; Tampons, Surgical

Epistaxis can be encountered in a wide range of specialties, and it is vital that doctors and nurses can identify the causes and manage it effectively. When managed correctly the potential morbidity and mortality can be significantly reduced.

Topics: Adult; Age Factors; Aged; Aminocaproic Acid; Antifibrinolytic Agents; Embolization, Therapeutic; Emergency Medicine; Epistaxis; Humans; Middle Aged; Nose; Risk Factors; Secondary Prevention; Tranexamic Acid

The treatment of epistaxis has undergone significant changes in recent years. Gone are the days when patients had an uncomfortable posterior nasal pack inserted then spent several days on the ward only to bleed again on its removal. New packing devices, ingenious haemostatic agents and endoscopic surgical approaches have been developed to provide a variety of effective and well-tolerated treatment options. This paper will discuss the evolution and utility of these devices and techniques for managing difficult epistaxis patients.. Modern packing devices are much easier to insert than traditional gauze packs and are no less effective. A major advance in the management of posterior epistaxis has been the development of the technique of endoscopic ligation.. Anterior epistaxis is generally easy to control with local cautery. The optimal management of posterior epistaxis is to insert a pack to control the bleeding before taking the patient to the operating theatre to ligate the sphenopalatine artery endoscopically.

Topics: Arteries; Cautery; Embolization, Therapeutic; Epistaxis; Gelatin Sponge, Absorbable; Hemostatics; Humans; Ligation; Nose; Palate; Tampons, Surgical

Topics: Embolization, Therapeutic; Epistaxis; Hospitalization; Humans; Ligation; Medical History Taking; Nose; Physical Examination; Physical Therapy Modalities; Surgical Sponges

This review is designed to update the reader on the current state of nasal endoscopy in the control of epistaxis. Recent articles are reviewed and demonstrate recent developments and results.. The use of endoscopy for control of anterior and posterior epistaxis is beneficial, with less morbidity then external procedures or Caldwell Luc approaches. Postoperative endoscopic sinus surgery epistaxis is easily treated with endoscopic visualization. Epistaxis secondary to tumors can be controlled via an endoscopic approach. Patients with Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia) can have more selective laser control of telangiectasia using endoscopic technique. Endoscopic septodermoplasty is straight-forward and avoids external incisions. Following a protocol for control of hemorrhage from an injured carotid artery during endoscopic sinus surgery, patients can survive with good function.. Endoscopic visualization and techniques are the state of the art for surgical control of epistaxis. Alternatives are embolization or external/Caldwell-Luc approaches.

Topics: Endoscopy; Epistaxis; Humans; Nose; Postoperative Complications

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.

Topics: Algorithms; Decision Trees; Epistaxis; Hemostatic Techniques; Humans; Intubation, Intratracheal; Maxillofacial Injuries; Nose; Oral Surgical Procedures

Nasal packing is used primarily to control bleeding in epistaxis and after surgical procedures to the nose such as septoplasty, turbinate and paranasal sinus surgery. It is also used for internal stabilisation after operations involving the cartilaginous-bony skeleton of the nose. Apart from haemostasis, packing is used to prevent synechiae or restenosis, particularly after surgery. Generally accepted standards regarding the materials which should be used for packing, how long the packing should be left in place or the indications for nasal packing are lacking (Egelund and Jeppessen, 1992; Hosemann, 1996; Weber et al., 1996b). For example, many authors do not use packing at all provided that there is no heavy bleeding during or after the operation. Of those who use packing, some remove it on the day of the operation, others up to 5 days postoperatively (for overview see Weber et al., 1996b). Most publications describe experience with packing materials developed or preferred by the authors. Results of comparative studies on the nature and duration of packing are listed in Table 1. The currently available materials are reviewed and their respective properties, indications and risks are outlined.

Topics: Bandages; Epistaxis; Hemostatic Techniques; Humans; Nose; Postoperative Care; Postoperative Hemorrhage; Rhinoplasty; Risk Factors; Shock, Septic; Stents

Standard cauterization therapy for chronic epistaxis is less than ideal because of the inadequacy of topical anesthesia and the difficulty of treating young, often uncooperative patients. The author has developed a new procedure for treating these patients, which entails ligation and cauterization while the patient is under light general anesthesia in an outpatient surgical facility. Of the approximately 75 procedures the author has performed, only one failed to achieve expected results. This article describes how this safe, simple, and ultimately cost-effective procedure is performed.

Topics: Chronic Disease; Epistaxis; Humans; Ligation; Nose; Secondary Prevention; Vascular Surgical Procedures

Epistaxis is a common clinical problem. The widespread availability of endoscopic equipment is shifting management philosophy toward targeting the bleeding point. This shift may have a significant impact on decreasing length of stay and blood transfusion rates. Advances in interventional radiology have also reduced the risk of embolization. Patient education, especially teaching first-aid measures to patients at high risk for nosebleeds, also encourages more effective use of health care resources.

Topics: Blood Transfusion; Embolization, Therapeutic; Endoscopy; Epistaxis; First Aid; Humans; Length of Stay; Nose; Patient Education as Topic; Radiology, Interventional; Risk Factors; Self Care

Patients present to the emergency department with a number of eye, ear, nose, and throat (ENT) problems. This article updates some very common problems; identifies a few pearls on nasal foreign body removal, ophthalmologic medication, and epistaxis; and reviews a few pitfalls in identifying malignancies and sore throats.

Topics: Emergency Medicine; Epistaxis; Foreign Bodies; Head and Neck Neoplasms; Humans; Nose; Otorhinolaryngologic Diseases; Pharyngitis; Referral and Consultation

Topics: Anesthesia, Local; Biopsy; Epistaxis; Humans; Infections; Nose; Nose Diseases; Postoperative Care

Epistaxis is a very common presenting symptom of patients seen in the emergency room or the physician's office. An understanding of the nasal anatomy and physiology is important for proper treatment of these patients. New methods of treatment are discussed briefly.

Topics: Catheterization; Emergencies; Epistaxis; Hemostatic Techniques; Humans; Nose

This comprehensive article reviews some of the most common injuries to the ear, nose, and throat, and in addition reviews the relative anatomy of this area of the body. Particular attention is paid to the treatment of the patient with epistaxis, a common presentation to the Emergency Department.

Topics: Abscess; Ear; Ear Diseases; Emergencies; Epistaxis; Esophagus; Foreign Bodies; Humans; Larynx; Nose; Pharynx

Blind nasotracheal intubation presumes a spontaneously breathing patient but offers a very useful alternative method to instrumented access to the airway and is used primarily in traumatized patients whose cervical spines are suspect. It has a high success rate (90-92 per cent), even when the operator is relatively inexperienced, and is associated with few complications (10 per cent or fewer); a rate that is lower when there is adequate time to prepare the patient with vasoconstrictor and topical anesthesia. The most common complication is epistaxis. Surgical methods of intubation also are discussed of which cricothyroidostomy currently enjoys prominence.

Topics: Emergencies; Epistaxis; Humans; Intubation, Gastrointestinal; Nose

Inverted papillomas which arise from the lining membranes of the nose and paranasal sinuses are relatively unfamiliar lesions which have been reported in the literature under a variety of titles. The uncertainly surrounding their etiology, their relationship to nasal polyps and their malignant potential have resulted in an ill-defined clinical approach to their management. The designation Inverted Schneiderian Papilloma is suggested as an appropriate title that best conveys the qualities of inversion, location and distinctiveness of character. The characteristic microscopic feature is the increase in thickness of the covering epithelium with extensive invasion of this hyperplastic epithelium into the underlying stroma. In the absence of a better explanation of the origin, the tumor should be considered a true epithelial neoplasm. The clinical features in 24 previously unreported cases are presented. The most common presenting complaints are nasal obstruction and epistaxis. The common site of origin is the lateral nasal wall in the region of the middle meatus and ethmoid cells. In no instance was an isolated lesion of the maxillary, frontal or sphenoid sinus present. The most characteristic attributes of the tumor were its tendency to recur, its destructive capacity and its propensity to be associated with malignancy. The common radiographic abnormality on routine sinus films was unilateral opacification of the sinuses and nasal airway. Tomography is helpful in defining the extent of the lesion and in selecting an appropriate surgical approach. A philosophy of management has evolved based on the experiences gained from these 24 patients, combined with a review of the experience of others and a study of the regional anatomy. Surgical excision is the treatment of choice. A bold surgical approach has been used for tumors involving the lateral nasal wall and paranasal sinuses. A lateral rhinotomy incision is employed and when necessary, this exposure is increased by extending the incision of split the upper lip and reflect the cheek flap as is customarily done with the Weber-Ferfusson incision. Fifteen patients have been followed for more than two years and the results have been excellent with the exception of one patient who later developed an invasive squamous carcinoma. An associated malignancy was found in 12.5 percent of the cases.

Topics: Adult; Aged; Airway Obstruction; Carcinoma, Squamous Cell; Epistaxis; Female; Humans; Hypersensitivity; Male; Maxillary Sinus; Middle Aged; Nasal Polyps; Nose; Nose Neoplasms; Papilloma; Paranasal Sinus Neoplasms; Paranasal Sinuses; Recurrence; Sex Factors; Terminology as Topic; Tomography, X-Ray; Virus Diseases

Topics: Epistaxis; Europe; Fractures, Bone; Humans; Hypersensitivity; Hypophysectomy; Nasal Cavity; Nose; Nose Neoplasms; Papilloma; Paranasal Sinuses; Polyps; Rhinitis; Rhinitis, Atrophic

The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols.. This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes.. Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group.. Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

Topics: Aged; Antifibrinolytic Agents; Epistaxis; Female; Formaldehyde; Hemostatics; Humans; Male; Middle Aged; Nose; Polyvinyl Alcohol; Prospective Studies; Tampons, Surgical; Tranexamic Acid

Topics: Adolescent; Adult; Aged; Emergency Treatment; Epistaxis; Equipment Design; Female; Hemostatic Techniques; Humans; Male; Middle Aged; Nose; Patient Satisfaction; Pressure; Surgical Instruments; Time Factors; Treatment Outcome; Young Adult

Patients frequently are advised to abstain from nose blowing following endoscopic sinus surgery (ESS), despite a lack of evidence supporting this recommendation. This randomized study assessed whether nose blowing in the first postoperative week affects subjective and objective clinical outcomes.. Forty patients undergoing ESS were randomized into an interventional arm in which patients blew their nose at least twice daily for the first 7 postoperative days, or a control arm in which patients refrained from nose blowing. All patients were allowed to blow their nose after 7 days. The frequency and degree of epistaxis was documented by daily diary and visual analog scale (VAS). At 1 and 4 weeks postoperatively, Nasal Obstruction Symptom Evaluation (NOSE) and Sino-Nasal Outcome Test-22 (SNOT-22) were collected, and endoscopies were recorded for blinded Lund-Kennedy scale scoring.. There were no differences between the two groups in terms of frequency and duration of bleeding events, VAS epistaxis scores, SNOT-22 scores, and NOSE scores at every postoperative timepoint. Lund-Kennedy scores also were similar at the 1-week (P = 0.0762) and 4-week (P = 0.2340) postoperative visits, but the nose-blowing group had improved nasal discharge subscores at the first (P = 0.0075) and second (P = 0.0298) postoperative visits.. Nose blowing after ESS does not appear to measurably improve symptoms of nasal congestion or general sinonasal quality of life, nor does it seem to adversely affect the frequency or severity of postoperative epistaxis during the first postoperative week. Judicious nose blowing may be permissible immediately after uncomplicated ESS.. 1b. Laryngoscope, 128:1268-1273, 2018.

Topics: Adult; Endoscopy; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Paranasal Sinuses; Postoperative Complications; Postoperative Period; Quality of Life; Rhinitis; Sinusitis

Epistaxis, or nasal bleeding, is a common complication after nasotracheal intubation (NTI). Because such bleeding is likely related to trauma during intubation, use of fiberoptic visualization and guidance rather than direct laryngoscopy may affect the incidence and severity of epistaxis. We compared the incidence of epistaxis after NTI using a fiberoptic versus a direct laryngoscopy approach.. Seventy patients who were able to breathe easily through unobstructed nostrils and required NTI as part of their anesthetic management were recruited. Exclusion criteria included unequal nasal airflow, nostril obstruction, previous nasal trauma or surgery, and coagulation abnormalities as determined by history. Patients were randomly assigned to undergo NTI with thermosoftened Mallinckrodt nasal Ring-Adair-Elwyn (RAE) tubes via either traditional direct laryngoscopy using a Macintosh blade or fiberoptic nasal intubation. All patients first underwent anesthetic induction and were randomized to blind or fiberoptic groups. Patients in the blind insertion/direct laryngoscopy group were then intubated via a randomly selected nostril. Patients in the fiberoptic group underwent an asleep nasal fiberoptic examination to determine the most patent nostril, followed by tube insertion under fiberoptic guidance. Ten minutes after NTI, the incidence and severity of epistaxis were evaluated and graded by the surgeon, who was blinded to the intubation method.. Initial nasal fiberoptic endoscopy identified asymptomatic nasal pathology in 51% of patients: inferior turbinate hypertrophy (28.6%) and deviation of the nasal septum in (22.8%). The incidence of epistaxis was higher in the blind insertion/direct laryngoscopy group (88%) than in the fiberoptic group (51%; relative risk, 0.55; 95% confidence interval, 0.38-0.79; P = .0011). The severity of bleeding was also greater in the blind tube insertion/direct laryngoscopy cohort (Wilcoxon Mann-Whitney odds, 3.5; 95% confidence interval, 1.8-11.1).. Fiberoptic nostril selection and guidance during NTI reduced the incidence and severity of epistaxis when compared with NTI performed via blind insertion and direct laryngoscopy.

Topics: Adult; Anesthesiology; Anesthetics; Elective Surgical Procedures; Epistaxis; Female; Fiber Optic Technology; Hemorrhage; Humans; Incidence; Intubation, Intratracheal; Laryngoscopes; Laryngoscopy; Male; Middle Aged; Nasal Cavity; Nose; Respiration; Young Adult

To compare the extent of bleeding and patient discomfort during packing removal of three different polyvinyl alcohol (PVA) packs: 1) a standard PVA sponge (s-PVA) (Mondocel Standard 10 cm; Mondomed NV, Hamont-Achel, Belgium); 2) a PVA sponge with oxidized cellulose (oc-PVA) (Merocel Hemox 10 cm; Medtronic Xomed Surgical Products, Jacksonville, FL); and 3) a PVA sponge with polyethylene film (pf-PVA) (Merocel 2000 8 cm; Medtronic Xomed Surgical Products, Jacksonville, FL), after functional endoscopic sinus surgery and inferior turbinoplasty.. A prospective, randomized, blinded, controlled trial.. Ninety consecutive patients were enrolled and randomized to receive in each side one pack in the middle meatus and another pack of the same material in the nasal fossa. The patients were equally divided in three groups of 30 patients each. Group A received the pf-PVA; group B received oc-PVA; and group C received s-PVA. Postoperatively, bleeding after removal of the entire nasal packing was evaluated by an observer, whereas the severity of pain was rated by patients with visual analog scales.. Our study evaluated three nasal packing materials, demonstrating that the pf-PVA is less painful than the others but with intermediate bleeding ratio. However, the oc-PVA has an intermediate pain score but minimum bleeding. The s-PVA showed the worst pain and bleeding results.. Considering that removal of the second pack (middle meatus) is more painful than the first (nasal fossa), our results suggest that a pf-PVA can be placed in the middle meatus and a oc-PVA in the nasal fossa in order to reduce patient's discomfort in terms of pain and bleeding.. 1b.

Topics: Adult; Aged; Epistaxis; Female; Follow-Up Studies; Formaldehyde; Hemostatics; Humans; Male; Middle Aged; Nasal Septum; Natural Orifice Endoscopic Surgery; Nose; Polyvinyl Alcohol; Polyvinyls; Postoperative Hemorrhage; Prospective Studies; Rhinoplasty; Tampons, Surgical; Time Factors; Young Adult

Noninvasive ventilation (NIV) in preterm infants is currently applied using intermittent positive pressure (2 positive-pressure levels) or in a conventional manner (one pressure level). However, there are no studies in the literature comparing the chances of failure of these NIV methods. The aim of this study was to evaluate the occurrence of failure of 2 noninvasive ventilatory support systems in preterm neonates over a period of 48 h.. A randomized, prospective, clinical study was conducted on 80 newborns (gestational age < 37 weeks, birthweight < 2,500 g). The infants were randomized into 2 groups: 40 infants were treated with nasal CPAP and 40 infants with nasal intermittent positive-pressure ventilation (NIPPV). The occurrence of apnea, progression of respiratory distress, nose bleeding, and agitation was defined as ventilation failure. The need for intubation and re-intubation after failure was also observed.. There were no significant differences in birth characteristics between groups. Ventilatory support failure was observed in 25 (62.5%) newborns treated with nasal CPAP and in 12 (30%) newborns treated with NIPPV, indicating an association between NIV failure and the absence of intermittent positive pressure (odds ratio [OR] 1.22, P < .05). Apnea (32.5%) was the main reason for nasal CPAP failure. After failure, 25% (OR 0.33) of the newborns receiving nasal CPAP and 12.5% (OR 0.14) receiving NIPPV required invasive mechanical ventilation.. Ventilatory support failure was significantly more frequent when nasal CPAP was used.

Topics: Apnea; Birth Weight; Continuous Positive Airway Pressure; Disease Progression; Epistaxis; Female; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Intubation; Male; Noninvasive Ventilation; Nose; Prospective Studies; Respiratory Distress Syndrome, Newborn; Single-Blind Method; Treatment Failure

The objectives of this study were (1) to devise a nasal trauma score for preterm infants receiving non-invasive respiratory support, (2) to compare the incidence of nasal trauma in preterm infants <32 weeks gestation randomised to either nasal continuous positive airway pressure (NCPAP) or heated humidified high-Flow nasal cannulae (HHHFNC), in the first 7 days post-extubation and (3) to assess the effect of two different nasal dressings in those assigned to NCPAP. We randomly assigned preterm ventilated infants to receive Vapotherm® HHHFNC or NCPAP post-extubation. Infants receiving HHHFNC were treated with Sticky Whiskers® and infants receiving NCPAP received either Sticky Whiskers® or Cannualaide® nasal dressings. Bedside nursing staff scored six sites on each infant's nose for erythema, bleeding or ulceration. Scores were recorded three times daily for the first 7 days post-extubation. The sum of these 21 scores was used as the summary measure of nasal trauma. The mean nasal trauma score for infants assigned HHHFNC was 2.8 (SD 5.7) compared to 11.7 for NCPAP (SD 10.4), p < 0.001. There was no difference in mean trauma score between infants on NCPAP assigned Sticky Whiskers® 14.4 (SD 12.5) or Cannualaide® 9.5 (SD 7.3), p = 0.06.. HHHFNC resulted in significantly less nasal trauma in the first 7 days post-extubation than NCPAP and was most significant in infants <28 weeks of gestation. The use of protective dressings was not associated with decreased nasal trauma for infants on NCPAP.

Topics: Airway Extubation; Bandages; Catheters; Continuous Positive Airway Pressure; Epistaxis; Equipment Design; Erythema; Female; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Nose; Respiratory Insufficiency; Trauma Severity Indices; Ulcer

Routine esophagogastroduodenoscopy (EGD) is increasingly performed without sedation. Transoral (TO) and transnasal (TN) EGD offer different patient comfort and complications.. For a controlled, randomized, clinical trial comparing TN-EGD with TO-EGD without sedation, patients were assigned to TN-EGD using a thin endoscope (group 1, 93 patients), or TO-EGD using a standard endoscope (group 2, 90 patients). Physician-rated procedural time and complications as well as patient-rated side effects and preferences were compared. In group 3, patients (118) who had previously undergone TO-EGD, now underwent TN-EGD.. Between group 1 and 2 there was no significant difference for procedural time. Nausea (p = 0.047) and epistaxis (p < 0.001) were significantly more frequent for TN-EGD. Conversion rate from TN- to TO-EGD was low with 4.3 %. For TN-EGD, patients' tolerance was better (p < 0.001), gagging was less (p < 0.001). In case of a future EGD, patients who know both procedures (group 3), strongly vote for TN-EGD (80 %). All groups vote against sedation for future procedures (90 %/90 %/89 %).. Epistaxis can be relevant after TN-EGD, but can mostly be managed conservatively. TN-EGD is superior to TO-EGD regarding subjective and objective gagging as well as procedural tolerance. Patients who experienced both access routes, prefer TN-EGD. TN-EGD without sedation should be aspired for patient comfort and is recommended for routine use.

Topics: Diagnostic Tests, Routine; Endoscopy, Digestive System; Epistaxis; Female; Gagging; Germany; Humans; Male; Middle Aged; Mouth; Nausea; Nose; Pain; Prospective Studies; Time Factors; Treatment Outcome; Vomiting

We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution.. The study was designed as a randomized prospective study.. A university hospital in Turkey.. Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group.. The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours.. The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

Topics: Adolescent; Adult; Anesthetics, Local; Epistaxis; Female; Follow-Up Studies; Formaldehyde; Gloves, Surgical; Headache; Hemostatics; Humans; Male; Middle Aged; Nasal Cavity; Nasal Septum; Nose; Pain, Postoperative; Polyvinyl Alcohol; Postoperative Complications; Postoperative Hemorrhage; Prospective Studies; Respiration; Rhinoplasty; Tampons, Surgical; Tetracaine; Tissue Adhesions; Young Adult

Nasal packing is used to control postoperative bleeding and wound healing, and it also exerts a very strong influence on the comfort of the patient. Sorbsan(®) (calcium alginate) is an absorbent packing that shows a potent hemostatic effect and is able to maintain wound surfaces in a moist environment by absorbing and gelling the wound exudate. The aim of this study was to evaluate the early symptoms and QOL with Sorbsan(®) versus Beschitin-F(®) (chitin-coated gauze) for middle meatus packing after endoscopic sinus surgery (ESS).. We performed a cohort study of 40 patients who underwent ESS. Following ESS, the patients were randomly allocated into two groups of 20 patients each who underwent insertion of either Sorbsan(®) or Beschitin-F(®) into the middle meatus. A daily diary was used to record the symptoms and QOL, measured using visual analogue scales, before the ESS and on each day thereafter. Postoperative bleeding and local infection were also recorded.. The scores for each of the symptoms of nasal pain, headache, nasal bleeding and postnasal drip were statistically significantly lower in the Sorbsan(®) group. The scores for each of the QOL parameters, including the effect on their stay in the hospital and sleep disturbance, were also significantly lower in the Sorbsan(®) group. There were no findings of postoperative hemorrhage or local infection in either group.. Sorbsan(®) packing did not cause any major complications and has the potential to reduce nasal pain and suffering in post ESS patients compared with gauze packing.

Topics: Adult; Alginates; Chitin; Cohort Studies; Epistaxis; Female; Hemostatics; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Pain, Postoperative; Paranasal Sinuses; Postoperative Hemorrhage; Quality of Life; Surgical Wound Infection; Treatment Outcome

It is commonly believed that for preventing epistaxis during nasotracheal intubation (NTI), the right nostril should be used. However, there is no real evidence as to which nostril should be used. In this study, we tested our hypothesis that epistaxis during NTI is more frequent and severe using the left nostril rather than the right, provided that patency appears equal on both sides of the nose.. A total of 54 patients who were scheduled for elective oral surgery, in which NTI was indicated to optimize the surgical approach, were recruited into this study. The nostril used for NTI was chosen randomly.. Epistaxis occurred significantly more frequently (44.4%) when the left nostril was used for NTI than when the right nostril was used (11.1%; P = .014). Although there were no statistical differences in the incidence of mild epistaxis between the 2 nostrils (P = .467), severe epistaxis was significant more frequent with the left (22.2%) than with the right nostril (0.0%; P < .023).. Our data show that epistaxis during NTI is more frequent and severe with the left nostril than the right. Hence, when deciding which nostril to use for NTI, the right nostril should be used if patency appears equal on both sides of the nose.

Topics: Adult; Epistaxis; Female; Humans; Intubation, Intratracheal; Male; Nose

Numerous strategies have been used to reduce epistaxis after nasotracheal intubation. The authors compared the severity of epistaxis after nasotracheal intubation in children with tubes at room temperature, warm tubes, and tubes telescoped into catheters.. Children who were scheduled for elective dental surgery were randomly assigned to undergo nasotracheal intubation using a tube at room temperature (control), warmed in saline, or whose distal end had been telescoped into a red rubber catheter. After an inhalational induction and intravenous propofol, a lubricated tube or red rubber catheter was inserted into the right naris. Tracheal intubation was achieved by direct laryngoscopy and tube placement using Magill forceps. The pharynx was swabbed for blood by an observer who was blind to the treatment. The severity of bleeding was rated using reference figures. Data were analyzed using Kruskal-Wallis and Fisher exact tests. P < 0.05 was accepted.. The demographics of the three groups were similar. The estimated median area of the gauze in the catheter group that was covered with blood (0%) was significantly less than the areas in the control (40%) and warm (20%) groups. The incidence of clinically relevant bleeding (>or= 40% of the gauze area covered in blood) in the catheter group (5%) was significantly less than in the control (56%) and warm (39%) groups. The incidence of no detectable blood in the catheter group (59%) was significantly greater than in the control (21%) and warm (26%) groups.. Telescoping the endotracheal tube into a catheter significantly reduces epistaxis in children undergoing nasotracheal intubation.

Topics: Child; Child, Preschool; Epistaxis; Female; Humans; Intubation, Intratracheal; Male; Nose

The aim of this study was to compare the acceptance and tolerance of transnasal and peroral esophagogastroduodenoscopy (EGD) using an ultrathin videoendoscope in unsedated patients.. A total of 124 patients referred for diagnostic endoscopy were assigned randomly to have an unsedated transnasal EGD (n = 64) or peroral EGD (n = 60) with local anesthesia. An ultrathin videoendoscope with a diameter of 5.9 mm was used in this study. A questionnaire for tolerance was completed by the patient (a validated 0-10 scale where '0' represents no discomfort/well tolerated and '10' represents severe discomfort/poorly tolerated).. Of the 64 transnasal EGD patients, 60 patients (94%) had a complete examination. Four transnasal EGD examinations failed for anatomical reasons; all four patients were successfully examined when switched to the peroral EGD. All 60 peroral EGD patients had a complete examination. Between the transnasal and peroral groups, there was a statistically significant difference in scores for discomfort during local anesthesia (1.5 +/- 0.2 vs 2.6 +/- 0.3, P = 0.003), discomfort during insertion (2.3 +/- 0.3 vs 4.3 +/- 0.3, P = 0.001), and overall tolerance during procedure (1.6 +/- 0.2 vs 3.8 +/- 0.2, P = 0.001). In all, 95% of transnasal EGD patients and 75% of peroral EGD patients (P = 0.002) were willing to undergo the same procedure in the future. Four patients in the transnasal EGD group experienced mild epistaxis.. For unsedated endoscopy using an ultrathin videoendoscope, transnasal EGD is well tolerated and considerably reduces patient discomfort compared with peroral EGD.

Topics: Adult; Aged; Anesthesia, Local; Endoscopes; Endoscopy, Digestive System; Epistaxis; Female; Humans; Male; Middle Aged; Mouth; Nose; Patient Acceptance of Health Care; Video Recording

To assess superiority and safety of nasotracheal intubation with a thermal-softened tube guided by fiberoptic bronchoscope to establish an artificial airway for the institution of mechanical ventilation.. A total of 209 patients were randomly allocated to two groups: "treated tube" group (52 centigrade treated tube group, n=105), common tube group (the tube was prepared at room temperature 23-26 centigrade, n=104). Nasotracheal intubation was guided by a fiberoptic bronchoscope to establish an artificial airway.. (1)The required time of the first successful nasotracheal intubation in the "treated tube" group [(14.48+/-8.31) seconds, 99 cases] was significantly shorter than in the common tube group [(23.85+/-11.97) seconds, 96 cases, P<0.01]. (2)Ratio of successful intubation in the "treated tube" group under conscious condition was higher than that of the common tube group [100% (28/28 cases) vs. 87.5% (21/24 cases), P<0.05]. (3) Ratio of successful intubation in 30 seconds in the "treated tube" group was significantly higher than that of the common tube group [93.9% (93/99 cases) vs. 68.6% (66/96 cases), P<0.01]. (4)The incidence of difficult intubation in the "treated tube" group [5.05% (5/99 cases)] was significantly lower than that of the common tube group [32.29%, (31/96 cases), P<0.01]. (5)The incidence of epistaxis in the first successful nasotracheal intubation in the "treated tube" group [4.0% (4/99 cases)] was significantly lower than that of the common tube group [15.6%,(15/96 cases), P<0.01]. (6)The incidence of epistaxis during nasotracheal intubation in conscious patients was lower in the "treated tube" (3.6%, 1/28 cases) group than that of the common tube group [28.6%, (6/21 cases), P<0.05].. The use of a thermal-softened nasotracheal tube to intubate guided by a fiberoptic bronchoscope to establish an artificial airway shortened preparation time before intubation. It is not necessary to use a vasoconstrictor for nasal mucosa before intubation, therefore cardiovascular effects due to the drugs can be avoided. It increases the willingness of conscious patients to accept the procedure and successful rate of the first intubation.

Topics: Adult; Aged; Aged, 80 and over; Bronchoscopy; Epistaxis; Female; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose; Respiration, Artificial

We evaluated whether a thermosoftening treatment with warm saline of a nasotracheal preformed tube can improve navigability through the nasal passageways and reduce epistaxis and nasal damage. A total of 150 patients were randomly allocated to three groups: Group I (untreated tube group, n = 50), Group II (35 degrees C treated tube group, n = 50), and Group III (45 degrees C treated tube group, n = 50). In Groups II and III, the tubes were softened at 35 +/- 2 degrees C and 45 +/- 2 degrees C with warm saline, respectively. In Group I the tube was prepared at room temperature (25 +/- 2 degrees C). The incidence of epistaxis and nasal damage in Groups II and III was significantly less than that of Group I (P: < 0.05). Despite the more frequent incidence of smooth passage in Group III, no statistical difference was found among the groups. Logistic regression analysis also confirmed that epistaxis was more likely to be reduced when the tube had been thermosoftened (odds ratio = 1.46, 95% confidence interval = 1.02, 2.11). We conclude that simple thermosoftening treatment of the nasotracheal tube with warm saline helps to reduce epistaxis and nasal damage.. Thermosoftening treatment of a nasotracheal tube with warm saline before intubation can effectively reduce epistaxis and nasal damage. This technique is safe, easy, and suitable for all types of tubes and does not require additional implements.

Topics: Adult; Epistaxis; Female; Hot Temperature; Humans; Intubation, Intratracheal; Male; Middle Aged; Nose

A prospective study was performed to compare Telfa, paraffin gauze, Merocel and BIPP used postoperatively following septal or turbinate surgery. Packs were assessed in terms of patient comfort, control of bleeding and ease of removal. There was little to choose between the packs while they were in situ and there was no significant difference in ease of removal. On removal the Telfa and paraffin gauze were associated with less discomfort and less bleeding than BIPP or Merocel (p < 0.05).

Topics: Bismuth; Drug Combinations; Epistaxis; Female; Humans; Hydrocarbons, Iodinated; Male; Nasal Septum; Nose; Occlusive Dressings; Postoperative Complications; Prospective Studies; Tampons, Surgical; Turbinates

We present a prospective controlled trial, comparing methods of analgesia for the relief of discomfort on removing nasal packing, including a general discussion on the considerations for, and methods of, nasal tamponade. On the basis that nasal packing is likely to continue to be used frequently, nitrous oxide (as Entonox) is advocated as a safe and relatively cheap means of pain relief with a statistically significant advantage over papaveretum.

Topics: Adult; Analgesia; Anesthetics; Drug Combinations; Epistaxis; Humans; Nasal Cavity; Nitrous Oxide; Nose; Opium; Oxygen; Postoperative Care; Prospective Studies; Tampons, Surgical

Various techniques, both chemical and mechanical, have been proposed to decrease trauma and hemorrhage associated with nasotracheal intubation. Nasotracheal intubation was performed on 44 healthy patients scheduled for oral surgical procedures to determine whether incremental dilation with nasopharyngeal airways helps to decrease nasal passage hemorrhage during nasotracheal intubation. Twenty men and 24 women were randomly assigned to dilated or nondilated groups. Repeated passage of the nasopharyngeal airway and nasotracheal tube over relatively friable nasal mucosa accounted for increased hemorrhage in the dilated group. For routine nasotracheal intubation of healthy patients, dilation with nasopharyngeal airways needlessly adds time, trauma, and hemorrhage to the induction of anesthesia.

Topics: Adult; Anesthesia, Dental; Dilatation; Epistaxis; Female; Humans; Intubation, Intratracheal; Male; Mouth; Nasopharynx; Nose

Epistaxis can be life-threatening. Simple first aid management can stem bleeding. This study compared knowledge of first aid management methods of epistaxis between the general public and healthcare workers.. A cross-sectional study of 100 healthcare workers and 103 adult members of the public was conducted at a large London teaching hospital. Respondents completed a survey assessing knowledge on nasal pinching site, head tilt and appropriate adjunct treatment use for first aid management of epistaxis.. Twenty-four per cent and 68 per cent of healthcare workers compared with 25.2 per cent and 37.9 per cent of the public answered correctly on nasal pinching position and head tilt position, respectively, with a statistical difference for head tilt position. Two per cent, 2 per cent and 24 per cent of healthcare workers mentioned ice use on the nose, ice use in the mouth or ice use but not site, respectively, compared with 0 per cent, 0 per cent and 4.9 per cent of the public, with a statistical difference for ice without site.. Healthcare workers and the public lack knowledge on first aid management of epistaxis. Improved education on first aid management is required, targeting healthcare workers and the public.

Topics: Adult; Cross-Sectional Studies; Epistaxis; First Aid; Humans; Ice; Nose

Recurrence of epistaxis after ligation or embolization of the sphenopalatine artery may require ligation of the ipsilateral anterior ethmoidal artery, which cannot be embolized because of the risk to the ophthalmic artery. We describe a transconjunctival transcaruncular approach that allows reliable low-risk access to the anterior ethmoidal artery. This technique offers a minimally invasive approach to the surgical site, without unsightly scar.

Topics: Epistaxis; Ethmoid Sinus; Humans; Ligation; Nose; Ophthalmic Artery

In severe refractory epistaxis, the anterior ethmoidal artery may need to be ligated. Previously described endonasal or transorbital approaches are not always effective, or they have suboptimal aesthetic outcomes. This paper describes a safe and effective surgical technique, with a consistent landmark allowing quick identification.. A transcaruncular incision is made, oriented medially in the direction of the medial orbital wall towards the level of the nasion. Once onto bone, a subperiosteal plane is developed and an endoscope is used to dissect posteriorly at the level of the nasion, until the anterior ethmoidal artery is identified, and subsequently ligated.. The nasion is an easy, constant landmark to use for ligation of the anterior ethmoidal artery in refractory epistaxis. The traditional method of identifying the anterior ethmoidal artery is not applicable or constant enough for use during the transorbital approach. The described technique avoids injury to surrounding structures and has a satisfactory aesthetic outcome.

Topics: Epistaxis; Humans; Ligation; Nose; Ophthalmic Artery; Orbit

The treatment of nasal foreign bodies involves safe and reliable removal. Few reports have investigated the relationship between equipment and the incidence of complications.. This retrospective study included 300 patients with nasal foreign bodies (average: 3.28 years, interquartile range: 2-4 years). Patients' background, characteristics of nasal foreign body, equipment to remove the nasal foreign body, and complications were obtained from medical records. Statistical analysis was performed using Pearson's chi-square test for associated factors and the incidence of epistaxis among the complications.. Nasal foreign bodies were found and removed in 256 patients. Forceps, hooks, suction, modified paper clips, and cotton swabs were mainly used to remove the nasal foreign bodies. Epistaxis due to the removal procedure was observed in 26 patients. The occurrence of epistaxis differed depending on the equipment (p = 0.077) and was less frequent in suction and paper clips than in forceps (p < 0.05 and p = 0.077). Epistaxis was not observed when a cotton swab was used. Aspiration and septal perforation were not observed. A statistical relationship was not detected between the hardness of foreign bodies and the occurrence of epistaxis (p = 0.251). The incidence of epistaxis was higher in cases nasal foreign bodies remained for 1 day and over than in cases foreign bodies were removed within 1 day (p < 0.05).. This study revealed that suction, modified paper clips, and cotton swabs could be beneficial options for minimizing complications in the removal of nasal foreign bodies.. 4 Laryngoscope, 133:2553-2557, 2023.

Topics: Epistaxis; Foreign Bodies; Humans; Nose; Retrospective Studies; Surgical Instruments

The aim of this study is to examine the reasons and the methods of approach to the patients for the ear nose and throat (ENT) consultations requested from the patients who applied to the pediatric emergency department.. The files of 351 patients who applied to the pediatric emergency outpatient clinic and were asked for consultation from the ENT clinic were reviewed retrospectively. Demographic data, complaints on admission, diagnostic examinations, diagnoses, treatment methods, and hospitalizations were recorded.. Of the patients included in the study, 190 (54.1%) were female and 161 (45.9%) were male. The median age of the patients was 4.0 years (3.0-8.0 years). The most common diagnoses after ENT examination are; 120 patients (34.2%) had foreign body (FB) in the nose, 58 patients (16.5%) had FB in the ear, 16 patients (4.6%) had FB in the throat, 16 patients (4.6%) had epistaxis, and 15 patients (4.3%) had Bell's palsy. According to age group, it was determined that FB in the nose and ear was more common in the 0- to 5- and 6- to 11-year age group, and Bell's palsy, FB in the ear and epistaxis were more common in the 12- to 17-year age group. A normal examination was also an important finding in 83 of the patients (23.6%).. Foreign bodies are the most common reason for admission to the emergency services in children, and it is frequently seen between 0 and 5 years of age. Informing and raising awareness of parents on this topic will reduce both unwanted complications and ENT consultations along with admission to pediatric emergency services.

Topics: Bell Palsy; Child; Child, Preschool; Emergency Service, Hospital; Epistaxis; Facial Paralysis; Female; Foreign Bodies; Humans; Male; Nose; Pharynx; Referral and Consultation; Retrospective Studies; Tertiary Care Centers

Juvenile nasopharyngeal angiofibromas (JNAs) are rare hyper vascular, benign tumours typically demonstrating a locally aggressive growth pattern. The cardinal presenting symptoms are unilateral nasal obstruction and recurrent, spontaneous epistaxis. Cases outside the adolescent male population are exceedingly rare and present a diagnostic challenge. We present the case of a man in his 30s referred to our tertiary skull base centre, presenting with left nasal obstruction. Examination showed left nasopharyngeal fullness without a discrete mass. Cross-sectional imaging detailed a 2.5×2.1×1.3 cm mass localised to his left sphenoid sinus with bony erosion. Due to the suspicion of malignancy, multidisciplinary consensus was to perform a diagnostic excisional biopsy and this revealed a JNA. He remains clinically well and asymptomatic following surgery. This case highlights the potential for subtle symptomatology in the presentation of these tumours and the challenge in diagnosing a JNA outside the adolescent male population.

Topics: Adolescent; Angiofibroma; Epistaxis; Humans; Male; Nasal Obstruction; Nasopharyngeal Neoplasms; Nasopharynx; Nose

A rare clinical case of recurrent nosebleeds associated with Randu-Osler disease, in which drug, hemostatic, transfusion therapy and combined nasal tamponade were ineffective, required ligation of the external carotid arteries on both sides, is presented.. В статье приведено описание редкого клинического случая рецидивирующего носового кровотечения на фоне болезни Рандю—Ослера, при котором медикаментозная, гемостатическая, трансфузионная терапия и комбинированная тампонада носа оказались неэффективными; это вызвало необходимость выполнения перевязки наружных сонных артерий с обеих сторон.

Topics: Carotid Arteries; Carotid Artery, External; Epistaxis; Humans; Ligation; Nose; Telangiectasia, Hereditary Hemorrhagic

Intranasal packs with breathing tubes are one of the possible methods of postoperative management of patients after endonasal surgery. The role of these devices is to provide the possibility of nasal breathing of patients to facilitate the course of the postoperative period. However, the possibility of providing proper nasal breathing with these devices has not been studied. The aim of the work is to study the calculated and clinical possibilities of nasal breathing when using intranasal packs with breathing tubes after endonasal surgical interventions.. We studied packs with air tubes from two manufacturers: Medtronic and Spiggle & Theis. During the experimental part, measurements of the air tubes and their study using acoustic rhinometry were carried out. In the clinical part, there were two groups of patients with different types of tampons and control group of volunteers with normal nasal breathing, the total number of participants was 45 people. All patients of groups 1 and 2 underwent septoplasty, bilateral lower partial conchotomy. In the postoperative period, rhinomanometry, rhinoflowmetry, a study of the duration of nasal breathing, and a subjective assessment of nasal breathing were performed.. According to measurements and acoustic rhinometry, the airway tubes of the tampons have a cross-sectional area that is more than 4 times smaller than the narrowest part of the nasal cavity in healthy volunteers. According to the results of a clinical study, the tampons in question are not able to provide a level of nasal breathing comparable to normal, even after clearing the lumen by a doctor. Medtronic packs provide somewhat better airway function due to the larger internal diameter of the tubes, but also do not create conditions for satisfactory nasal breathing.. Improving the respiratory function of tampons in the future can be achieved by increasing the internal lumen of the breathing tubes while maintaining comfort of use.. Использование внутриносовых тампонов с трубками для дыхания является одним из возможных способов послеоперационного ведения пациентов после эндоназальных операций. В задачу данных устройств входит обеспечение носового дыхания пациентов для облегчения течения послеоперационного периода. Однако возможность обеспечения полноценного носового дыхания данными устройствами не изучена.. Изучение расчетных и клинических возможностей носового дыхания при использовании внутриносовых тампонов с трубками для дыхания в ранние сроки после эндоназальных хирургических вмешательств.. Мы исследовали тампоны с воздуховодными трубками двух производителей — Medtronic (США) и Spiggle & Theis (Германия). В ходе экспериментальной части проведены измерения воздуховодных трубок тампонов и их исследование с помощью акустической ринометрии. В клинической части участвовали две группы пациентов с тампонами разных типов и контрольная группа добровольцев с нормальным носовым дыханием, общее число участников составило 45 человек. Всем пациентам 1-й и 2-й групп выполнены септопластика, двусторонняя нижняя щадящая конхотомия. В послеоперационном периоде проводили риноманометрию, ринофлоуметрию, исследование длительности носового дыхания и субъективную оценку носового дыхания.. По данным измерений и акустической ринометрии, воздуховодные трубки тампонов имеют более чем в 4 раза меньшую площадь сечения, чем самая узкая часть полости носа у здоровых добровольцев. По результатам клинического исследования, рассматриваемые тампоны не способны обеспечить уровень носового дыхания, сопоставимый с нормальным, даже после очистки просвета врачом. Тампоны Medtronic обеспечивают несколько лучшую воздуховодную функцию за счет большего внутреннего диаметра трубок, но также не создают условий для удовлетворительного носового дыхания.. В перспективе можно добиться улучшения дыхательной функции тампонов за счет увеличения внутреннего просвета дыхательных трубок при сохранении комфорта использования.

Topics: Epistaxis; Humans; Nasal Cavity; Nasal Obstruction; Nasal Septum; Nose; Respiration; Rhinoplasty

Bleeding is a life-threatening condition, requiring an urgent care. The first line of treatment this kind of patients is ambulance doctors (emergency medical team). Spontaneous bleeding (SB), in this case, don't have a traumatic agent (including surgical trauma).. The purpose of this study was to evaluate spontaneous bleeding epidemiological profile of Moscow city emergency service.. Study included statistical reports of Moscow city emergency services medical teams (EMT) were servicing adults. We analyzed total number of calls and number of EMT calls to pa-tients with SB during the period between 2015 and 2019. The excluding criteria was EMT re-calls to patents with SB.. In a study, it was found that over five-year period of observation, EMT made 15 709 862 calls, included 215 840 calls (1.37%) to patients with SB. It was found that the most frequency sources of SB were: the gastrointestinal tract (33.18%), the nasal cavity (28.14%) and the vagina with the uterus (23.91%). There is the proportion of patients suffering of SB from ENT organs is 28.52% in structure of Moscow city Emergency Medical Service. There are the proportion of epistaxis 98.65%, ear bleeding - 0.89%, throat bleeding - 0.46% in structure of SB from ENT organs. We analyzed, that spontaneous epistaxis most frequent between October and April. This period characterized with 70.6% EMT calls from the total EMT calls to patients with SE.. Кровотечение является патологическим состоянием человеческого организма, угрожающим жизни больного, и показанием к неотложной медицинской помощи. Первым звеном в лечении таких больных остаются врачи бригад скорой медицинской помощи (СМП). К спонтанным кровотечениям (СК) относят кровотечения, при которых отсутствует явная причинно-следственная связь с травмой (в том числе хирургической).. Установить эпидемиологические особенности СК из уха, горла, носа в структуре оказания скорой медицинской помощи в Москве.. В исследование вошли статистические отчеты всех выездных бригад СМП, обслуживающих взрослое население Москвы. Изучены общее количество вызовов и количество вызовов бригад СМП к больным со СК. Период наблюдения с 2015 по 2019 г. Критерий исключения — повторные вызовы бригад СМП к больным со СК.. Установлено, что за 5-летний период наблюдения бригады СМП провели 15 709 862 вызовов, при этом 215 840 (1,37%) — к пациентам со СК. Установлено, что наиболее частыми источниками СК являются желудочно-кишечный тракт (33,18%), полость носа (28,14%) и влагалище с маткой (23,91%). В структуре оказания экстренной медицинской помощи бригадами СМП Москвы доля больных со СК из уха, горла, носа составляет 28,52%. В структуре СК из уха, горла, носа доля кровотечений из носа достигает 98,65%, из уха — 0,89%, из горла — 0,46%. Анализ полученных данных позволил установить, что наибольшая распространенность носовых кровотечений отмечается в сезон с октября по апрель. На данный период времени 70,6% от всех вызовов бригад СМП приходится к больным с носовыми кровотечениями.. Изученные нами вопросы эпидемиологии спонтанных кровотечений в Москве имеют чрезвычайно важное значение для медицины в целом, а полученные результаты дают возможность максимально широко оценить существующую проблему, проводить динамический мониторинг и принимать решения, направленные на улучшение качества лечения данного контингента больных.

Topics: Adult; Emergencies; Emergency Medical Services; Epistaxis; Female; Humans; Nose; Pharynx

Epistaxis or nosebleeds (NB) are the most common emergency pathology that otorhinolaryngologists have to deal with. Purpose of the work: to study the prevalence of patients with NB in the otorhinolaryngological departments of hospitals in Moscow from 2003 to 2019. The reports of the heads of the ENT departments of the city clinical hospitals in Moscow were studied. Inclusion criteria were hospitals working with an adult contingent of patients. An approximation analysis was carried out and trend indicators of the prevalence of NB were studied.. 2003 to 2019 the total number of patients treated in ENT hospitals was 563 189 people, 20 623 (3.7%) patients were treated with NB, of which 52 (0.25%) died. The average age of the deceased was 64.7 years, men are 73.7% more prevalent than women. In 96.2% of patients, epistaxis was a complication of the underlying disease, and in 3.8%, it was regarded as a concomitant condition. In 30.8% of the deceased, NB recurred with the background of malignant lesions of the nose and nasopharynx, in 69.2% - posthemorrhagic anemia aggravated diseases of other organs and systems. Over the past 17 years, there has been a tendency for the growth of treated patients with diseases of ENT organs and patients with nosebleeds by 58.5% and 51.1%, respectively. The studied approximation of the relative prevalence and mortality rates in patients with NB showed that for the period from 2003 to 2019. trend values are practically at the same level with the minimum multidirectional linear dynamics - -0.24% and +0.04%, respectively.. Носовые кровотечения (НК) являются наиболее частой экстренной патологией, с которой приходится сталкиваться оториноларингологам.. Изучить распространенность больных с НК в структуре оториноларингологических отделений стационаров Москвы за длительный период времени и на основании полученных данных построить математическую модель данного эпидемиологического процесса с трендовым анализом установленных показателей.. Изучены отчеты заведующих отделений оториноларингологии городских клинических больниц Москвы. Критерием включения были стационары, работающие со взрослым контингентом больных. Проведен аппроксимационный анализ и изучены трендовые показатели распространенности НК.. С 2003 по 2019 г. общее число больных, пролеченных в отделениях оториноларингологии, составило 563 189 человек, 20 623 (3,7%) пациента находились на лечении с НК, из них 52 (0,25%) скончались. Средний возраст умерших составил 64,7 года, мужчин на 73,7% больше, чем женщин. У 96,2% больных НК представляло осложнение основного заболевания, а у 3,8% — расценено как сопутствующее состояние. У 30,8% умерших НК рецидивировало на фоне злокачественного поражения носа и носоглотки, у 69,2% — постгеморрагическая анемия усугубила заболевания других органов и систем. За последние 17 лет зафиксирована тенденция увеличения пролеченных больных с заболеваниями уха, горла, носа и пациентов с НК на 58,5 и 51,1% соответственно. Изученная аппроксимация относительных показателей распространенности и летальности больных с НК показала, что за период с 2003 по 2019 г. трендовые значения находятся практически на одном уровне с минимальной разнонаправленной линейной динамикой — –0,24% и +0,04% соответственно.. Полученные данные свидетельствуют о том, что оториноларингологическая служба стационаров Москвы на сегодняшний день обладает достаточным «запасом прочности» в возможности оказания экстренной помощи больным с носовыми кровотечениями.

Topics: Adult; Epistaxis; Female; Humans; Male; Middle Aged; Moscow; Nose; Recurrence

Nosebleeds (epistaxis) are usually minor. Medical intervention is only necessary in about 6% of cases. The source of bleeding is frequently located in the anterior region of the nose (Kiesselbach's plexus). The estimated lifetime prevalence of epistaxis is 60%. Diffuse epistaxis is often a manifestation of systemic disease. Epistaxis is the leading symptom of Rendu-Osler-Weber disease (hereditary hemorrhagic telangiectasia, HHT). If intervention is required, the first-choice of treatment is bidigital compression for several minutes. Common therapeutic measures include local hemostasis using electrocoagulation or chemical agents, e.g., silver nitrate. Resorbable anterior nasal tampons or tampons with a smooth surface are also frequently employed. In case of failed surgical closure of the sphenopalatine artery, angiographic embolization is the method of choice.. Meist handelt es sich beim Nasenbluten (Epistaxis) um kleinere Blutungen. Medizinische Maßnahmen sind nur in etwa 6 % der Fälle erforderlich. Oft liegt die Blutungsquelle im vorderen Nasenabschnitt (Locus Kiesselbachii). Die geschätzte Gesamtlebenszeitprävalenz für Epistaxis beträgt 60 %. Tritt die Epistaxis in diffuser Form auf, so ist das häufig die Manifestation einer systemischen Erkrankung. Beim M. Rendu-Osler-Weber (hereditäre hämorrhagische Teleangiektasie, HHT) stellt die Epistaxis das Leitsymptom dar. Erstmaßnahme der Wahl bei Interventionsbedarf ist die bidigitale Kompression über mehrere Minuten. Verbreitete Therapiemaßnahmen sind u. a. die lokale Blutstillung mittels Elektrokoagulation oder mit chemischen Mitteln wie Silbernitrat. Auch resorbierbare vordere Nasentamponaden oder Tamponaden mit glatter Oberfläche werden häufig eingesetzt. Beim Versagen des chirurgischen Gefäßverschlusses der A. sphenopalatina ist die angiographische Embolisation Methode der Wahl.

Topics: Embolization, Therapeutic; Epistaxis; Humans; Nose; Telangiectasia, Hereditary Hemorrhagic

Posterior nasal nerve (PNN) cryoablation is a novel surgical technique used to address chronic rhinitis. The purpose of this study is to review the medical device reports (MDRs) submitted to the Food and Drug Administration's (FDA) Manufacturer and User Device Facility Experience (MAUDE) database to identify adverse events related to the use of ClariFix, a device designed for office-based cryosurgical ablation of the PNN. A total of 12 adverse events associated with ClariFix from January 2017 to August 2020 were identified and analyzed. The most common adverse events associated with ClariFix PNN cryoablation include epistaxis and nasal swelling. Further studies are needed to clarify whether PNN cryoablation is associated with epistaxis in certain populations.

Topics: Chronic Disease; Cryosurgery; Edema; Epistaxis; Humans; Nose; Rhinitis; United States

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anatomic Landmarks; Central Nervous System Neoplasms; Cerebrospinal Fluid Rhinorrhea; Endoscopy; Epistaxis; Female; Humans; Male; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Postoperative Complications; Prospective Studies; Retrospective Studies; Sphenoid Sinus; Young Adult

Nasotracheal intubation remains an underused but invaluable technique for securely managing the airway during oral and maxillofacial surgery. In this article, we present a modified clinical technique that allows for the potential introduction into clinical practice of 2 new airway devices: a nasal laryngeal mask airway and an interchangeable oral/nasal endotracheal tube. We hypothesize that with the use of proper techniques, these devices can add new and safer alternatives for securing an airway by the nasal route. The advantage of this novel technique is that the airway is secured by the oral route prior to performing a modified retrograde nasal intubation, eliminating the danger of profuse epistaxis precipitating a "cannot intubate, cannot ventilate" scenario. In addition, the design and materials used in the components of the devices may minimize trauma. The authors aim to inform clinicians about the indications, physical characteristics, and insertion/removal techniques related to these new devices.

Topics: Epistaxis; Humans; Intubation, Intratracheal; Laryngeal Masks; Nose

In China, nasal cannula oxygen therapy is typically humidified. However, it is difficult to decide whether to suspend nasal cannula oxygen inhalation after the nosebleed has temporarily stopped. Therefore, we conducted a preliminary investigation on whether the use of humidified nasal cannulas in our hospital increases the incidence of epistaxis.. We conducted a survey of 176,058 inpatients in our hospital and other city branches of our hospital over the past 3 years and obtained information concerning their use of humidified nasal cannulas for oxygen inhalation, nonhumidified nasal cannulas, anticoagulant and antiplatelet drugs, and oxygen inhalation flow rates. This information was compared with the data collected at consultation for epistaxis during these 3 years.. No significant difference was found between inpatients with humidified nasal cannulas and those without nasal cannula oxygen therapy in the incidence of consultations due to epistaxis (χ2 = 1.007, p > 0.05). The same trend was observed among hospitalized patients using anticoagulant and antiplatelet drugs (χ2 = 2.082, p > 0.05). Among the patients with an inhaled oxygen flow rate ≥5 L/min, the incidence of ear-nose-throat (ENT) consultations due to epistaxis was 0. No statistically significant difference was found between inpatients with a humidified oxygen inhalation flow rate <5 L/min and those without nasal cannula oxygen therapy in the incidence of ENT consultations due to epistaxis (χ2 = 0.838, p > 0.05). A statistically significant difference was observed in the incidence of ENT consultations due to epistaxis between the low-flow nonhumidified nasal cannula and nonnasal cannula oxygen inhalation groups (χ2 = 18.428, p < 0.001). The same trend was observed between the 2 groups of low-flow humidified and low-flow nonhumidified nasal cannula oxygen inhalation (χ2 = 26.194, p < 0.001).. Neither high-flow humidified nasal cannula oxygen inhalation nor low-flow humidified nasal cannula oxygen inhalation will increase the incidence of recurrent or serious epistaxis complications; the same trend was observed for patients who use anticoagulant and antiplatelet drugs. Humidification during low-flow nasal cannula oxygen inhalation can prevent severe and repeated epistaxis to a certain extent.

Topics: Cannula; Epistaxis; Humans; Nose; Oxygen; Oxygen Inhalation Therapy

Intractable epistaxis is a challenge to manage and often requires multiple interventions, both medical and surgical. After anterior and posterior packing, many options exist on how to manage the patient.. We performed a retrospective chart review of patients who presented to a private ear, nose, and throat practice with intractable epistaxis from January 2010 until July 2015. The clinical notes were reviewed, noting the demographic characteristics of the patients and the treatment plan that followed. In particular, we determined the site of bleeding that was documented. Of the 17 patients with intractable epistaxis identified, 5 had the site of bleeding documented and were included in the study.. The documented areas that may have contributed to bleeding included the nasal olfactory region (n = 3), nasal inferior meatus (n = 1), and sphenoethmoid recess (n = 1).. After resuscitation and hematologic investigation, nasal endoscopy should be considered in patients with intractable epistaxis.

Topics: Endoscopy; Epistaxis; Humans; Nasal Cavity; Nose; Retrospective Studies

Nasal closure, also known as the modified Young's procedure was introduced in Denmark in 2008, as a surgical solution to severe epistaxis in patients with hereditary haemorrhagic telangiectasia (HHT). The objective of this study was to report the overall satisfaction of the procedure from a patient's point of view as well as the occurrence of complications.. All the HHT patients who underwent nasal closure from 2008 to 2018 were included in the study. The patients were evaluated for postoperative complications and subjective outcome using Glasgow Benefit Inventory (GBI).. Ten patients were included in the study and were observed for a mean of 64 months. None of the patients was completely free of complications, and reversal was requested in a single case. Haemoglobin levels rose with an average of 2.8 g/dl. The average GBI score after surgery was 38.05. Nine of ten patients would recommend nasal closure to fellow HHT patients.. Nasal closure is highly recommended among patients, but due to the rate of postoperative complications, the procedure should be reserved for a carefully selected group of HHT patients.

Topics: Adult; Aged; Cohort Studies; Denmark; Epistaxis; Female; Humans; Male; Middle Aged; Nasal Mucosa; Nasal Surgical Procedures; Nose; Patient Reported Outcome Measures; Patient Satisfaction; Surgical Flaps; Telangiectasia, Hereditary Hemorrhagic; Treatment Outcome

Topics: Bandages; Epistaxis; Humans; Nose; Telangiectasia, Hereditary Hemorrhagic

Nasal fractures present in 39% of patients with facial trauma. These patients are assessed in the emergency department followed by outpatient review in the senior house officer-led emergency ear, nose and throat (ENT) clinic. Inadequate treatment of nasal trauma can result in debilitating functional and aesthetic problems. Inexperienced junior doctors may be apprehensive in assessing nasal trauma resulting in time pressured clinics and suboptimal management.. A retrospective review of clinical noting over 3 months was carried out to gauge the extent of the problem. Three baseline measurements for satisfactory quality of assessments included: (1) 3/5 key symptoms elicited by the clinician (epistaxis, rhinorrhoea, nasal airway obstruction, dental malocclusion and diplopia). (2) Presence/absence of 'septal haematoma' (SH) and 'deviated nasal septum' (DNS) documented. (3) Patient follow-up within 2 weeks after the initial injury. Three Plan-Do-Study-Act (PDSA) cycles were conducted with implementation of interventions (proforma, clinic poster, patient information leaflet and training) as visualised in our 'driver diagram'.. The quality of nasal trauma assessments improved following each intervention. There was an increase from 86% to 100% patients being seen within 2 weeks of the injury. There was an improvement in quality of assessments following the teaching as two-thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) of clinical documentation included 'rhinorrhoea' and 83% (PDSA cycle 2) to 100% (PDSA cycle 3) included 'nasal airway obstruction'. Similarly, two thirds (PDSA cycle 2) followed by 100% (PDSA cycle 3) examined and documented the presence/absence of SH and DNS. A 100% improvement in trainee confidence was reported. We are now conducting more comprehensive assessments of nasal trauma patients.. The need to provide relevant training and support to ENT junior doctors is crucial in their development, as well as to ensure delivery of high-quality patient-centred care.

Topics: Epistaxis; Hospitals; Humans; Nasal Septum; Nose; Nose Deformities, Acquired; Quality Improvement; Retrospective Studies; Trauma Centers; United Kingdom

Hereditary hemorrhagic telangiectasia (HHT) is characterized by recurrent epistaxis that can lead to a feeling of losing control. We assessed potential benefits and side effects of different nasal packings used by patients themselves.. An online-questionnaire in English and German was used to analyze nasal self-packings.. 588 of the 915 respondents suffered from HHT with most of them having moderate or severe epistaxis. Almost two thirds of the patients had already treated themselves with nasal packings. While one quarter used non-pneumatic nasal packings (NPNP) or pneumatic nasal packings (PNP), nearly half of the patients took only tissues to stop the bleeding. Patients with severe epistaxis used PNP more often than NPNP. Using nasal packings, most patients could stop their nosebleeds after a while. Patients using PNP reported the feeling of losing control less often and significant improvements in quality of life with a positive GBI.. Our study showed that most patients with HHT using nasal self-packings could stop the bleeding after a while. Nasal self-packing is a user-friendly and secure method leaving patients more self-confident and independent.

Topics: Epistaxis; Humans; Nose; Quality of Life; Self Care; Surveys and Questionnaires; Telangiectasia, Hereditary Hemorrhagic

To investigate the clinical profile and outcomes of different treatment strategies in patients hospitalized for spontaneous severe epistaxis.. This is a retrospective descriptive study of a case series of patients hospitalized for epistaxis in the University Hospital of Ghent between 2005 and 2012.. 124 patients with, respectively, 132 episodes were included. 64% were male. The mean age was 65 years. 73% had comorbidities of which arterial hypertension was the most common. 61% were taking one or more antithrombotics and in 25.7% a recent change in the medication schedule took place. 47% of the episodes necessitated a vascular intervention. The most performed surgery was endoscopic sphenopalatine artery ligation. The 1-year success rate of conservative treatment was 47% and of vascular intervention 81%. No significant difference between the recurrence rates and need for vascular intervention of the different comorbidities and medications was detected using Pearson chi-squared and Fisher's exact testing. The overall 5-year survival rate was 83.6%.. The typical pattern of a patient presenting with severe epistaxis was a patient in the sixth decade, male, suffering from comorbidities and taking one or more antithrombotic agents. Based on the above-mentioned success rates of the different treatment options, we think all centres treating epistaxis should apply a well-defined protocol to guide the decision when to proceed with surgery. Furthermore, prospective research needs to precisely investigate the role played by comorbidities and their treatment in the occurrence of epistaxis and to test the effectiveness of proposed algorithms.

Topics: Aged; Belgium; Comorbidity; Embolization, Therapeutic; Endoscopy; Epistaxis; Female; Hospitals, University; Humans; Ligation; Male; Middle Aged; Nose; Outcome and Process Assessment, Health Care; Recurrence; Retrospective Studies; Risk Factors

Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy Abstract. In this overview the clinical pictures of ear, nose and throat diseases and their symptoms, which occur frequently but also particularly during pregnancy, are presented. In addition, the respective therapy options in this partially vulnerable phase of mother and child are discussed. The primary principle is 'as much as necessary, but as little as possible'. Even if the complaints often disappear with the birth of the child, there may be considerable suffering of the pregnant woman and therapy may be necessary. Moreover, an adequate therapy should be applied with all ENT diseases, even for those not specifically associated with pregnancy.. Zusammenfassung. In dieser Übersicht werden die Krankheitsbilder aus der Hals-/Nasen- und Ohrenheilkunde und deren Symptome, die gehäuft oder aber auch speziell nur in der Schwangerschaft auftreten, vorgestellt. Zusätzlich werden die jeweiligen Therapieoptionen in dieser teilweise vulnerablen Phase der Mutter und des Kindes diskutiert. Primär gilt der Grundsatz «so viel wie nötig, aber so wenig wie möglich». Auch wenn die Beschwerden häufig mit der Geburt des Kindes verschwinden, kann ein erheblicher Leidensdruck für die Betroffenen bestehen und eine Therapie nötig sein. Bei sämtlichen HNO-Erkrankungen, auch den nicht speziell mit der Schwangerschaft assoziierten, sollte eine adäquate Therapie durchgeführt werden.

Topics: Epistaxis; Female; Humans; Nose; Otorhinolaryngologic Diseases; Pharyngeal Diseases; Pregnancy; Pregnancy Complications

Munchausen syndrome by proxy (MSBP) is a condition diagnosed when a caregiver knowingly fabricates or inflicts illness on another for his/her own gain. Typical cases of MSBP detected by otolaryngologists involve facial trauma or otologic injury, while descriptions involving the nose are rare. Destructive nasal lesions have a broad differential diagnosis and may require visits to numerous specialists, placing strain on both the patient and the healthcare system. Early recognition of MSBP in patients with chronic nasal destruction may prevent such unnecessary strain. We present a case of MSBP involving two half-brothers with unexplainable nasal destruction and discuss the literature and current recommendations for managing the diagnosis.

Topics: Chronic Disease; Diagnosis, Differential; Epistaxis; Humans; Infant; Male; Munchausen Syndrome by Proxy; Nose; Nose Deformities, Acquired; Siblings

Epistaxis is a common cause for emergency department visits for both children and adults. In particular, posterior bleeds can be difficult to identify and treat. In adults, endoscopic sphenopalatine artery (SPA) ligation has been shown to be safe, cost-effective, and curative. Conversely, very few studies have delved into the safety and efficacy of SPA ligation in children. This study aims to evaluate the feasibility of SPA ligation for treatment of recalcitrant epistaxis in children.. A retrospective analysis of outcomes in pediatric patients who underwent SPA ligation at a tertiary academic center was performed. Patients with coagulopathies or other underlying conditions were excluded from the study.. Data obtained from 5 patients demonstrated 60% of the population were female, with ages ranging from 2 to 13 years. 7 SPA ligations were performed among the 5 patients, with 3 undergoing unilateral SPA ligation only. The remaining 4 underwent contralateral SPA ligation subsequently. No postoperative complications were observed, and all patients experienced resolution of significant epistaxis.. Although additional studies are necessary to further support our findings, SPA ligation in the pediatric population appears to be a safe and effective treatment to control persistent posterior bleeds.

Topics: Adolescent; Arteries; Child; Child, Preschool; Endoscopy; Epistaxis; Female; Humans; Infant; Ligation; Male; Nose; Retrospective Studies; Treatment Outcome

Spontaneous epistaxis under general anesthesia is a rare untoward event. Typically, mild epistaxis occurs from a nasal airway manipulation and usually resolves spontaneously or with external pressure to the affected nares for a short period of time. In case of epistaxis that is difficult to control with pressure or oxymetazoline, thorough evaluation should be considered. We present a case of a 12-year-old experiencing spontaneous nasal bleeding upon emergence difficult to control with noninvasive methods and required intervention by otolaryngology.

Topics: Anesthesia, General; Anesthetics; Child; Epistaxis; Humans; Intraoperative Complications; Male; Nasal Cavity; Nose

The majority of epistaxes are anterior in nature, resolve with simple first aid measures and require no further follow-up. However, some cases pose more of a diagnostic challenge and prove resistant to standard investigation and treatment. We present a case of recurrent epistaxis, refractory to multiple treatment modalities and with CT imaging suggestive of a vascular aetiology which was ultimately disproved. The case highlights the shortcomings of CT imaging and importance of thorough examination technique. Nasal haemangiomas are a rare but recognised cause of epistaxis and should be considered in refractory cases.

Topics: Aged; Aneurysm; Carotid Artery, Internal; Computed Tomography Angiography; Diagnosis, Differential; Epistaxis; Female; Hemangioma; Humans; Nose; Treatment Outcome

Topics: Arteries; Endoscopy; Epistaxis; Humans; Maxillary Artery; Nose

Combined mid-face and nasal apparatus trauma injuries pose a significant challenge to airway patency (AW), in the immediate postoperative setting following fracture reduction. As such, the authors describe a modified technique with the goal of maintaining a patent nasal AW, while at the same time, minimizing nasopharyngeal bleeding and nasal AW edema-which can complicate patients requiring intermaxillary fixation (IMF) in the setting of pan-facial trauma.. A modified technique was devised to assist the reconstruction surgeon in avoiding the risks associated with tracheostomy placement. In an effort to avoid surgical AW complications and improve nasal AW patency in the setting of concurrent IMF and nasal trauma, the authors developed a 2-stage technique drawing upon knowledge from the literature and the authors' own experiences.. Following safe extubation, the authors insert open lumen nasal splints in both the nostrils, and suture them together to the nasal septum. If additional inner nasal support is required, polyvinyl alcohol nonabsorbable nasal packing dressing is covered with antibiotic ointment, and then placed within the nasal cavity lateral to the open lumen splints-as a way to further bolster the internal valve and mid-vault anatomy.. Given the fact that traditional nasal packing with merocele/gauze dressing in concomitant to IMF reduced patients ability to ventilate, the authors felt that a modified technique should be applied. The authors' preferred materials in such patients are open lumen splint, which provides nasal AW patency along with some septum support accompanied by merocele dressing. The authors feel that by applying this technique they achieve dual objectives by supporting the traumatized nose and maintaining nasal AW patency.

Topics: Bandages; Epistaxis; Fracture Fixation; Fracture Fixation, Internal; Humans; Maxillofacial Injuries; Nasal Obstruction; Nasal Septum; Nose; Postoperative Period; Splints

Topics: Anesthetics, Local; Epistaxis; Headache Disorders; Humans; Nose; Pain Measurement; Ropivacaine; Sphenopalatine Ganglion Block; Treatment Outcome

Orbital blowout fractures are nearly always caused by acute trauma. Non-traumatic cases of orbital blowout fractures have only been rarely described. In this case study, we discuss an orbital blowout fracture directly caused by nose blowing. The patient developed unilateral eye swelling and orbital emphysema. It is important for the clinician to investigate all suspected orbital blowout fractures with imaging and full ophthalmological examination regardless of a trauma history. Most cases of orbital emphysema resolve spontaneously, however one must always exclude compression of the central retinal artery. This may present as acute loss of vision and/or ophthalmoplegia.

Topics: Adult; Amoxicillin-Potassium Clavulanate Combination; Barotrauma; beta-Lactamase Inhibitors; Epistaxis; Female; Humans; Nose; Orbital Fractures; Patient Education as Topic; Referral and Consultation; Tomography, X-Ray Computed; Treatment Outcome

Topics: Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Retrospective Studies; Sphenoid Sinus; Treatment Outcome; Vascular Surgical Procedures

In this study, we analyze and discuss the treatments of postoperative nasal complications after endonasal transsphenoidal resection of pituitary neoplasms (PNs). We performed 129 endonasal transsphenoidal resections of PNs and analyzed and treated cases with nasal complications. After endonasal transsphenoidal resection of PNs, there were 26 cases of postoperative nasal complications (20.1%), including nasal hemorrhage (4.8%), cerebrospinal fluid rhinorrhea (6.9%), sphenoid sinusitis (2.3%), atrophic rhinitis (1.6%), olfactory disorder (1.6%), perforation of nasal septum (0.8%), and nasal adhesion (2.3%). All patients clinically recovered after therapy, which included treatment of the cavity through nasal endoscopy, intranasal corticosteroids, and nasal irrigation. We propose that regular nasal endoscopic review, specific nasal medications, and regular nasal irrigation can effectively clear nasal mucosal hyperemia-induced edema and nasal/nasoantral secretions, as well as promote regeneration of nasal mucosa, prevent nasal adhesion, maintain the sinus cavity drainage, and accelerate the recovery of the physiological function of the paranasal sinus. Timely treatment of patients with nasal complications after endonasal transsphenoidal resections of PNs could greatly relieve the clinical symptoms. Nasal cleaning is very beneficial to patients after surgery recovery.

Topics: Adolescent; Adult; Aftercare; Aged; Cerebrospinal Fluid Rhinorrhea; Child; Epistaxis; Female; Humans; Male; Middle Aged; Nasal Lavage; Nasal Mucosa; Nasal Septal Perforation; Nasal Surgical Procedures; Natural Orifice Endoscopic Surgery; Nose; Nose Diseases; Olfactory Nerve Diseases; Paranasal Sinuses; Pituitary Neoplasms; Postoperative Complications; Recovery of Function; Retrospective Studies; Rhinitis, Atrophic; Sphenoid Sinus; Sphenoid Sinusitis; Tissue Adhesions; Young Adult

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease that leads to frequent epistaxis. It can have a significant impact on quality of life. Many reports exist regarding various therapies to address the epistaxis.. We presented our technique for addressing the epistaxis associated with HHT.. Patients are treated in the operating room while they are under general anesthesia. A local anesthetic is injected sublabially, and oxymetazoline is dripped into the nose. The coblation wand is used to treat the telangiectasias. Bevacizumab is then injected into the nasal cavity bilaterally.. The coblation wand, with or without adjunctive bevacizumab injection, is a technically feasible intervention for patients with HHT that all providers can perform.

Topics: Anesthesia, Local; Bevacizumab; Cautery; Electrosurgery; Endoscopy; Epistaxis; Humans; Nose; Oxymetazoline; Practice Guidelines as Topic; Telangiectasia, Hereditary Hemorrhagic; Video Recording

Epistaxis constitutes a significant proportion of the Otolaryngologist's emergency workload. Optimal management differs in relation to the anatomic origin of the bleeding. The outcome of our study was to determine which artery(ies) could be considered as the cause of severe bleeding in the context of severe epistaxis.. Fifty-five procedures of embolization preceded by angiography were reviewed. Medical records of interventionally treated patients were analysed for demographics, medical history, risk factors and clinical data. Angiographic findings were also assessed for active contrast extravasation (blush), vascular abnormality and embolised artery.. Previous angiography showed an active contrast extravasation in only 20 procedures. The most common bleeding source was the sphenopalatine artery (SPA) followed by anterior ethmoïdal artery (AEA) and facial artery. Majority of multiple or bilateral extravasations occured in patients with systemic factors.. A better understanding of the potential bleeding source might help and limit the risk of treatment failures. Our study confirms that the SPA is the most common cause of severe bleeding. We also emphasise the role of the AEA not only in traumatic context. Others arteries are rarely involved except in patients with comorbidities or frequent recurrences.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Arteries; Chronic Disease; Comorbidity; Embolization, Therapeutic; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Risk Factors; Treatment Outcome

To optimize the outcome of transnasal endoscopic sphenopalatine artery ligation (TESPAL) by determining the key surgical steps and applying them accordingly.. This is a case-control study carried out in a tertiary care teaching institution on subjects who underwent TESPAL during the period of October 2010 to September 2015. Their surgical and clinical records were reviewed, and success (no re-bleed) and failure (return with re-bleed) were considered the main outcome measures of TESPAL. Accordingly, depending on whether the subjects returned with re-bleed or not, they were classified as "failure" and "success" groups. After appropriate matching in terms of age, gender and a given set of exclusion criteria that could influence per-operative decision-making or contribute to post-operative epistaxis, the groups were considered as cases (subjects undergoing TESPAL and returned with re-bleed; part of the "failure" group following matching) and controls (subjects undergoing TESPAL and did not return with re-bleed; part of the "success" group following matching). Per-operative/surgical factors executed or followed in varied combinations in each group that influenced the outcome of TESPAL were then identified from the surgical notes and were subsequently analyzed statistically.. In 89% of cases, the sphenopalatine artery (SPA) pedicle was either clipped or cauterized, whereas in 90% of the controls, it was both clipped and cauterized. The posterior nasal artery (PNA), when found, was cauterized in 25% of the cases, compared to 85% in the controls. Also, the septal artery region was cauterized in only 33% of cases. Both cauterization/clipping of the SPA along with cauterization of PNA was done in 69% of the controls, whereas in 59% the septal artery region was also cauterized. However, there were no cases when all these steps were combined. The results were statistically significant.. When only the per-operative/surgical factors were considered, the outcome of TESPAL was most favorable when the procedure could be done combining both clipping and cauterization of the SPA, along with cauterization of the PNA and the septal artery region.

Topics: Adult; Aged; Case-Control Studies; Cautery; Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Natural Orifice Endoscopic Surgery; Nose; Recurrence; Retrospective Studies; Surgical Instruments; Young Adult

A 9-year-old girl developed a recurrent headaches and had a runny nose with occasional nosebleed for three years. She was diagnosed as sinusitis and the infection of upper respiratory tract, and given the corresponding treatment in local hospital several times before admitted by our hospital. In our department, a suspected metal body was found by nasal endoscopy and confirmed by CT scan. She was extracted foreign body under local anesthesia. The symptoms were relieved a week after the operation.

Topics: Child; Endoscopy; Epistaxis; Female; Foreign Bodies; Humans; Nasal Cavity; Nose; Sinusitis

The aim of this study is to determine whether rhinologic preoperative evaluation and pretreatments reduce intranasal trauma and decrease postoperative complications, such as nasal obstruction and epistaxis, in patients undergoing 2-jaw surgery with nasotracheal intubation. This study included 360 patients with malocclusion (Class III) who underwent 2-jaw surgery under general anesthesia via nasotracheal intubation in our hospital from January to December 2013 and categorized into 3 groups. Nasotracheal intubation was performed according to the nasal cavity the patient was able to breathe comfortably (Group I). The site of nasotracheal intubation was decided by 1 rhinologic specialist who evaluated preoperative dental computed tomography (Group II). The site of nasotracheal intubation was decided upon nasal endoscopic findings, dental computed tomography evaluation, and rhinologic pretreatment (Group III).Group II and Group III showed less damage to the nasal mucosa compared with the nasal status of Group I. Upon comparing Group II and Group III, Group III showed better overall status of the nasal mucosa compared with Group II. Visual analogue scale scores for nasal obstruction were pretty similar for all groups on the first postoperative day. In Group III, the nasal mucosa, however, was improved to that of preoperative status on the third postoperative day.In conclusion, it may be useful to pre-evaluate the mucosal and anatomical status of the nasal cavity to select patients requiring rhinologic pretreatment and decide the site for nasotracheal intubation to minimize complications arising from nasotracheal intubation.

Topics: Endoscopy; Epistaxis; Female; Follow-Up Studies; Humans; Intraoperative Complications; Intubation, Intratracheal; Male; Malocclusion, Angle Class III; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nasal Septum; Nose; Orthognathic Surgical Procedures; Postoperative Complications; Retrospective Studies; Tomography, X-Ray Computed; Turbinates; Visual Analog Scale; Young Adult

Nasal closure has been shown to effectively manage severe epistaxis refractory to other treatments in patients with hereditary hemorrhagic telangiectasia (HHT). The nasal closure procedure may be underutilized because of its surgical complexity and flap breakdown.. This work is a retrospective review of 13 HHT patients treated for severe epistaxis with nasal closure between 2005 and 2013. Operating room (OR) time, need for revision surgery, preprocedure, and postprocedure epistaxis severity score (ESS), complete blood count values, and Glasgow Benefit Inventory (GBI) questionnaire results were collected for each patient. The technique is described. We characterize a typical nasal closure patient and compare outcomes based on our experience with the traditional 3-flap closure and a simplified 2-flap nasal closure procedure.. The average candidate for nasal closure in this series had an ESS of 7.88, hemoglobin (Hgb) of 8.3 g/dL, and received multiple transfusions, iron therapy, and cautery/coagulation procedures. Average ESS subsequent to nasal closure using the 2-flap method is 0.92 and mean GBI score is 56.3. Comparison of 5 patients who underwent the traditional 3-flap nasal closure procedure and 8 patients receiving the 2-flap nasal closure showed no significant difference in postoperative ESS or GBI metrics. Mean operating room times of the traditional and simplified methods were 3.12 hours and 1.44 hours (p = 0.0001). Mean time to first revision for 8 nasal closure patients was 21.5 months.. In short-term follow-up, the 2-flap procedure showed comparable effectiveness with significantly reduced complexity and operative time compared to the traditional nasal closure method.

Topics: Adult; Aged; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Otorhinolaryngologic Surgical Procedures; Surgical Flaps; Telangiectasia, Hereditary Hemorrhagic; Treatment Outcome

This article presents the guidelines for the treatment of epistaxis in an out-patient setting in Sweden. Nasal hemorrhage from the anterior part of the nasal cavity is best treated with silver nitrate cauterization or electrocautery. Bleeding from the posterior part of the nasal cavity often requires treatment with a pneumatic nasal tamponade, RapidRhino, or a posterior nasal packing with a Foley catheter. When a patient requires treatment with posterior nasal packing it is recommended that a contact be taken with the nearest ENT clinic. The guidelines described are used by otorhinolaryngologists at Karolinska University Hospital, Stockholm, Sahlgrenska University Hospital, Gothenburg, Lund University Hospital, Lund and District Hospital Sundsvall-Härnösand, Sundsvall.

Topics: Ambulatory Care; Critical Pathways; Epistaxis; Humans; Nose; Practice Guidelines as Topic; Sweden

Topics: Anticoagulants; Emergency Service, Hospital; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Platelet Aggregation Inhibitors

Epistaxis is the most common ENT emergency encountered in the Emergency Department. Most cases can be managed by simple anterior nasal packing. This is usually a safe and very effective option in an emergency situation, requiring minimal expertise and infrastructure. This paper describes a rare instance of a serious complication following anterior nasal packing in a case of nasopharyngeal angiofibroma.. A 27-year-old man diagnosed with nasopharyngeal angiofibroma presented to the Emergency Department with bilateral epistaxis. The patient was stabilised and anterior nasal packing was performed, which controlled the bleeding. Three hours later, the patient developed complete blindness in both eyes. Aggressive medical management was initiated immediately, but failed to restore the patient's vision.. Anterior nasal packing is a simple and minimally invasive procedure practised regularly in an Emergency Department setting. However, it can occasionally lead to serious complications such as blindness. Thus, obtaining informed consent is essential to avoid medico-legal consequences in high-risk cases.

Topics: Adult; Angiofibroma; Blindness; Epistaxis; Hemostatic Techniques; Humans; Male; Nasopharyngeal Neoplasms; Nose

From 2006 to 2013, 12 patients with severe epistaxis refractory to prior conservative and surgical therapy were treated by superselective embolization of nasal arteries. Supersoft platinum microcoils with smallest diameters were used as the sole embolic agent in all cases. Coils were applied far distally in a stretched position for obtaining ideal target vessel superselectivity. The objective of this study is to evaluate efficacy and complications of superselective coil embolization for treatment of severe intractable epistaxis and to discuss results from an otorhinolaryngologic and an interventional neuroradiologic point of view. Retrospectively, all epistaxis inpatients between 2006 and 2013 were identified and subdivided by form of treatment: conservative, surgical and interventional therapy. Medical records of interventionally treated patients were reviewed for demographics, medical history, risk factors, clinical data, complications and short-term success, and patients were followed up for long-term success. Mean follow-up was 37 months. In 12 patients, 14 embolizations were carried out, with short-term success in 9 patients (75%), while early post-interventional rebleeding occurred in 3 patients (25%). Of 9 patients with short-term success, 1 died during stay, 1 was lost to follow-up and 1 had minor re-bleeding after 30 months. Six patients had short-term and long-term success. Before the first embolization, 3 ± 1 conservative and/or surgical procedures had been undertaken. Length of stay was 12.8 ± 3.6 days. 8 patients (67%) received red cell concentrates. Most frequent complications were mucosal damage and nasal pain, but these were related to repeated packing and surgery. Typical embolic complications as neurological or visual impairment or soft tissue necrosis were not observed in any patient. From the otorhinolaryngologic point of view, surgery is the treatment of choice in severe refractory epistaxis, but in case of repeated failure, superselective microcoil embolization is a valuable addition to the therapeutic spectrum. From the interventional neuroradiologic point of view, superselective microcoil embolization is an effective, well tolerable and safe procedure and complications may be reduced in comparison to microparticle embolization. Modern supersoft microcoils with smallest diameters enable ideal superselectivity of the target vessels.

Topics: Adult; Aged; Aged, 80 and over; Attitude of Health Personnel; Embolization, Therapeutic; Epistaxis; Female; Hospitalization; Humans; Male; Middle Aged; Nose; Patient Selection; Retrospective Studies; Treatment Outcome

Topics: Aged; Animals; Diptera; Epistaxis; Humans; Male; Nose; Screw Worm Infection; Sinusitis

Topics: Aged; Cheek; Epistaxis; Gastrointestinal Hemorrhage; Humans; Male; Nose; Telangiectasia, Hereditary Hemorrhagic

The treatment of epistaxis sometime requires an embolization. This may result in ischemic palate necrosis, oronasal communication and dental losses. The repair of these lesions is complex.. A 53-year-old patient, suffering from high blood pressure and hypercholesterolemia, benefited from bilateral embolization of the sphenopalatine arteries in order to treat a persistent epistaxis. He developed a middle cerebral artery stroke in the aftermath. During the treatment of the neurological sequelae, a necrosis of the 2/3 of the posterior aspect of the hard palate was discovered. The angio-MRI showed an obstruction of both sphenopalatine arteries and of their vascular supplies resulting in a bilateral involvement of the alveolar bone. The diagnosis of iatrogenic palate necrosis was made. Tissue repair was successfully achieved by two loco-regional flaps. The dental rehabilitation was made by mean of a removable prosthesis.. Palatine necrosis following embolization of the sphenopalatine arteries is uncommon. Ischemia resulted in a loss of substance in form of a punch, similar to noma's lesions. It could also be a consequence of the vascular background. The management of these lesions is complex and calls for forensic reflection about the iatrogenic origin.

Topics: Arteries; Embolization, Therapeutic; Epistaxis; Humans; Iatrogenic Disease; Male; Middle Aged; Necrosis; Nose; Palate, Hard; Pterygopalatine Fossa; Recurrence

We reported a case of nasal malignant granular cell tumor. The patient was a 51 years old man who went to the hospital because of "right nasal intermittent bleeding for half a year". The pathological examination after resection showed malignant granular cell tumor. No recurrence was noted during a year after resection. The etiology and pathogenesis, clinical features, pathological features and treatments of malignant granular cell tumor were reviewed.

Topics: Epistaxis; Granular Cell Tumor; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Nose; Nose Neoplasms

Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. Successful treatment requires knowledge of nasal anatomy, and potential risks and complications of treatment.. Epistaxis is often a simple and readily treatable condition. However, given the potential consequences of a significant bleed, GPs should have an understanding of the causes, potential risks and emergency management.. Epistaxis can be classified into anterior or posterior bleeds, the former being the most common. Anterior bleeds can often be treated with cauterisation with silver nitrate sticks, provided there is good preparation, correct equipment and assistance close at hand. If there is a lack in any of these aspects, prompt use of nasal packing and referral to an emergency department or a specialist ENT service is recommended.

Topics: Arteries; Cautery; Embolization, Therapeutic; Epistaxis; First Aid; General Practice; Humans; Ligation; Nose; Patient Education as Topic; Tampons, Surgical

We aimed to investigate the effect of removal of merocel nasal packings on patients anxiety after septoplasty using Hamilton Anxiety Scale.. Total amount of 50 patients who had septoplasty operation in the Department of Ear, Nose and Throat Clinic of our hospital were enrolled to the study. Patients anxiety determined using Hamilton Anxiety Scale. The patients anxiety levels were measured before 24 hours before the operation (Group 1), 48 hours after operation before nasal packing removal (Group 2) and 60 minutes after nasal packing removal (Group 3).. Patients were evaluated according to the Hamilton Anxiety Scale; in Group 1 15.3 ± 7.2, 19.3 ± 7 in Group 2, 14.6 ± 6,5 in Group 3 was measured.. There was no statistically significant difference between Groups 1 and 3. There is a statistically significant difference on patients anxiety levels 48 hours after operation before nasal packing removal (p<0.001). There is an statistically significant increase of patients anxiety before packing removal. We recommend using soluble packings or sewing techniques without nasal packings after septoplasty because of patient comfort after operation.

Topics: Adolescent; Adult; Anxiety; Educational Status; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Postoperative Care; Sex Factors; Young Adult

Metastatic renal cell carcinoma (RCC) in the nose and paranasal sinuses is very rare. We report an unusual case of metastatic RCC that presented as recurrent epistaxis ten years after curative nephrectomy. The purpose of this report is to draw the attention of clinicians to the possibility of metastatic RCC in patients with recurrent epistaxis and nasal mass. We also discuss treatment options and review the relevant literature.

Topics: Adult; Carcinoma, Renal Cell; Chemoradiotherapy; Diagnosis, Differential; Epistaxis; Humans; Indoles; Kidney Diseases; Male; Neoplasm Metastasis; Nose; Nose Neoplasms; Positron-Emission Tomography; Pyrroles; Recurrence; Sunitinib; Tomography, X-Ray Computed

To demonstrate the efficacy of identification of bleeding source with nasal endoscopy and cauterization (bipolar or radiofrequency) without nasal packing in adults with posterior epistaxis unable to be treated with nasal packing.. The average age of patients was 56.16 ± 12.6 (38-72) years, and female-male ratio was 1/5. The average systolic blood pressure was found to be 150 ± 30, while diastolic blood pressure was 90 ± 20 mmHg. Average hemoglobin concentration was 11.2 ± 3.1 (7-15). The bleeding was on the left side in 8 patients and on the right in 4 patients. Probable etiology was considered hypertension crisis (33.3%), use of nasal steroids (8.3%), nasal surgery (8.3%), however in half (50%) of the cases the cause was unidentified. Of the cases, 6 had hypertension, 4 COPD, 10 tobacco use and 5 alcohol use. The source of epistaxis was anterior ethmoidal artery in 2 cases and spheopalatine artery in 10 cases. Two of the cases were treated with radiofrequency coagulation, and ten with bipolar cauterization. Only one of the cases was administered 2 units of packed red blood cells, and one of the cases had postoperative recurrent bleeding. The patients were hospitalized in average 3.2 (2-5) days and no reccurence of hemorrhage was seen in 3 month follow up.. Dundee epistaxis menagement protocol described by Barnes and Spielman may be applied in adults. Endoscopical detection of the bleeding site and cauterizing the arterial feed source is highly successful in the treatment. Nasal packing may more commonly lead to complication especially in the elderly and in patients with heart and respiratory problems.

Topics: Adult; Aged; Endoscopy; Epistaxis; Female; Humans; Hypertension; Male; Middle Aged; Nose; Postoperative Period; Tampons, Surgical

Juvenile nasopharyngeal angiofibroma (JNA) is the most common benign neoplasm of the nasopharynx. Almost always unilateral on diagnosis, JNAs are locally invasive and may extend across the midline, giving a false bilateral appearance; as such, true bilateral JNA is exceedingly rare. We present a recent case of true bilateral JNA.. Single case report of a patient with bilateral JNA, including clinical presentation, diagnosis, and management.. The patient presented with unilateral nasal obstruction and recurrent epistaxis. Computed tomography and magnetic resonance imaging demonstrated bilateral, noncontiguous masses. Angiography revealed independent vascular supplies from each respective side with no bilateral supply noted. The patient underwent preoperative embolization followed by endoscopic surgical removal of the larger mass; no complications were noted. Follow-up at 2 years demonstrated no recurrence or growth.. The vast majority of JNAs are unilateral, though invasive growth to the contralateral side may appear "bilateral" in presentation. Proper identification of true bilateral JNA is helpful in guiding management, wherein excision of both tumors may not be necessary.

Topics: Adolescent; Angiofibroma; Early Detection of Cancer; Endoscopy; Epistaxis; Humans; Magnetic Resonance Imaging; Male; Nasal Obstruction; Nasopharyngeal Neoplasms; Nose; Pharynx; Tomography, X-Ray Computed; Treatment Outcome

Treatment of Recurrent Epistaxis by Artery Ligation: Up to Date or Old Fashioned?. Despite the ongoing development in the field of endoscopic treatment techniques, recurrent epistaxis remains a challenge for otolaryngologists. The aim of the present study was to compare our own results of various interventions for the treatment of recurrent epistaxis.. From 2007 to 2013 we performed surgical treatment of recurrent epistaxis under general anaesthesia in 148 cases. While the majority of causes were idiopathic (n=98), epistaxis also occurred postoperatively (n=30), post-traumatically (n=7) or as a result of M. Osler (n=12). In 141/148 cases the treatment was performed by mono- or bipolar coagulation in the area of the bleeding source - this required an ethmoidectomy in 17 cases. In 19 cases the intervention was combined with a septoplasty. In 4 patients with recurrent bleeding of unknown origin, where electrocoagulation under general anaesthesia failed, we performed a clipping of the ethmoid- and/or the maxillary arteries in the pterygopalatine fossa. Following this intervention no further bleeding episodes occured. In further 3 patients, neuroradiological embolization was successfully performed.. If conservative measures fail in the treatment of epistaxis, surgical treatment by electrocoagulation of the bleeding site under general anaesthesia is an effective intervention in 95% of cases. However for the remaining 5% where these measures have been proven to be ineffective, clipping of the ipsilateral anterior and posterior ethmoid- and/or the maxillar artery provides a treatment option being equally efficient as neuroradiological interventions.

Topics: Adult; Aged; Arteries; Electrocoagulation; Epistaxis; Ethmoid Sinus; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Recurrence; Reoperation; Retrospective Studies

Although epistaxis is common during pregnancy, large volume epistaxis is rare. Many standard epistaxis management options are limited in pregnancy due to absolute or relative contraindications. Ear, nose and throat surgeons need to be aware of what options can be used safely and effectively. We present a case of a 32-year-old woman, 32 weeks pregnant, who was admitted with heavy epistaxis refractive to conservative management. Several potential interventions including bismuth iodoform paraffin paste (BIPP) and Floseal were contraindicated or involved additional risk in pregnancy necessitating unorthodox management. This challenging case highlights suitable alternatives for managing large volume epistaxis during pregnancy, as well as discussing the differential diagnosis and relevant investigations.

Topics: Adult; Bismuth; Contraindications; Disease Management; Drug Combinations; Epistaxis; Female; Gelatin Sponge, Absorbable; Humans; Hydrocarbons, Iodinated; Nose; Pregnancy; Pregnancy Complications; Pregnancy Trimester, Third

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Endoscopy; Epistaxis; Female; Humans; Male; Microwaves; Middle Aged; Nose; Treatment Outcome; Young Adult

To investigate the potential risk factors and management of excessive epistaxis after endoscopic endonasal surgery (EES).. Six hundred and forty-one patients who underwent EES in our hospital from December 2011 to December 2012 were reviewed retrospectively. Factors which potentially affect the incidence of excessive epistaxis after EES were analyzed with univariate and multivariate logistic regression model.. The incidence rate of excessive epistaxis after EES was 8.4% in our study. Multivariate logistic regression analysis revealed that history of previous EES, along with other four factors, correlated significantly with the occurrence of excessive epistaxis after EES.. Previous EES, along with other three factors, may increase the chance of excessive epistaxis after EES, while pre-operative corticosteroid therapy may reduce the risk to some extent.

Topics: Adolescent; Adult; Aged; Child; Endoscopy; Epistaxis; Female; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nasal Surgical Procedures; Nose; Postoperative Complications; Retrospective Studies; Risk Factors; Young Adult

The use of cold nasal packs on the nose and nape of the neck is currently recommended for patients with epistaxis as this is thought to induce reflex nasal vasoconstriction, which decreases the bleeding. There have been a few investigations on the effect of cold compress application to the nose, but none of these focused specifically on nasal cooling of the skin of the nose.. Acoustic rhinometry was performed to obtain baseline measurements. Nasal dorsal skin was then cooled with two ice packs that were held on the left and right side of the nose for a total of 10 minutes by the subjects. The rhinometry measurements were taken at the time of initial application (baseline), and after 5 and 10 minutes of ice pack application.. Comparisons of the first and second minimal cross-sectional area values, and total nasal cavity volume measurements revealed no statistical differences.. The results of this study indicate that one should be sceptical about the efficiency of cold compress application, which is frequently used in clinical practice in cases with epistaxis.

Topics: Adult; Cold Temperature; Epistaxis; Female; Humans; Male; Nasal Cavity; Nasal Mucosa; Nose; Regional Blood Flow; Rhinometry, Acoustic; Skin Temperature

Topics: Endoscopes; Endoscopy; Epistaxis; Humans; Nose

Topics: Endoscopy; Epistaxis; Humans; Nasal Surgical Procedures; Nose

We consider sphenopalatine artery ligation to be a safe and effective treatment of posterior epistaxis as the long-term need for revision surgery and the complication rates are low. Surgery should be considered earlier in the treatment of posterior epistaxis.. Posterior epistaxis is common and surgical endoscopic ligation of the sphenopalatine arteries is indicated in severe cases. Knowledge about long-term effects and complications is sparse.. Within 2001-2006, 78 patients underwent endonasal endoscopic-guided surgery for posterior epistaxis in one of the eight ENT clinics in Denmark treating these patients. In 2011, 45 patients were still alive and eligible for the study. Patients were contacted by telephone and invited to complete an interview questionnaire on late adverse affects and recurrence.. In all, 42 of 45 patients participated in the mean follow-up. The mean follow-up was 6.7 years: 90% of patients (n = 38) obtained an effect of the treatment during follow-up; 78% (n = 33) had no recurrent epistaxis, 12% (n = 5) had recurrent epistaxis but only needed non-surgical specialized treatment; 10% (n = 4) required revision surgery due to recurrent epistaxis within the 6.7 mean years of follow-up; and 26% of the patients had minor postoperative complications, permanent nasal crusting being most persistent and frequent.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Arteries; Cohort Studies; Denmark; Endoscopy; Epistaxis; Female; Follow-Up Studies; Humans; Ligation; Male; Middle Aged; Nose; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Time Factors; Treatment Outcome; Young Adult

Topics: Antibodies, Monoclonal, Murine-Derived; Autoimmune Diseases; Diagnosis, Differential; Epistaxis; Female; Glucocorticoids; Humans; Immunologic Factors; Middle Aged; Mouth Mucosa; Nose; Oral Ulcer; Pemphigoid, Bullous; Prednisone; Rituximab; Vasculitis

Topics: Aged; Arteries; Diagnosis, Differential; Electrocoagulation; Emergencies; Epistaxis; Humans; Hypertension; Male; Nose

The management of traumatic epistaxis is an important issue for maxillofacial trauma patients, because of their frequency and severity. We assessed a single use sterile hemostatic gel matrix (surgiflo© [SF], Floseal © [FS]) available for this indication.. Ten patients were managed between 2008 and 2012 by the same surgeon. The following data was documented for each patient: gender, age, mechanism of trauma or type of surgery, characteristics of epistaxis, the various hemostatic techniques used before using SF, and its effectiveness. The primary endpoint was SF effectiveness compared with usual techniques. The secondary endpoint was the evaluation of patient comfort compared to other hemostatic methods, using a visual analogue scale (VAS).. In nine out of ten cases, epistaxis was controlled after endonasal instillation of SF after failure of wicking, or double balloon catheter in first line treatment, or use of SF directly as first line treatment. The mean post procedure VAS was: 7/10 for wicking (eight patients), 9.3/10 for the double balloon catheter (three patients), 3.2/10 for SF (ten patients).. Our study highlights the effectiveness of hemostatic gel matrix in the management of post-traumatic epistaxis compared to usual methods. It also pointed out better patient comfort. A prospective comparative study on a larger cohort of patient would support the legitimacy of SF as first-line treatment for severe posttraumatic epistaxis.

Topics: Adult; Epistaxis; Female; Gelatin Sponge, Absorbable; Gels; Hemostatic Techniques; Hemostatics; Humans; Male; Middle Aged; Nose; Pain, Postoperative; Patient Satisfaction; Severity of Illness Index; Young Adult

Injuries and illness to the ears, nose, and throat are frequently seen in the emergency department. The emergency medicine physician must be proficient in recognizing these injuries and their associated complications and be able to provide appropriate management. This article discusses the most common otorrhinolaringologic procedures in which emergency physicians must be proficient for rapid intervention to preserve function and avoid complications. A description of each procedure is discussed, as well as the indications, contraindications, equipment, technique and potential complications.

Topics: Anesthesia; Ear; Emergencies; Epistaxis; Foreign Bodies; Hematoma; Humans; Lacerations; Nose; Otorhinolaryngologic Diseases; Peritonsillar Abscess

The authors report a case of nasal malignant melanoma involving the septum, nasal turbinates and nasopharynx which was approached by lateral rhinotomy combined with an anterior transantral approach with excision of the septum and the lateral wall of the nasal cavity for wide exposure of the tumour. Using this technique complete surgical resection of a large nasal malignant melanoma was achieved with minimal morbidity and good aesthetics.

Topics: Aged; Epistaxis; Esthetics; Humans; Male; Maxillary Sinus; Melanoma; Nasal Cavity; Nasal Mucosa; Nasal Obstruction; Nasal Polyps; Nasal Septum; Nasopharyngeal Neoplasms; Nose; Nose Neoplasms; Sphenoid Sinus; Turbinates

To investigate common origins of intractable epistaxis, and the efficacy of endoscopic management.. Retrospective study of 265 patients with uncontrolled idiopathic epistaxis presenting between July 2008 and July 2009. Patients underwent endoscopic examination and subsequent radiofrequency electrocautery, selective packing or observation.. Nasal endoscopy indicated that the commonest bleeding sources were the superior nasal septum at the olfactory cleft (39.2 per cent), the inferior meatus (27.5 per cent), the sphenoethmoid recess (6.0 per cent), the middle meatus (5.3 per cent) and other locations (3.4 per cent). Bleeding was successfully controlled with nasal endoscopy plus radiofrequency electrocautery or selective packing. In 49 (18.5 per cent) patients, no abnormality was identified; these patients received observation only, and no further bleeding occurred. None of the patients had serious complications or recurrent epistaxis during the three-month follow-up period.. Thorough endoscopic examination combined with radiofrequency electrocautery should be used as first-line therapy for intractable epistaxis.

Topics: Adult; Aged; Aged, 80 and over; Anesthetics, Local; Catheter Ablation; Endoscopy; Epistaxis; Female; Hemostatic Techniques; Humans; Male; Middle Aged; Nose; Retrospective Studies; Tampons, Surgical; Treatment Outcome; Young Adult

Topics: Epistaxis; Equipment Design; Humans; Nose; Rhinoplasty; Surgical Flaps; Surgical Tape

The removal of hypophyseal tumor by transsphenoidal pituitary surgery using microsurgical instruments was first performed over 100 years ago. Operating techniques for this surgery are constantly being renewed, first by using a microscope and later on with the use of an endoscop. The authors provide an overview of the minimal invasive posterior transseptal-transsphenoidal aproach with the combined utilization of classical techniques with the assistance of the endoscop.. Sixty-one patients (33 female, 28 male, 21-84 yrs) were treated for sellar region tumor resection using an endonasal transsphenoidal aproach with the help of an endoscope. Follow ups were performed within 2-21 months.. Total tumor resection was successful in 91.8%, and partial resection in 8.2% of the patients. The rate of complications using the endoscopic method was not higher compared to that of the classical microscopic method. There was no major bleeding in any of the cases. Adverse events such as minor epistaxis occurred in 4.9%, transitional diabetes insipidus in 6.5%, inraoperative CSF leak in 16.67%, postoperative CSF leak in 11.5% and meningitis in 8.2% of the patients. After the operation the pathological hormonal production stoped in all patients except in two patients who were acromegalic. However their GH level normalized and they did not require further treatment, the IGF-1 still remained high.. The success of the surgical treatment is based on both, the proficient pre- and postoperative endocrinological care, and the minimal invasive surgical technique. The endoscope was used partially or continuously during the operation for better visualization of the operation field in multiple angles (30 degrees, 45 degrees). It was useful in differentiating between normal and tumorous glandular tissue, and also offered an enhanced view of the intrasellar (via hydroscopy) and parasellar region. Moreover the endoscopic method is able to decrease the operating time, reduce blood loss. In different stages of the surgery, depending on the anatomical and pathological situation, switching back and forth from microscope to endoscope technique, gives us the benefit of a clearer view in each situation.

Topics: Adult; Aged; Aged, 80 and over; Cerebrospinal Fluid Rhinorrhea; Diabetes Insipidus; Epistaxis; Female; Humans; Learning Curve; Male; Meningitis; Middle Aged; Neuroendoscopes; Neuroendoscopy; Nose; Pituitary Gland, Posterior; Pituitary Neoplasms; Sphenoid Sinus

Abstract Nasal foreign bodies may result from the abundant availability of tiny objects in our society and a curious child exploring his or her nasal cavities. An inserted object that is not witnessed or retrieved can remain relatively asymptomatic or cause local tissue damage and potentially yield more serious consequences. An unusual case of a young child who presented for dental rehabilitation under general anesthesia is described. Immediately prior to the nasotracheal intubation, an unanticipated foreign body was detected and safely removed before any injury occurred. This case report discusses the presentation and pathophysiology of nasal foreign bodies. Moreover, applicable suggestions are provided to aid in the prevention and management of the unexpected discovery of a nasal foreign body after the induction of general anesthesia.

Topics: Anesthesia, General; Child, Preschool; Epistaxis; Foreign Bodies; Foreign-Body Migration; Humans; Intubation, Intratracheal; Male; Nose; Suction

In our experience, the technique described can be applied independently according to the specific patient's anatomy and disease, allowing simple, easy, and safe identification of the anterior ethmoidal artery (AEA).. The aim of this study was to provide the anatomic rationale for endoscopic cauterization of the AEA and to present our surgical approach to AEA in the treatment of severe nasal bleeding.. A retrospective study reviewed 300 endoscopic transnasal AEA cauterizations, over a 20-year period from 1991 to July 2010, at the Instituto Felippu, Sao Paolo, Brazil. All surgeries were carried out under general anesthesia and with the help of a rigid 30° endoscope.. The AEA was identified in all the patients treated. In 299 patients we found the AEA located at the level of the horizontal portion of the frontal bone into the anterior ethmoidal canal; in 88 (29.4%) of these patients the canal bone was partially open and in 211 (70.6%) it was completely closed. In only one patient, we found a dehiscent AEA. No patients presented short-term failure and/or long-term failure.

Topics: Adult; Aged; Aged, 80 and over; Arteries; Electrocoagulation; Epistaxis; Female; Hemostasis, Endoscopic; Humans; Ligation; Male; Middle Aged; Nose; Retrospective Studies

Epistaxis is a common ear, nose, and throat emergency, and severe cases are traditionally controlled by the placement of anteroposterior nasal packing. In this article, a way of controlling severe epistaxis with the combination of two RapidRhino packs is described. Although not always successful, it is a technique that in the majority of patients can control severe bleeding faster, easier, with decreased pain, and increased patient comfort, compared to the traditional anteroposterior nasal packing.

Topics: Arteries; Balloon Occlusion; Endoscopy; Epistaxis; Female; Humans; Ligation; Male; Nose; Recurrence; Tampons, Surgical

Topics: Epistaxis; Hemostatic Techniques; Humans; Nose; Patient Simulation; Tampons, Surgical

This paper reports the case of a 50-year-old man who underwent superselective embolization after severe posterior rhinorrhagia caused by hypertension. Twelve hours after the procedure, left-sided hemiparesis and right-sided facial nerve paresis developed, followed by ulceration and necrosis of the soft palate, diaphragm, and right nasal ala. Reconstruction was implemented with porous polyethylene for the nasal pyramid, a forehead flap and a mucosal flap from the oral vestibulum for polyethylene coverage, and a rotational palatal flap for closure of the oroantral fistula. Exposure of the material occurred after 4 weeks, and removal was followed by satisfactory maintenance of the shape and function of the nose. Postembolization necrosis is a rare complication of the area, and there are very few similar reports in the literature.

Topics: Embolization, Therapeutic; Epistaxis; Facial Nerve Diseases; Facial Paralysis; Follow-Up Studies; Humans; Ischemia; Male; Maxillary Artery; Middle Aged; Mouth Mucosa; Necrosis; Nose; Nose Diseases; Oral Fistula; Palate, Soft; Paresis; Plastic Surgery Procedures; Polyethylene; Prosthesis Design; Prosthesis Implantation; Respiratory Tract Fistula; Skin Transplantation; Surgical Flaps

To test the hypothesis that potential sites of weakness within normal nasal arteries, when stressed, contribute to the mechanism of epistaxis, we 'stress-tested' nasal arteries in unfixed cadaveric heads, using pressure injection of feeding arteries.. Indian ink with latex was injected into maxillary arteries under high pressure (620 mmHg). Stepwise dissection was carried out and areas showing ink leakage were examined. Control heads were injected at standard embalming pressures (375 mmHg).. Ink leakage was found in all heads injected at higher pressure, and was restricted to the nasal mucosa. Histological examination of leakage points demonstrated vessel disruption consistent with dissecting aneurysm formation.. Results showed that high pressure injection caused leakage from arteries in the posterior nose; the distribution of leakage points was consistent with many clinical investigations. The lesions produced were comparable with our best histopathological model of epistaxis, i.e. dissecting aneurysm formation. This suggests that pre-existing weaknesses in the arterial configuration may exist.

Topics: Cadaver; Epistaxis; Humans; Injections, Intra-Arterial; Maxillary Artery; Nasal Cavity; Nose; Pressure

Topics: Animals; Epistaxis; Foreign Bodies; Male; Nose; Nose Diseases

Topics: Arteries; Epistaxis; Female; Humans; Middle Aged; Nose

Epistaxis is one of the commonest ENT emergencies. It affects people of all ages, more commonly males. Bleeding may be due to local nasal pathology, systemic diseases, or sometimes no specific cause is found, which is called idiopathic epistaxis. This descriptive study was designed to evaluate role of nasal endoscopy for diagnosis and management of epistaxis in a tertiary care hospital. Sixty-two selected patients with active epistaxis or with history of epistaxis within last 24 hours were evaluated and underwent nasal endoscopy. Patients were managed following standard protocols. This study demonstrated a bimodal distribution with incidence peaks in below 20 years and above 50 years age groups. Males were affected nearly twice commonly as females. Anterior nasal bleeding was noted in majority. Most common cause was found to be hypertension closely followedby trauma. Nasal endoscopy helped to localise bleeding points in majority of the cases. Cases were managed accurately with the help of endoscopes and any local disease was eradicated thoroughly. During follow-up, endoscopy helped in early detection of recurrences and thereby prevented complications. Epistaxis can be controlled very efficiently by electro or chemical cauterisation with the help of endoscopes, the source can be localised more efficiently. In cases of failure to localise or access of bleeding points, anterior and/or posterior nasal packing can control majority of nosebleeds. In majority of cases non-surgical interventions were sufficient.

Topics: Adult; Cautery; Electrocoagulation; Endoscopy; Epistaxis; Female; Humans; Hypertension; Male; Middle Aged; Nose; Nose Neoplasms; Young Adult

Topics: Anxiety; Endoscopes; Endoscopy, Digestive System; Epistaxis; Equipment Design; Humans; Mouth; Nose; Patient Satisfaction

Following a suggestion by ward patients that Rapid Rhino nasal packs may deflate over time, allowing recurrence of epistaxis, we aimed to demonstrate deflation of 7.5 cm Rapid Rhino packs when used in vivo for post-operative nasal packing.. The volume of air insufflated and retrieved from Rapid Rhino nasal packs used for post-operative nasal packing was recorded, as was the pressure following inflation and prior to removal. The time taken for the initial inflation pressure to stabilise was monitored in a number of packs. Similar pressure and volume measurements were repeated in a series of in vitro packs for comparison.. Fourteen consecutive patients undergoing septoplasty were recruited. High but unsteady pressure values were obtained in the first patient's packs. In the subsequent five patients, continuous pressure monitoring demonstrated that gradual depressurisation occurred over the first 16 to 22 minutes following inflation. A typical pressure was 35 cmH2O after inflating with 8 ml of air. Only one Rapid Rhino pack was demonstrated to leak air in vivo.. When used in vivo, Rapid Rhino nasal packs initially depressurise over a period of about 20 minutes. Actual leakage (deflation) was not demonstrated to be an expected feature of Rapid Rhino packs in this study.

Topics: Air Pressure; Epistaxis; Equipment Design; Hemostatics; Humans; Nose; Tampons, Surgical; Time Factors

In epistaxis, anterior bleeding points are easily cauterised under direct vision, but those which occur in the posterior nose present a greater challenge. Standard cautery techniques limit simultaneous use of other equipment in the narrow posterior nose.. This article presents a novel device which combines suction, cautery stick and sheath in one single-handed implement for ease of use.. This novel, hand-held device for simultaneous suction and safe cautery of posterior epistaxis is both safe and cost-effective. It enables successful treatment by a single operator and is relatively easy to use by the non-skilled, junior trainee.

Topics: Cautery; Epistaxis; Equipment Design; Humans; Nose; Nose Diseases; Suction; Treatment Outcome

Endoscopic coagulation of the sphenopalatine artery (SPA) is indicated in patients with recurrent or severe posterior epistaxis. The present work aimed at studying the effects of the sphenopalatine artery coagulation on the nasal seromucinous glands. The study was carried out on 30 patients who were scheduled for endoscopic SPA coagulation. All patients signed informed consents that were approved by the Committee of Medical Ethics. Minute punch biopsies were taken from the inferior turbinates, under local anesthesia, just before the procedure as well as 12 weeks and 1 year postoperatively. The biopsies were stained with hematoxylin and eosin and PAS Alcian blue. Histochemical examination was done for the activity of the succinic dehydrogenase, alkaline phosphatase and cholinesterase enzymes. Morphometric analysis as well as analysis of the histological and histochemical results showed that SPA coagulation was followed by an early decrease in the size, number and secretory activity of the nasal seromucinous glands, which was associated with decreased activity of the alkaline phosphatase enzyme in the endothelial cells of the nasal blood vessels and decreased activity of the cholinesterase enzyme in the cholinergic nerve fibers. These changes, however, were temporary and reversible since examination of the late postoperative biopsies, at 1 year, showed normalization of the number, appearance, and histochemical activity of the glandular acini as well as the surrounding blood vessels and cholinergic nerve fibers.

Topics: Adult; Alkaline Phosphatase; Cholinesterases; Epistaxis; Female; Hemostasis, Endoscopic; Histocytochemistry; Humans; Male; Middle Aged; Nasal Mucosa; Nose; Succinate Dehydrogenase

Topics: Adult; Animals; Ectoparasitic Infestations; Epistaxis; Humans; Leeches; Male; Nose

Topics: Adult; Biopsy; Carcinoma; Combined Modality Therapy; Endoscopy; Epistaxis; Facial Pain; Humans; Laryngoscopy; Male; Nasal Obstruction; Nose; Paranasal Sinus Neoplasms; Pharynx; Pressure

Topics: Catheterization; Epistaxis; Humans; Necrosis; Nose; Nose Deformities, Acquired; Pressure Ulcer

The objective of this study was to review the various clinical features associated with Wegener's granulomatosis (WG) in the head and neck region and to discuss the difficulty of diagnosing patients with early stage WG.. Between January 1998 and August 2007, WG was diagnosed and treated in 16 patients at the Department of Otolaryngology, Hyogo College of Medicine. Clinical and operating records of these patients were analyzed retrospectively. Diagnosis was based on the Japanese criteria proposed by the Japanese Ministry of Health and Welfare in 1998.. Ten patients (62.5%) had a definite diagnosis of WG, and the other six patients (37.5%) had a probable diagnosis of WG. The period from the onset to diagnosis was between 1 month and 30 years. The generalized form of WG was observed in three patients (18.8%), and the limited form of WG was observed in the other 13 patients (81.2%). Nasal, aural, and ophthalmic symptoms were initially presented in 10, 3, and 3 patients, respectively. Cytoplasmic pattern antineutrophil cytoplasmic antibodies (cANCAs) and perinuclear pattern ANCA (pANCA) were positively detected in 68.8% (11/16) and 27.2% (3/11) of the patients, respectively. Five of 14 patients (35.7%) had pathologic features of WG in biopsy samples from the head and neck region. Three patients in whom a diagnosis of WG was difficult are presented, and immediate lessons of our experience were discussed.. This study emphasized the difficulty of diagnosing WG, particularly at an early stage and when limited to the head and neck region. The biggest challenge faced in diagnosing WG is that it requires a high index of suspicion. When WG was suspected, we should obtain an accurate medical history from patients and repeat serologic and histopathologic examinations.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Aged; Antibodies, Antineutrophil Cytoplasmic; Blood Sedimentation; C-Reactive Protein; Cerebrospinal Fluid Otorrhea; Cranial Nerve Diseases; Dacryocystitis; Diplopia; Earache; Epistaxis; Exophthalmos; Female; Follow-Up Studies; Granulomatosis with Polyangiitis; Hearing Loss; Humans; Immunosuppressive Agents; Male; Middle Aged; Nasal Obstruction; Nose; Retrospective Studies; Scleritis; Tinnitus; Visual Acuity

Epistaxis is very common in children but its cause remains unknown. We postulate that nasal colonization with Staphylococcus aureus leads to inflammation, crusting, and ultimately new vessel formation.. A prospective case-control study.. Sixty-seven children were recruited, 42 with epistaxis (22 had crusting in the nasal vestibule; 20 did not) and 25 control subjects. A microbiology swab was taken from the anterior nasal cavity of each child.. All groups were equally likely to have a positive culture. S aureus was more common in the epistaxis group (P = 0.008) compared with the control group. There was no difference in the prevalence of S aureus between crust and noncrust groups. Epistaxis patients were much less likely to have isolates of respiratory pathogens or a skin commensal.. Children with epistaxis are more likely to have nasal colonization with S aureus than controls. Our data would support the hypothesis that S aureus replaces existing nasal flora and causes inflammation and new vessel formation.

Topics: Case-Control Studies; Child; Child, Preschool; Epistaxis; Humans; Male; Nose; Prospective Studies; Staphylococcus aureus

We postulated that epistaxis patients frequently have their nose packed in the accident and emergency department without any reasonable prior attempt at nasal assessment and nasal cautery.. Telephone survey of 104 accident and emergency departments.. A 100 per cent response rate was achieved. In all but one of the departments surveyed, first line management was carried out by accident and emergency doctors. Seventy-four per cent of accident and emergency doctors perform nasal cautery as first line management. Within accident and emergency departments, the availability and usage of head illumination, nasal speculums, topical anaesthesia and suction was grossly suboptimal. Only one-sixth of the accident and emergency doctors surveyed had received training in the management of epistaxis, whilst 81 per cent of accident and emergency departments would admit nasally packed patients under the ENT team.. Despite the majority of accident and emergency doctors claiming to attempt nasal cautery before packing, this is unlikely to be effective if performed without the correct equipment. Better training and equipment need to be provided to accident and emergency doctors in order to optimise the management of epistaxis patients. This could potentially reduce inappropriate admissions.

Topics: Cautery; Clinical Competence; Emergency Medicine; Epistaxis; Health Care Surveys; Hemostatic Techniques; Humans; Nose; Patient Care Management; Practice Patterns, Physicians'; Tampons, Surgical; Telephone

Topics: Epistaxis; Humans; Nose; Pressure; Treatment Outcome

We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform,fairly well tolerated, easily reversible, and highly effective.

Topics: Aged, 80 and over; Epistaxis; Humans; Male; Nose; Recurrence; Sutures; Time Factors

Teleangiectases are the source of hemorrhage in many HHT patients. Most frequent site of bleeding is the nose and more than 90% of all individuals with HHT suffer from recurrent epistaxis. Despite all efforts, treatment of epistaxis in HHT continues to be a problem for many otorhinolaryngologists, who can alleviate recurrent nosebleeds by Septodermoplasty or laser therapy, but rarely can stop nasal hemorrhages permanently. Recurrence is almost inevitable, but the mechanisms of recurrence are not fully understood.. Prior to routine Nd:YAG laser therapy of nasal telangiectases the nasal mucosa of 17 patients with HHT according to the clinical diagnostic criteria of the HHT Foundation International was examined with a 0 degrees contact rhinoscope in areas with clinically visible telangiectases as well as in clinically normal mucosa. The digitally recorded images were compared to findings of a group of five healthy volunteers and the findings of five patients with polypoid sinusitis.. Visualization of subepithelial vessels was feasible in all individuals of the study group as well as the control groups. Dilated vascular loops and tortuous vessels could be found in the study groups as well as in the control group, but the overall density of telangiectatic vessels was on an average higher in the HHT group. The process of vessel dilatation and tortuous configuration seemed to progress with age.. Contact endoscopy allows the investigation of the angioarchitecture of capillaries of the nasal mucosa in vivo. This observation may be of significance for studies of nasal diseases, which are accompanied by epistaxis. With this regard it seems to be of special interest for studies of HHT.

Topics: Adolescent; Adult; Aged; Child; Endoscopy; Epistaxis; Female; Humans; Laser Therapy; Male; Middle Aged; Nose; Recurrence; Telangiectasia, Hereditary Hemorrhagic

The melanomas are unusual tumours with a high mortality. The mucosal malignant melanoma type supposes loss than 1% of the total of melanoma. The initial symptoms are unspecific and the regional metastasis are rare. The surgical approach it's the most effective treatment complemented with radiotherapy and or chimiotherapy. We present the case of primary nasal mucosal malignant melanoma and review the litterature of this disease.

Topics: Aged; Biopsy; Combined Modality Therapy; Epistaxis; Female; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Maxillary Sinus Neoplasms; Melanoma; Nasal Obstruction; Nose; Nose Neoplasms; Prognosis; Tomography, X-Ray Computed

Topics: Epistaxis; Humans; Nose; Suction; Treatment Outcome

Topics: Child; Child, Preschool; Epistaxis; Female; Hot Temperature; Humans; Intubation, Intratracheal; Male; Nose

Topics: Body Weights and Measures; Child; Child, Preschool; Epistaxis; Humans; Intubation, Intratracheal; Larynx; Nose

Topics: Blood Coagulation; Epistaxis; Equipment Design; Equipment Failure; Humans; Nose; Suction

We present two cases where a large titanium implant has been used in nasal reconstruction without regard to the basic principles and current philosophy in reconstructive techniques. A full thickness nasal defect requires reconstruction with an inner lining, scaffolding and external skin. Autogenous grafts are preferable particularly when they are used for support or their insertion creates tension on the overlying soft tissue. We report serious complications that result from a disregard to these basic principles in two patients following the insertion of giant titanium nasal implants along with their management.

Topics: Adult; Epistaxis; Facies; Female; Humans; Middle Aged; Nose; Prostheses and Implants; Prosthesis Failure; Rhinoplasty; Titanium

Nasal packing is routinely performed by many surgeons following nasal surgery and is also frequently used for the treatment of epistaxis. The use of nasal packing, however, is sometimes associated with serious complications such as aspiration, bowel perforation, obstructive apnea, and hypoxia. This author has also once had the experience of losing a nasal pack during a procedure performed on a mentally impaired patient. If a nasal pack could be easily tracked by x-ray, treatment would be faster and easier. We now use x-ray indicators quilted into our nasal packs, which enable us to find the packs quickly and easily with plain x-ray film.

Topics: Epistaxis; Female; Humans; Male; Monitoring, Physiologic; Nose; Postoperative Care; Radiography; Rhinoplasty; Sensitivity and Specificity; Tampons, Surgical

Topics: Adult; Arteriovenous Fistula; Diagnosis, Differential; Endoscopy, Gastrointestinal; Epistaxis; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Nose; Postoperative Hemorrhage; Sphincterotomy, Endoscopic

Topics: Anti-Infective Agents, Local; Blood Cell Count; Cautery; Child; Chlorhexidine; Coagulants; Drug Combinations; Epistaxis; Humans; Male; Nasal Septum; Neomycin; Nose; Recurrence; Silver Nitrate

A 55-year-old Chinese woman presented with a 3-week history of unilateral left-sided epistaxis and nasal obstruction. She had swam in a freshwater stream 1 month prior to the onset of symptoms. Endoscopic examination revealed a live leech at the left middle meatus with a large part of its body inside the left maxillary antrum. Local anaesthetic was applied to anaesthetise the leech and facilitate removal. Magnetic resonance imaging performed following removal confirmed that no other leeches were present in the sinonasal area. The endoparasitism might have persisted because of the inconspicuous site of infestation and the absence of pain. This form of leech infestation has not been previously reported.

Topics: Animals; Epistaxis; Female; Humans; Leeches; Middle Aged; Nose; Rivers; Swimming

Topics: Aged; Anesthetics, Local; Animals; Child; Epistaxis; Female; Humans; Leeches; Lidocaine; Male; Nasal Obstruction; Nose

A swimmer's nose clip is a very useful adjunct when treating patients with spontaneous, anterior epistaxis. This clip is extremely efficient at providing constant, localised pressure over the bleeding vessel, in Little's area, and alleviates the need to pinch the nose. This allows for haemostasis to occur. This should alleviate the need for nasal packs and thus for admission into hospital. Any medical practitioner treating epistaxis patients can apply it.

Topics: Emergency Treatment; Epistaxis; Equipment Design; Hemostatic Techniques; Humans; Nose; Otolaryngology; Pressure; Referral and Consultation; Surgical Instruments; Swimming; Time Factors; Treatment Outcome

Foley's catheter is used for post-nasal packing in severe epistaxis. Various methods have been described for securing the catheter in position, all of which can be associated with patient discomfort, risk of alar necrosis or unsightliness. We describe a new method to secure the Foley's catheter without these problems. The ribbon gauze used for anterior nasal packing is tied over the catheter in multiple knots to secure it in place. This has been successfully tried on over 50 patients.

Topics: Acute Disease; Cartilage Diseases; Catheterization; Epistaxis; Hemostasis, Surgical; Humans; Necrosis; Nose

Nosebleeds from a break and/or obstructon can result in life-threatening problems. The nose is the airway opening that warms, humidifies and filters air. Control epistaxis with well-aimed direct pressure for 10-15 minutes. Nasal fractures, which are the most common facial fracture, can be the outward sign of skull fracture, brain injury or c-spine impairment, and may pose a threat to the airway and breathing. The greatest concern of a nose obstruction is aspiration.

Topics: Emergency Medical Services; Epistaxis; Fractures, Bone; Humans; Nose; Patient Care

To find if the presence of epistaxis after nasal trauma can be used to predict post-traumatic external nasal deformity or a symptomatic deviated nasal septum.. Retrospective analysis of all patients seen in the fractured nose clinic by the first author between 17 October 2003 and 27 February 2004. Presence of epistaxis, newly developed external nasal deformity, and the presence of a deviated nasal septum with new symptoms of nasal obstruction were noted.. A total of 139 patients were included in the study. Epistaxis following injury was noted in 106 (76%). Newly developed external nasal deformity was noted in 71 (51%), and 33 (24%) had a deviated nasal septum with new symptoms of nasal obstruction. Of the 106 patients with post-trauma epistaxis, 50 (67%) had newly developed external nasal deformity and of the 33 patients without post-traumatic epistaxis, 11 (33%) had nasal deformity (p<0.05). Post-trauma epistaxis was not associated with the presence of a newly symptomatic deviated septum (25% in patients with epistaxis after injury versus 18% if there was no epistaxis).. Presence of epistaxis after nasal trauma is associated with a statistically significant increase in external nasal deformity. However, one third of patients without epistaxis following nasal trauma also had external nasal deformity and hence all patients with a swollen nose after injury, irrespective of post-trauma epistaxis, still need to be referred to the fractured nose clinic.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Epistaxis; Female; Humans; Infant; Male; Middle Aged; Nasal Septum; Nose; Nose Deformities, Acquired; Retrospective Studies

We report the case of a 22-year-old male who presented a diferred, recurrent and severe epistaxis after nasal trauma which required several admissions in our hospital and different treatments. Concretely by chronological order it has been practiced anterior tamponades, endoscopic ligature-cauterization of the sphenopalatine artery, classic posterior packing and finally a new FENS with cauterization of anterior ethmoidal artery. Besides it was necessary a transfusion to go up the anemia suffered by the patient whose global stay was 16 days. Recurrent postraumatic epistaxis are very rare but can be represent a difficult problem to solve.

Topics: Adult; Embolization, Therapeutic; Epistaxis; Humans; Male; Nose; Recurrence; Severity of Illness Index; Wounds and Injuries

Anterior rhinoscopy with a Thudicum's or Killian's speculum is essential in the assessment and treatment of anterior epistaxis. A simple technique for visualization of the nasal septum is described which enables a two-handed approach to treatment and is achieved with materials readily available in the emergency department.

Topics: Cautery; Endoscopy; Epistaxis; Humans; Nose; Stents

To determine the outcomes for healthy children who require admission to hospital with acute epistaxis.. A 10-year retrospective review of admissions with acute epistaxis under the Otolaryngology Department in a tertiary pediatric centre was performed.. 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).. 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.

Topics: Acute Disease; Adolescent; Anti-Inflammatory Agents, Non-Steroidal; Aspirin; Child; Child, Preschool; Epistaxis; Female; Hospitalization; Humans; Infant; Length of Stay; Male; Nose; Patient Admission; Retrospective Studies

Epistaxis is a common complication in patients with hereditary hemorrhagic telangiectasia. Its treatment is generally aimed at controlling the frequency and severity of nasal hemorrhage and involves surgery, transcatheter embolization, topical treatment, or a combination. Despite this multitude of treatment methods, the long-term prognosis for many patients remains poor. We describe a patient in whom direct intralesional injections of bleomycin successfully palliated severe recurrent epistaxis for almost 2 years without the need for adjuvant therapy.

Topics: Anesthesia, General; Angiography, Digital Subtraction; Antimetabolites, Antineoplastic; Bleomycin; Dose-Response Relationship, Drug; Drug Administration Schedule; Epistaxis; Follow-Up Studies; Humans; Injections, Intralesional; Male; Middle Aged; Nose; Retreatment; Telangiectasia, Hereditary Hemorrhagic

A nasal septal abscess is usually the result of an infected hematoma of the septum. A secondary septal abscess may be the result of infections extending from any of the neighbouring tissues. The necrosis of septal cartilage may lead to nasal deformities and severe impairment of nasal patency and growth.. Assess if the drainage of the abscess and the immediate reconstruction of the destroyed nasal septum in the acute phase is the best treatment to prevent short- and long-term effect on nasal and midface growth.. Three pediatric patients treated with drainage and immediate implantation of homologous bank cartilage prior to 1990 and four treated with mosaic plastic using small pieces of residual septal cartilage assembled with fibrin glue.. No complication were observed in the follow-up and any deformities in the long-term controls.. The drainage and immediate reconstruction of the nasal septum are the golden standard in the treatment of the septum infected haematoma.

Topics: Abscess; Cartilage; Child; Child, Preschool; Drainage; Epistaxis; Female; Fever; Formaldehyde; Hemostatics; Humans; Male; Nasal Obstruction; Nasal Septum; Nose; Polyvinyl Alcohol; Transplantation, Homologous; Treatment Outcome

Topics: Controlled Clinical Trials as Topic; Double-Blind Method; Epistaxis; Formaldehyde; Hemostatics; Humans; Nose; Polyvinyl Alcohol; Postoperative Hemorrhage; Research Design; Tampons, Surgical

Topics: Adult; Aneurysm, False; Arteries; Embolization, Therapeutic; Epistaxis; Female; Humans; Male; Nasopharynx; Nose; Osteotomy, Le Fort; Postoperative Hemorrhage

Topics: Drainage; Epistaxis; Humans; Maxillary Sinus; Maxillary Sinusitis; Nose; Otorhinolaryngologic Surgical Procedures; Tampons, Surgical

The fashion of body piercing among adults has encouraged children to have similar procedures or imitate them by applying small magnets to sustain the jewelery used in piercing in position [Emerg. Med. J. 19 (2002) 71]. We present cases of children who have placed magnets on their nasal alae that became misplaced on to the nasal septum causing severe pain and in some cases nasal bleeding and septal perforation. We describe management of these cases.

Topics: Adolescent; Child; Epistaxis; Female; Foreign Bodies; Humans; Magnetics; Male; Nasal Obstruction; Nasal Septum; Nose; Pain; Surgical Instruments

We performed a study to confirm which risk factors are significantly associated with epistaxis during nasotracheal intubation. One hundred patients who underwent nasotracheal intubation were included. Risk factors for epistaxis were analysed using the multiple logistic regression analysis with stepwise variable selection method. Epistaxis was most likely to occur if transit of the tube through the nasal passage was difficult (P=0.0001, odds ratio 625, 95% confidence interval 3.14-14.26). On the other hand, age and gender, obesity, smoking, tube size, repeated attempts of intubation, and intubation performed with the aid of Magillforceps were not significantly related with risk of epistaxis. The presence of nasal anatomical abnormalities also did not correlate significantly with epistaxis. Strategies to ensure smooth transit of the tube through the nasal passageways are essential to reduce the incidence of epistaxis.

Topics: Adult; Epistaxis; Female; Humans; Intubation, Intratracheal; Logistic Models; Male; Nose; Odds Ratio; Risk Factors

Topics: Epistaxis; Humans; Intubation, Intratracheal; Nasal Septum; Nose; Preoperative Care

We studied 128 patients undergoing nasal intubation to see whether the nostril side used influenced peri-operative nasal complications. In the apparently normal nostril, there is no significant difference between either nostril in difficulty of intubation (p > 0.8). Similarly, there is no significant difference in the incidence of bleeding at intubation (p > 0.2), at extubation (p > 0.5) and once the patient has returned to recovery (p > 0.1). Postoperative nostril patency is also similar between groups (p > 0.85).

Topics: Adult; Chi-Square Distribution; Epistaxis; Female; Humans; Intraoperative Complications; Intubation, Intratracheal; Logistic Models; Male; Nasal Obstruction; Nose; Statistics, Nonparametric

Transnasal esophagoscopy (TNE), a new diagnostic technology, allows comprehensive, in-office examination of the esophagus without sedation.. To report the authors' experience using TNE.. Retrospective review of 100 consecutive patients undergoing TNE.. The most frequent indications for TNE were screening examination of the esophagus in reflux, globus, and/or dysphagia patients (n = 79), biopsy of a lesion in the laryngopharynx, trachea, or esophagus (n = 8), screening examination of the esophagus in head and neck cancer patients (n = 5), tracheoscopy and bronchoscopy (n = 4), and evaluation for an esophageal foreign body (n = 2). Four procedures were aborted secondary to a tight nasal vault. Significant findings were found in 44% (42/96). The most frequent findings were esophagitis (n = 19), Barrett's (n = 6), hiatal hernia (n = 4), and carcinoma (n = 5).. TNE is safe and well tolerated by patients with topical anesthesia alone. TNE may replace radiographic imaging of the esophagus in otolaryngology patients with reflux, globus, and dysphagia.

Topics: Anesthesia, Local; Biopsy; Conscious Sedation; Deglutition Disorders; Dilatation; Epistaxis; Equipment Design; Esophageal Diseases; Esophagitis, Peptic; Esophagoscopes; Esophagoscopy; Esophagus; Foreign Bodies; Head and Neck Neoplasms; Hernia, Hiatal; Humans; Mass Screening; Nose; Office Visits; Patient Selection; Retrospective Studies; Safety; Treatment Outcome

Embolization can play an important role in controlling epistaxis. However, one must be careful to avoid nontarget embolization via the dangerous anastomoses between the ECA branches, the carotid siphon, and ophthalmic arteries.

Topics: Adult; Aged; Aged, 80 and over; Angiography; Angiography, Digital Subtraction; Carotid Artery, Internal; Embolization, Therapeutic; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Recurrence; Retreatment

Topics: Catheterization; Cautery; Epistaxis; Formaldehyde; Hemostatic Techniques; Hemostatics; Humans; Nose; Polyvinyl Alcohol; Tampons, Surgical

We have introduced a method of securing a Foley's catheter in the nose, in the management of posterior epistaxis. Our method has the advantage of securing the catheter in situ, while maintaining traction on the balloon in the posterior nasal space and preventing nasal alar cartilage necrosis.

Topics: Cartilage; Cartilage Diseases; Catheterization; Epistaxis; Equipment Design; Humans; Necrosis; Nose

Topics: Child; Epistaxis; Fatal Outcome; Hemostatic Techniques; Humans; Necrosis; Nose; Precursor Cell Lymphoblastic Leukemia-Lymphoma

In patients with lesions of the cervical spine, direct laryngoscopy for endotracheal intubation entails the risk of injuring the spinal cord. In an attempt to avoid this complication, the authors used flexible fiberoptic nasal intubation in a series of 327 patients with cervical lesions undergoing elective neurosurgical procedures. The nasal route was preferred for laryngeal intubation because it is easier than the oral route and a restraining collar or halo device does not impair the intubating maneuver. Bronchoscopic intubation was possible in all patients. In 12 patients (3.6%), anatomic abnormalities prevented transnasal insertion of the endotracheal tube, and transoral fiberoptic intubation was necessary. Endotracheal intubation was graded as slightly difficult in 85 patients (26%). The minimal peripheral oxygen saturation during intubation exceeded 90% in 289 patients (88%). In the other 38 patients, the mean O2 saturation was 84.2+/-4.3% (range, 72-89%). Intubation was well tolerated by all patients and none had recall of the procedure. Cervical stabilizers did not have to be removed for intubation in any patient. None of the patients had postoperative neurologic deficits attributable to the intubation procedure. The authors consider fiberoptic transnasal intubation to be a useful alternative to direct laryngoscopic tracheal intubation in patients undergoing elective surgical procedures on the cervical spine to avoid potential injury to the cervical spinal cord.

Topics: Adolescent; Adult; Aged; Anesthetics, Intravenous; Anesthetics, Local; Braces; Bronchoscopes; Bronchoscopy; Cervical Vertebrae; Child; Elective Surgical Procedures; Epistaxis; Equipment Design; Female; Fiber Optic Technology; Humans; Intubation, Intratracheal; Laryngeal Masks; Male; Middle Aged; Mouth; Nose; Oxygen; Pliability; Respiration, Artificial; Spinal Cord Injuries; Spinal Diseases; Time Factors

In 42 endotracheally intubated patients, we examined the utility of a miniaturized monoplane probe for transnasal transesophageal echocardiography (TEE). Transnasal TEE was prospectively evaluated in 26 deeply and 16 mildly sedated patients receiving topical anesthesia with lidocaine jelly 2%. The patients with deep sedation were additionally examined with transoral monoplane and multiplane TEE. Transnasal esophageal insertion of the TEE probe was successfully performed in 90% of patients. Endotracheal malpositioning was corrected in two patients. Nasal bleeding required treatment in another patient. Topical anesthesia was adequate in 82% of mildly sedated patients. Left ventricular short- and four-chamber long-axis views of good quality were obtained with transnasal (transoral) monoplane TEE in 76% (81%) and 92% (96%) of patients (differences not significant). Compared with conventional multiplane TEE, transnasal monoplane TEE missed diagnoses in 19% of patients. The relative error (mean +/- SEM) of quantification with transnasal TEE was <9% +/- 2% for ventricular diameters and <7% +/- 2% for cross-sectional area measurements, with a bias of 0.5 +/- 3.8 cm2 and 0.1 +/- 2.4 cm2 (mean +/- 2 SD) for left ventricular end-diastolic and end-systolic short-axis areas. The relative error in measuring intracardiac flow velocities was >40%, but systolic to diastolic peak velocity ratios at the valvular site were determined with an error <4% +/- 3%. Transnasal monoplane TEE can be performed even in mildly sedated patients with an endotracheal tube without further need for analgesia or sedation. The technique is as useful as conventional transoral TEE to image standard tomographic planes for quantification, but it is less suited for comprehensive echocardiographic diagnosing.. Transnasal insertion of a miniaturized monoplane transesophageal echocardiography (TEE) probe was studied in endotracheally intubated patients. Nasal passage was well tolerated even by patients with only mild sedation. Imaging quality was similar to conventional transoral monoplane TEE with larger transducers, but technical restraints cause a deficit in complete cardiac diagnosing obtained with multiplane TEE.

Topics: Anatomy, Cross-Sectional; Anesthesia, Intravenous; Anesthesia, Local; Anesthetics, Local; Bias; Blood Flow Velocity; Cardiac Output; Echocardiography; Echocardiography, Transesophageal; Epistaxis; Equipment Design; Female; Heart Valves; Humans; Hypnotics and Sedatives; Intubation, Intratracheal; Lidocaine; Male; Middle Aged; Miniaturization; Nose; Prospective Studies; Respiration, Artificial; Sensitivity and Specificity; Transducers; Ventricular Function, Left

Topics: Adult; Amyloidosis; Biopsy; Ear Canal; Epistaxis; Female; Humans; Larynx; Male; Middle Aged; Nasopharynx; Nose; Otitis Media; Otorhinolaryngologic Diseases; Tomography, X-Ray Computed

Epistaxis is a common and difficult problem to manage in patients with bleeding disorders. We present a case of recurrent epistaxis in a patient with Bernard-Soulier syndrome (a platelet disorder) and describe a non-invasive but effective method of closing the nasal vestibule using a silastic obturator thus preventing the drying effects of airflow on the nasal mucosa which may precipitate epistaxis in patients with a bleeding diathesis.

Topics: Adult; Bernard-Soulier Syndrome; Epistaxis; Humans; Male; Nose; Prostheses and Implants; Prosthesis Design; Recurrence; Treatment Outcome

Topics: Adult; Athletic Injuries; Epistaxis; Female; Humans; Nose; Platelet Count; Purpura, Thrombocytopenic, Idiopathic; Recurrence

The present study comprises 300 cases of epistaxis. The analysis of these cases revealed a higher incidence in young males. Unilateral bleeding was seen in almost 60% each of indoor and outdoor cases. Litte's area was the most common site responsible for epistaxis in 28.8% of the indoor and 26.2% of the outdoor patients. Hypertension was the most common systemic cause among indoor patients (62.2%) and sickle cell disorder among the outdoor patients (37.5%). Atrophic rhinitis with myiasis was the local cause of epistaxis in maximum (27%) of the indoor patients and traumatic epistaxis was the commonest cause (33%) among outdoor patients-fingernail trauma in 75.9% of them. Idiopathic epistaxis contributed for 16.5% indoor and 26.1% of outdoor cases. Intractable epistaxis was seen in one case following accidental facial trauma.

Topics: Adolescent; Adult; Child; Diagnosis, Differential; Epistaxis; Facial Injuries; Female; Hematologic Diseases; Humans; Hypertension; Incidence; India; Male; Neoplasms; Nose; Prospective Studies; Retrospective Studies; Rhinitis, Atrophic

Angiography with selective embolization has become an accepted method of treating posterior epistaxis that is not controlled with conservative measures. The authors reviewed 112 cases of patients who had received selective angiographic embolization for refractory epistaxis from January 1990 to December 1995. There were 114 embolizations over this 5-year period. The immediate success rate was 93%, with long-term success achieved in 88% of patients. The overall complication rate was 17%, with the long-term morbidity rate less than 1%. Selective angiographic embolization is a safe and effective method that should be considered in the treatment of refractory epistaxis.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angiography; Brain Ischemia; Catheterization, Peripheral; Embolization, Therapeutic; Epistaxis; Female; Follow-Up Studies; Hemiplegia; Humans; Length of Stay; Longitudinal Studies; Male; Maxillary Artery; Middle Aged; Nose; Palate; Polyvinyl Alcohol; Recurrence; Retreatment; Risk Factors; Safety; Sphenoid Bone; Treatment Outcome

Topics: Aged; Endoscopy; Epistaxis; Ethmoid Sinusitis; Follow-Up Studies; Humans; Ligation; Male; Maxillary Artery; Maxillary Sinusitis; Nose; Palate; Sphenoid Sinus

The rigid nasal endoscope was used through a transseptal approach to reach the sphenopalatine foramen and to ligate its artery in 9 patients with intractable posterior epistaxis. Immediate and complete cessation of the bleeding uniformly occurred, except in 1 case, in which there was persistent bleeding on endoscopic examination of the nasal cavity at the end of the procedure. The ligature was checked and the artery was reclipped. Thereafter, the patient's recovery was uncomplicated and free of further epistaxis. Endoscopic transseptal sphenopalatine artery ligation offers a reliable option in the treatment of intractable posterior epistaxis. The submucoperiosteal dissection reduces bleeding, shortens operation time, and allows relatively easy identification of the sphenopalatine foramen. The procedure allows direct positive control of the major vessel supplying the posterior nasal cavity. It avoids the complications associated with transantral and pterygopalatine fossa surgery.

Topics: Aged; Endoscopy; Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Medical Illustration; Middle Aged; Nose; Treatment Outcome

Malignant neoplasms of the nasal cavity and paranasal sinuses are uncommon. Choriocarcinoma is a highly malignant germ cell tumour occurring in the reproductive organs. Metastasis may be principally by the lymphatic route as in other germ cell tumours but choriocarcinoma is also known to spread haematogenously. We present a rare case of metastatic choriocarcinoma to the nasal cavity from testicular teratoma presenting with intractable epistaxis in a 32-year-old Caucasian male, who ultimately succumbed to this disease.

Topics: Adult; Choriocarcinoma; Epistaxis; Fatal Outcome; Humans; Male; Nose; Nose Neoplasms; Paranasal Sinuses; Skin Neoplasms; Testicular Neoplasms; Tomography, X-Ray Computed

Topics: Angiofibroma; Diagnosis, Differential; Epistaxis; Female; Humans; Middle Aged; Nasal Polyps; Nasopharynx; Nose; Nose Neoplasms; Paranasal Sinus Neoplasms; Paranasal Sinuses

Topics: Accidents, Traffic; Alcoholic Intoxication; Anesthesia, Local; Cerebrospinal Fluid Rhinorrhea; Child; Contusions; Ecchymosis; Edema; Epistaxis; Frontal Bone; Hematoma; Humans; Nasal Bone; Nasal Septum; Nose; Orbital Fractures; Skull Fractures; Violence

Topics: Epistaxis; Female; Heart Valve Prosthesis; Hemorrhagic Disorders; Humans; Middle Aged; Mitral Valve; Nose; Postoperative Hemorrhage; Thermometers; Tricuspid Valve

Topics: Arteries; Electrocoagulation; Epistaxis; Humans; Ligation; Nasal Septum; Nose; Recurrence; Rhinoplasty; Tampons, Surgical

Authors describe a controlling device in a nasal haemorrhage which has been accepted as the registered model No: PL 52469-Y1. The presented device has been applied in many cases of nasal haemorrhage in patients in First Department of Laryngology of the Silesian University School of Medicine in Katowice.

Topics: Epistaxis; Equipment Design; Humans; Nose

Epistaxis and tubal obstruction in the subglottic region are difficulties encountered during nasotracheal intubation. Trauma to the nasal airway must be avoided, especially in patients receiving anticoagulant therapy. In addition, smooth passage of the tracheal tube through the larynx is desired. The tip of an Airguide tracheal tube system has a soft, round, glossy balloon head which should be less traumatic to the nasal mucosa than other more commonly used tubes. We, therefore, determined whether the Airguide reduces the incidence of epistaxis and increases smooth passage of the tracheal tube in the subglottic region during nasotracheal intubation. Sixty-six patients were divided into two groups, Airguide (n = 39) and Standard (n = 27). Each group was divided into two subgroups, topical epinephrine application as a mucosal decongestant and non-epinephrine. The incidences of epistaxis and smooth passage were compared between the two groups. The Airguide group had a significantly lower incidence of epistaxis (9/39 vs 13/26; P < 0.05; bleeding was not checked in one patient in the Standard group) and provided a significantly smoother passage in the subglottic region than the Standard group (tube impingement in the subglottic region, 0/39 vs 11/27; P < 0.01). There was no significant difference in the incidence of epistaxis between the subgroups with and without topical application of epinephrine. The Airguide helps to minimize epistaxis and increases navigability in the subglottic region during nasotracheal intubation.

Topics: Epistaxis; Equipment Design; Female; Humans; Incidence; Intubation, Intratracheal; Male; Nose

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.

Topics: Adult; Aged; Endoscopy; Epistaxis; Female; Humans; Male; Middle Aged; Nose

Functional endonasal sinus surgery (FESS) is becoming the procedure of choice for the surgical treatment of chronic and recurrent sinusitis in adults and children. Retrospective analysis of the charts of 513 adult and 260 pediatric patients who underwent FESS after failing to respond to optimal medical treatment revealed an improvement rate of approximately 80% for both age groups. Although high response rates and low complication rates were found for both groups, there were significant differences in indications, preoperative evaluation, operative technique, and methods of postoperative follow-up for children.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Chronic Disease; Endoscopes; Epistaxis; Female; Follow-Up Studies; Humans; Infant; Male; Middle Aged; Nose; Postoperative Complications; Radiography; Recurrence; Reoperation; Retrospective Studies; Sinusitis; Surgical Instruments; Tissue Adhesions

Topics: Angiography; Embolization, Therapeutic; Epistaxis; Humans; Nose

A case-control study on cancer of the nose and paranasal sinuses, and several risk factors including previous nasal diseases and symptoms, was performed in France from January 1986 through February 1988. The frequency of previous nasal diseases and symptoms was analyzed by histologic type of cancer. Different results were observed for squamous cell carcinomas and adenocarcinomas. In men, there were statistically significant associations between squamous cell carcinomas and sinusitis, bleeding from the nose, polyps, rhinitis, and trauma to the nose; and between adenocarcinomas, bleeding from the nose, and rhinitis. In women, there was an association between squamous cell carcinomas and nasal polyps.

Topics: Adenocarcinoma; Aged; Carcinoma, Squamous Cell; Case-Control Studies; Epistaxis; Female; France; Humans; Male; Middle Aged; Nasal Polyps; Nose; Nose Diseases; Nose Neoplasms; Paranasal Sinus Neoplasms; Rhinitis; Risk Factors; Sex Factors; Sinusitis; Time Factors

Topics: Aged; Arteries; Epistaxis; Humans; Ligation; Male; Maxillary Artery; Methods; Middle Aged; Nose

Despite there being a wide range of different epistaxis balloons their mode of action is unknown. Manufacturers' drawings depict balloons neatly filling the nasal cavity or precisely occluding the anterior and posterior nasal apertures. In view of the complexity of nasal internal anatomy these explanations seem unlikely. A better understanding of the configuration of these devices within the human nasal cavity may explain their mode of action and complications. This study aimed to delineate radiographically the configuration of 3 commonly used balloons within the noses of 4 human cadavers and to observe the effects of alterations in inflation volumes. The results showed that devices designed to fill the nasal cavity do not achieve this aim. Balloons do not conform to the contours of the nasal cavity but expand along pathways of least resistance and prolapse into the nasopharynx. The findings may explain the occurrence of complications such as headache and Eustachian tube obstruction. Accurate nasal tamponade is unlikely to be their true mode of action. These devices probably work by a combination of factors rather than as a result of specific design features. The possibility of rational design modifications is discussed.

Topics: Balloon Occlusion; Catheterization; Epistaxis; Evaluation Studies as Topic; Female; Humans; Male; Nose; Radiography

Bismuth subnitrate, one of the constituents of BIPP is known to cause methaemoglobinaemia. Ten patients had blood estimations for methaemoglobin levels before and after nasal packing with BIPP impregnated gauze. Only one patient exhibited abnormal levels of methaemoglobin and this was most probably the result of the large quantity of BIPP used. It is unlikely that significant methaemoglobinaemia occurs during the routine use of BIPP in the nose.

Topics: Administration, Intranasal; Adolescent; Bandages; Bismuth; Drug Combinations; Epistaxis; Humans; Hydrocarbons, Iodinated; Male; Methemoglobinemia; Nose

When interruption of the related arteries fails to control epistaxis, angiography is recommended for identification of the vascular base, the collateral circulation, and the possibility of arterial abnormalities. Criteria are proposed for utilization of vascular mapping, and relevant cases are cited to support the specific indications for application.

Topics: Aged; Angiography; Carotid Arteries; Collateral Circulation; Constriction, Pathologic; Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Ophthalmic Artery

A 69-year-old male patient with hereditary hemorrhagic telangiectasia presented with severe epistaxis requiring repeated transfusions. Both nasal passages were densely populated with these vascular malformations that involved the entire nasal mucosa. A total rhinotomy was performed and all the nasal mucosa and turbinates were excised. Both nasal passages were completely resurfaced with a free radial forearm skin flap. The vascular pedicle was delivered from the nasal passage via the maxillary antrum to anastomose with the facial vessels in the cheek. Following surgery the patient had no further significant epistaxis.

Topics: Aged; Epistaxis; Humans; Male; Nose; Surgical Flaps; Telangiectasia, Hereditary Hemorrhagic

This procedure, used since some years because of its easy application and effectiveness, is spreading nowadays in the management of posterior epistaxis either in primary assistance centers or specialized. The method is actually advantageous in polytrauma, chronic bronchitis patients or in some postoperative cases. Nevertheless the device should close controlled in order to prevent injuries of the nose structures.

Topics: Balloon Occlusion; Catheterization; Epistaxis; Humans; Nose; Tampons, Surgical

A 75-year-old man with obstructive sleep apnea and secondary right heart failure was started on nasal CPAP therapy. Shortly thereafter he experienced massive life-threatening epistaxis requiring nasal packing and hospitalization. The epistaxis was thought to be due to the drying effect of nasal CPAP.

Topics: Aged; Epistaxis; Humans; Humidity; Male; Nose; Positive-Pressure Respiration; Sleep Apnea Syndromes

Internal maxillary artery ligation is effective in treating epistaxis. Occasionally a patient may continue to hemorrhage after this procedure. Evaluation of postoperative angiograms reveals several factors accounting for the failure of internal maxillary artery ligation. These factors include incomplete ligation of vessels, alternative dominance of vessels, and reconstitution of flow through collaterals. Eleven such patients have been successfully treated with angiography and embolization. There was one complication of skin slough in the region of the columella. Embolization is a useful modality in the management of these difficult cases.

Topics: Adult; Aged; Angiography; Embolization, Therapeutic; Epistaxis; Female; Humans; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Recurrence

Presentation of a simple and cheap method for treating posterior Epistaxis with Foley's catheter. The paper recalls and analyzes the facts concerning 235 cases admitted and treated in the ENA Service of the Hospital Virgen del Camino, Pamplona, all patients coming from the emergency Unit, between 1983 and 1986.

Topics: Catheterization; Epistaxis; Humans; Nose

One hundred twenty-eight patients have undergone nasal/sinus operations using endoscopes and the KTP/532 laser. The pathologic processes have included turbinate dysfunction, nasal ethmoid polyps, hereditary hemorrhagic telangiectasia, granulomatous disease (sarcoid), nasal granulation secondary to cocaine abuse, and nasal papilloma. Early follow-up indicates rapid healing with minimal crusting, edema, scar formation, and complications and good resolution of disease.

Topics: Endoscopy; Epistaxis; Humans; Laser Therapy; Nose; Nose Diseases; Paranasal Sinus Diseases; Paranasal Sinuses; Turbinates

Percutaneous embolization to control the nasal blood circulation was used in 19 patients with vascular nasal disorders. Embolization was the initial treatment for intractable posterior epistaxis in 11 patients, 9 (82%) of whom were controlled without further treatment. Used as an adjunct to surgery on vascular nasal tumors, embolization reduced intraoperative blood loss in four patients to an average of 800 cc. In four patients with Osler-Weber-Rendu disease, treatment with embolization did not significantly alter the course of their disease. Overall, however, this relatively new technique enhances successful management of difficult epistaxis cases.

Topics: Embolization, Therapeutic; Epistaxis; Histiocytoma, Benign Fibrous; Humans; Nose; Nose Neoplasms; Punctures; Telangiectasia, Hereditary Hemorrhagic

Nosebleed in children can result from dryness and picking of the resultant crust over the anterior part of the nasal septum, trauma to the nose, juvenile angiofibroma, or disorders of hemostatic mechanisms. In most cases it is not difficult to treat; often the primary care physician can assist a patient by giving instructions over the telephone to a parent. In the office or hospital, the usual measures are firm pressure, placement of a piece of cotton dipped in a cocaine-epinephrine solution, taking of a brief history, application of petrolatum, and taping of the nose. If bleeding persists, anterior nasal packing and, rarely, posterior packing should be performed. Maxillary artery ligation is done in cases of severe epistaxis. Special care must be taken with children who have a bleeding disorder or who are recovering from adenoidectomy.

Topics: Adenoidectomy; Blood Coagulation Disorders; Child; Epistaxis; Hemostatic Techniques; Histiocytoma, Benign Fibrous; Humans; Nasal Cavity; Nose; Nose Neoplasms; Postoperative Complications; Referral and Consultation

Epistaxis is a problem that is commonly seen by emergency physicians. Its complete evaluation requires an understanding of the anatomy in addition to the various etiologies, including mechanical, traumatic, hematologic, cardiovascular, inflammatory, and congenital causes. Although the management of epistaxis will vary according to the cause, the basic principles of hemostasis and packing are emphasized. In cases in which the bleeding cannot be controlled.

Topics: Emergencies; Epistaxis; Humans; Nose

Epistaxis was diagnosed in 10 patients with apparent upper gastrointestinal bleeding, comprising a 0.55% incidence of hematemesis and melena in the population studied. A sufficient amount of blood can be swallowed during epistaxis to cause hematemesis and melena. Recent facial trauma or epistaxis, absence of a history of chronic dyspepsia, and impairment of blood coagulation emerge as strong indicators of the diagnosis and should lead to a careful examination of the nose and nasopharynx for the source of bleeding.

Topics: Adult; Aged; Diagnosis, Differential; Epistaxis; Female; Gastrointestinal Hemorrhage; Hematemesis; Humans; Male; Melena; Middle Aged; Nose

Topics: Child, Preschool; Epistaxis; Foreign Bodies; Humans; Male; Nose; Radiography

The greater palatine foramen extends in a posterosuperior direction at an angle of 60-80 degrees from the horizontal plane of the hard palate. A needle can be inserted 22-25 mm without the risk of intracranial or intraorbital injection. Sixty-one patients with posterior epistaxis were treated by greater palatine canal injection of either xylocaine 1% without epinephrine (34 cases) or sterile water (27 cases). There were no serious complications. Effective hemostasis was obtained immediately in 55 cases. Recurrent bleeding occurred in 22 cases, all of which responded to repeat injections.

Topics: Adult; Aged; Arteries; Epistaxis; Female; Hemostatic Techniques; Humans; Injections; Length of Stay; Lidocaine; Ligation; Male; Middle Aged; Nose; Palate; Recurrence

Topics: Airway Obstruction; Child; Ear; Emergencies; Epistaxis; Foreign Bodies; Humans; Nose; Tracheostomy

Topics: Aged; Epistaxis; Female; Humans; Leeches; Nose

For the past 25 years we have been able to control severe epistaxis in all patients by an intranasal procedure. If the source of bleeding in patients with epistaxis from the upper part of the nose cannot be seen during the acute phase, a combined anterior-posterior nasal pack is inserted and left in place for three days. Should bleeding persist or recur after removal of the packing we resect the superior nasal septum to expose the bleeding point in the anterior area of the cribriform plate. Cauterization at this site is not safe because of the risk of CSF rhinorrhea, and it is not always successful, as the main blood supply to the ethmoidal arteries stems from the internal carotid artery. Cauterization of the anterior or posterior ethmoidal arteries within the bony canal of the ethmoidal sinus (after partial ethmoidectomy) is always successful. Ligation or embolization of the carotid arteries is indicated only for tumour patients. Intranasal ethmoidal microsurgery requires much practice and preliminary experience on at least 50 cadavers. In 25 years with an annual load of about 180 ethmoidal sinus surgery cases we have never had serious complications such as cerebrospinal fluid rhinorrhea or persisting optical disturbances in more than 4,000 operations. During 1984 at the Krupp Hospital we used the intranasal microsurgical approach for all patients with septal, ethmoidal sinus and lacrimal duct pathology, for 98% of cases requiring maxillary sinus procedures and for 82% of patients with frontal sinus problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Arteries; Dacryocystorhinostomy; Electrocoagulation; Endoscopy; Epistaxis; Ethmoid Bone; Frontal Sinus; Humans; Hypotension, Controlled; Maxillary Sinus; Microsurgery; Nose; Postoperative Complications; Prostheses and Implants

Topics: Epistaxis; Gelatin; Gelatin Sponge, Absorbable; Humans; Nose; Tampons, Surgical

A brief review of surgery for severe posterior epistaxis has been outlined. Hundred and forty-five (27.3%) patients were treated by transnasal microsurgery in order to undergo ligation of the branches of the sphenopalatine artery in the nasal cavity. The rate of failure was 6.1%. It seems that by using this kind of operation, we can significantly decrease the morbidity in relation to other methods of controlling the posterior epistaxis.

Topics: Acute Disease; Arteries; Epistaxis; Humans; Ligation; Microsurgery; Nose

Trauma is the most common problem involving the nose in sports and athletic events. Injury may lead to "vasomotor syndrome" and chronic rhinitis. Nasal and sinus obstruction may cause additional discomfort. Exposure to irritants, particularly solvents, cleaning solutions, paints, and varnishes as well as air pollutants exacerbates vasomotor rhinitis. Allergic rhinitis is another major problem of atopic athletes. It may be caused by exposure to pollens, molds, dust, or animal danders. Treatment is aimed at reducing the exposure to etiologic factors as well as pharmacologic management. Antihistamines, topical cromolyn, and topical steroids may be used to control rhinitis without violating " antidoping " regulations.

Topics: Allergens; Basophils; Cold Temperature; Epinephrine; Epistaxis; Headache; Histamine H1 Antagonists; Humans; Mast Cells; Methacholine Chloride; Methacholine Compounds; Nose; Rhinitis, Allergic, Perennial; Sinusitis; Sports

Topics: Blood Coagulation; Epistaxis; Hemostatic Techniques; Humans; Nose

Topics: Arteries; Combined Modality Therapy; Embolization, Therapeutic; Epistaxis; Humans; Nose

Topics: Epistaxis; Humans; Nasal Mucosa; Nose

The nasal cavity and sinus system is extensive but its examination is limited. Listening to breathing and respiration can afford useful clues to underlying abnormality. Examination of the nasal cavity may reveal the pale swollen mucosa of allergic rhinitis or the overdeveloped lining seen in perennial rhinorrhoea and hypertropic rhinitis. Localised hypertrophy gives rise to the nasal polyp which usually forms in the region of the ethmoid sinus. Atrophic rhinitis is a destructive condition of the nasal lining. Sinusitis may be open or closed, presenting with localised pain and displacement of the eye in the case of frontal or ethmoidal abscess or mucocoele. Deformities of the external nose or nasal septum are often encountered during examination. Epistaxis may be caused by bleeding simply from Kiesselbach's vessels, or may be an early feature of telangiectasia or cardiovascular diseases. Tumors are rarely found but include papillomata and the mucous membrane melanoma.

Topics: Aerospace Medicine; Barotrauma; Epistaxis; Humans; Nose; Nose Diseases; Nose Neoplasms; Otitis; Rhinitis; Sinusitis

Augmentation rhinoplasty has become a popular plastic operation in Asia. In Korea most surgeons prefer using silicone rubber prosthesis instead of autogenous material. The authors have used the standard shaped silicone prosthesis, boat-shaped and also L-shaped prostheses. The standard shape prosthesis has less extrusion and fixation problems. In over 1,500 cases, there were 357 complications (20.8%). All the complications were due to the silicone prosthesis acting as a foreign body or failure in design of implant or unskillful operative technique. In order to minimise complications, care should be taken to use the proper size of prosthesis, the correct shape of implant and to ensure that there is adequate undermining and meticulous closure technique. To minimise the overlying skin tension at the tip and on the dorsum of the nose, the cutting of the depressor septi nasi muscle and transverse part of the nasalis muscle are recommended. In this review, we report the types and incidence of complications by analysing the cases seen during the past 10 years in our Unit and offer a few solutions to overcome these complications.

Topics: Asian People; Cerebrospinal Fluid Rhinorrhea; Enterobacteriaceae Infections; Epistaxis; Erythema; Humans; Korea; Nose; Postoperative Complications; Prostheses and Implants; Rhinoplasty; Serratia marcescens; Silicone Elastomers; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Time Factors

Topics: Adult; Anesthesia, Dental; Anesthesia, General; Epistaxis; Female; Humans; Intubation, Intratracheal; Nose; Turbinates

Topics: Ear Diseases; Ear, External; Epistaxis; Humans; Intubation, Intratracheal; Laryngectomy; Nose; Tampons, Surgical; Therapeutic Irrigation; Tracheotomy

Topics: Adolescent; Child; Child, Preschool; Epistaxis; Hemorrhagic Disorders; Humans; Nasal Mucosa; Nose; Respiratory Tract Infections

Topics: Aged; Arteries; Electrocoagulation; Epistaxis; Hemostatic Techniques; Humans; Male; Nose

Topics: Cautery; Electrocoagulation; Epistaxis; Hospitalization; Humans; Nose

Selective carotid arteriography can provide useful information in patients with massive epistaxis. It is limited in application because special techniques and preparation are necessary. Careful selection of patients is mandatory. It is not appropriate as a screening procedure for all patients with epistaxis. The procedure is especially useful when previous surgical control of the bleeding site has failed. Residual branches of the internal maxillary and ethmoid arteries are readily identified. The development of collateral blood flow to the nasal area from many sources can be recognized. The complexity of collateral blood flow emphasizes the necessity for controlling hemorrhage as close to the source as possible. At the same time, it suggests that long-term control of bleeding in the nasal area may fail due to this vast network of vessels.

Topics: Adolescent; Aged; Carotid Arteries; Collateral Circulation; Epistaxis; Female; Humans; Male; Middle Aged; Nose; Radiography

233 cases with posterior nasal pack are compared, two third being treated with Foley catheter technique. Using the Bellocq technique there are 47% of bleeding at intervals and 9% of bleeding while using the Foley catheter. Local and general complications are 3.5 times higher in Bellocq technique than in Foley catheter use.

Topics: Catheterization; Epistaxis; Female; Hemostatic Techniques; Humans; Male; Nose; Tampons, Surgical

Topics: Angiography; Embolization, Therapeutic; Epistaxis; Humans; Nose

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Chronic Disease; Epistaxis; Hemorrhagic Disorders; Humans; Nose; Respiratory Tract Infections; Sweden

The authors examined blood pO2 and pCO2 in patients whose noses had been tamponaded because of epistaxis, nasal surgery and in animals whose noses had been artificially obstructed. A marked fall of pO2 and an increase of pCO2 were found as well as certain differences of the gas quantities between the first and second groups of patients. For this phenomenon an explanation is given.

Topics: Adult; Aged; Airway Obstruction; Animals; Carbon Dioxide; Dogs; Epistaxis; Female; Hemostasis; Humans; Male; Middle Aged; Nose; Oxygen; Tampons, Surgical

Unremitting severe nose bleeds may require arterial ligation. One or more of the four vascular systems supplying the nose may need such surgical interference. Dye injection of 14 cadavers was performed to demonstrate the vascular supply of the nose and the effects of various arterial ligations. Depending upon the site of haemorrhage within the nose, up to three vascular systems may need occlusion. These are the ipsilateral and contralateral external carotid arterial systems and the ipsilateral ethmoidal arteries.

Topics: Aged; Carotid Arteries; Carotid Artery, External; Carotid Artery, Internal; Coloring Agents; Epistaxis; Humans; Ligation; Nose

Potentially life threatening self-mutilation of the nose in a patient with a severe passive aggressive character disorder is described. The phenomenological and psychodynamic features of this case are contrasted with those of schizophrenia and factitious dermatoses with similar excoriations.

Topics: Adult; Epistaxis; Humans; Male; Nose; Nose Deformities, Acquired; Passive-Aggressive Personality Disorder; Self Mutilation; Suicide, Attempted

Topics: Adult; Craniocerebral Trauma; Emergencies; Epistaxis; Eye Injuries; Facial Injuries; Female; Foreign Bodies; Humans; Larynx; Male; Nasopharynx; Neck Injuries; Nose; Nose Deformities, Acquired; Paranasal Sinuses; Skull Fractures; Tongue; Trachea

Topics: Adult; Anesthesia, Local; Carotid Artery, External; Child; Epistaxis; Humans; Ligation; Maxillary Artery; Nasal Mucosa; Nose; Tampons, Surgical

Eustachian tube function was assessed by tympanometry in 47 patients (94 ears) with anterior nasal packing placed after nasal surgery and in 12 patients (24 ears) requiring anterior and posterior packing for epistaxis. Twenty-four of the 94 ears (25.5%) in patients with anterior packing exhibited reductions in middle ear pressure (greater than or equal to --100 mm H2O), whereas 12 of 13 ears (92.3%) ipsilateral to and six of 11 ears (45.4%) contralateral to the posterior pack demonstrated comparable reductions in middle ear pressure. The observation that posterior packing is associated with a greater incidence of eustachian tube dysfunction than anterior packing suggests that the mechanism of this dysfunction may be related to stasis in the peritubal lymphatic plexus rather than to nasal obstruction per se.

Topics: Adolescent; Adult; Ear, Middle; Epistaxis; Eustachian Tube; Humans; Lymphatic System; Middle Aged; Nose; Pressure; Tampons, Surgical

A pneumatic nasal tube is recommended to control serious bleeding in the nasal cavity and nasopharynx. This is easily administered and tightly seals the nasal cavity and nasopharynx. The tube allows reduced nasal respiration with sufficient sealing. It is available in three sizes and has been proven useful by the authors.

Topics: Epistaxis; Humans; Intubation; Nasopharynx; Nose; Tampons, Surgical

Topics: Adult; Child; Epistaxis; Female; Humans; Methods; Nose

Topics: Adolescent; Bandages; Blood Coagulation Disorders; Carotid Artery, External; Epistaxis; Female; Hemostasis; Humans; Hypertension; Hypnotics and Sedatives; Ligation; Male; Maxillary Artery; Middle Aged; Nasal Decongestants; Nose; Nose Neoplasms; Pressure; Recurrence; Telangiectasia, Hereditary Hemorrhagic; Wounds and Injuries

Topics: Adult; Arteries; Epistaxis; Ethmoid Bone; Facial Injuries; Fractures, Bone; Humans; Ligation; Male; Nasal Bone; Nose; Zygomatic Fractures

If arterial ligation is contemplated and the site of bleeding has not been identified it is reasonable to ligate the external carotid or maxillary artery, on the basis that this vessel supplies the major part of the nose. If bleeding persists in spite of ligation, this does not mean that the wrong vessel has been tied off but that arterial anastomoses are allowing blood to seep from the ethmoidal to the sphenopalatine area of the nose. If the anterior ethmoidal artery is to be ligated it is worth remembering that in 14-3 per cent of cases the anterior ethmoidal artery is absent unilaterally and in 2-4 per cent of cases absent bilaterally (Shaheen, 1967). The presence of a foramen with a periosteal cuff going through it does not necessarily mean that there is an artery present (Fig. 23). Finally, the blood vessel changes which occur and which are responisble for the persistence of nose bleeds in the elderly are a collagenous change in the muscle coat of medium and small arteries and calcification (not atheroma) in the larger feeding vessels.

Topics: Adult; Age Factors; Aged; Arteries; Blood Pressure; Carotid Artery, External; Epistaxis; Ethmoid Bone; Female; Humans; Hypertension; Ligation; Male; Maxillary Artery; Middle Aged; Nose; Regional Blood Flow; Rupture, Spontaneous; Sex Factors

A modification of an absorbent, non-adherent material (Telfa) is described for use as an anterior nasal packing. The ideal nasal packing should fulfill certain criteria. It should be easy to introduce and remove, contour to the nasal cavity to exert a tamponade effect, and should not prolapse or react unfavorably with the mucous membranes of the nose. The advantages of Telfa as a nasal packing is discussed and compared to previously described materials in this regard. During the past three years this pack has been used in over 800 patients for anterior epistaxis, septal and rhinoplastic surgery. The results have been extremely satisfactory, and the authors suggest their use in these cases.

Topics: Bandages; Epistaxis; Evaluation Studies as Topic; Gossypium; Humans; Nose; Otolaryngology; Plastics; Rhinoplasty; Tampons, Surgical

Topics: Epistaxis; Humans; Nasal Cavity; Nose; Tampons, Surgical; USSR

Topics: Adult; Angiography; Carotid Artery, Internal; Epistaxis; Ethmoid Bone; Fractures, Bone; Humans; Male; Nose

Topics: Epistaxis; Humans; Nose

Topics: Cerebrospinal Fluid Rhinorrhea; Cryosurgery; Epistaxis; Fractures, Bone; Histiocytoma, Benign Fibrous; Humans; Mucous Membrane; Nasal Polyps; Nasopharyngeal Neoplasms; Nose; Nose Deformities, Acquired; Nose Diseases; Nose Neoplasms; Rhinitis; Rhinoplasty; Rosacea; Skin Neoplasms

Topics: Epistaxis; Humans; Nasal Septum; Nose; Nose Diseases; Otorhinolaryngologic Diseases; Paranasal Sinuses; Psychology; Rhinoplasty; Surgery, Plastic

Topics: Adult; Asthma; Epistaxis; Female; Finland; Headache; Heart Diseases; Humans; Male; Middle Aged; Nose; Nose Deformities, Acquired; Nose Diseases; Posture; Pressure; Respiration; Rhinitis; Rhinitis, Allergic, Seasonal; Sleep; Smell; Smoking; Sneezing; Spirometry

Topics: Adolescent; Arteriosclerosis; Cautery; Child; Epistaxis; Humans; Hypertension; Ligation; Nose; Occlusive Dressings; Pressure

Topics: Anesthesia, Local; Carotid Artery, External; Cocaine; Epistaxis; Ethmoid Sinus; Hemostasis; Humans; Lidocaine; Ligation; Maxillary Artery; Methods; Nasal Mucosa; Nose; Surgical Instruments; Tampons, Surgical

Topics: Adolescent; Catheterization; Child; Child, Preschool; Cocaine; Dacryocystitis; Dacryocystorhinostomy; Epistaxis; Humans; Methods; Nasal Mucosa; Nose; Preoperative Care

Topics: Arteries; Carotid Artery, External; Cryosurgery; Epistaxis; Ethmoid Sinus; Humans; Ligation; Maxillary Artery; Nose; Telangiectasis

Topics: Cautery; Cryosurgery; Epistaxis; First Aid; Humans; Ligation; Nose; Oxygen Inhalation Therapy; Tampons, Surgical

Topics: Epistaxis; Humans; Nasal Septum; Nose; Nose Deformities, Acquired; Olfaction Disorders; Postoperative Complications; Rhinitis, Atrophic; Rhinoplasty; Sinusitis; Turbinates

Topics: Anesthesia, General; Anesthesia, Local; Anti-Bacterial Agents; Epistaxis; Fractures, Bone; Humans; Maxillary Sinus; Methods; Nose; Oral Hemorrhage; Orbit; Postoperative Care; Preoperative Care; Tampons, Surgical; Time Factors

Topics: Adult; Epistaxis; Follow-Up Studies; Humans; Male; Methods; Nose; Skin Transplantation; Surgery, Plastic; Telangiectasia, Hereditary Hemorrhagic; Transplantation, Homologous

Topics: Adolescent; Adult; Aged; Airway Obstruction; Anesthesia, Intravenous; Carcinoma, Squamous Cell; Cough; Epistaxis; Female; Fracture Fixation, Internal; Fractures, Bone; Hemorrhage; Humans; Ketamine; Male; Mandibular Neoplasms; Nose; Orthopedic Fixation Devices; Pharynx; Reflex; Surgery, Oral

Topics: Arteries; Epistaxis; Female; Humans; Ligation; Middle Aged; Nasopharynx; Nose

Topics: Adult; Aged; Carbon Dioxide; Epistaxis; Female; Hemostasis; Humans; Hypoxia; Ligation; Lung Diseases, Obstructive; Male; Maxillary Artery; Middle Aged; Nose; Oxygen

Topics: Adolescent; Adult; Aged; Blood Transfusion; Cautery; Child; Cryosurgery; Epistaxis; Estrogens; Female; Humans; Lubrication; Male; Middle Aged; Nose; Postoperative Complications; Pressure; Skin Transplantation; Telangiectasia, Hereditary Hemorrhagic

Topics: Epistaxis; Humans; Male; Methods; Middle Aged; Nasal Septum; Nose; Osteotomy; Skin Transplantation; Telangiectasia, Hereditary Hemorrhagic; Transplantation, Autologous

Topics: Adult; Child; Epistaxis; Humans; Intubation, Intratracheal; Methods; Nasal Mucosa; Nasopharynx; Nose

Topics: Adolescent; Dacryocystitis; Endarteritis; Epistaxis; Female; Fistula; Humans; Lacrimal Apparatus; Nose; Postoperative Complications; Syphilis, Cardiovascular

Topics: Arteries; Blood Pressure; Epistaxis; Ethmoid Bone; Hemostasis; Humans; Ligation; Maxillary Artery; Maxillary Sinus; Methods; Nose; Orbit

Topics: Carotid Arteries; Epistaxis; Humans; Nasal Septum; Nose; Nose Neoplasms; Seasons; Telangiectasia, Hereditary Hemorrhagic

Topics: Bone Plates; Cerebrospinal Fluid Rhinorrhea; Craniofacial Dysostosis; Epistaxis; Ethmoid Bone; Face; Facial Bones; Facial Injuries; Fracture Fixation; Frontal Bone; Frontal Sinus; Humans; Lead; Nose; Radiography; Skull Fractures

Topics: Child; Child, Preschool; Edema; Epistaxis; Fractures, Cartilage; Hematoma; Humans; Infant; Methods; Nasal Septum; Nose; Physical Examination; Surgical Instruments

Topics: Catheterization; Epistaxis; Humans; Intubation; Methods; Nose

Topics: Carotid Arteries; Epistaxis; Germany, West; Humans; Maxillary Artery; Methods; Nose; Suture Techniques; Vascular Surgical Procedures

Topics: Adolescent; Adult; Child; Child, Preschool; Epistaxis; Female; Humans; Male; Middle Aged; Myiasis; Nasal Mucosa; Nose; Olfaction Disorders; Postoperative Care; Rhinitis, Atrophic

Topics: Aged; Blood Transfusion; Electrocoagulation; Epistaxis; Female; Humans; Nose; Pedigree; Peptic Ulcer Hemorrhage; Pregnancy; Pregnancy Complications, Hematologic; Telangiectasia, Hereditary Hemorrhagic; Uterine Hemorrhage

Topics: Anatomy, Comparative; Animals; Arteries; Carnivora; Carotid Arteries; Dogs; Epistaxis; Fetus; Guinea Pigs; Haplorhini; Hominidae; Humans; Maxillary Artery; Nose

Topics: Adult; Aged; Child; Chronic Disease; Epistaxis; Female; Hemostasis; Humans; Male; Maxillary Artery; Methods; Middle Aged; Nose

Topics: Cryosurgery; Emergencies; Epistaxis; Humans; Hypertension; Intubation; Methods; Nose; Telangiectasia, Hereditary Hemorrhagic

Topics: Denervation; Epistaxis; Humans; Maxillary Artery; Methods; Nasal Polyps; Neuralgia; Nose; Otorhinolaryngologic Diseases; Palate; Postoperative Complications; Sphenoid Bone; Surgical Instruments; Sutures

Topics: Catheterization; Epistaxis; Hemostasis; Humans; Methods; Nose

Topics: Adolescent; Azathioprine; Epistaxis; Fluorescent Antibody Technique; Granulomatosis with Polyangiitis; Heparin; Humans; Kidney; Male; Nose; Phagocytosis; Prednisone

Topics: Epistaxis; Hemostasis; Humans; Nose; Tampons, Surgical

Topics: Adolescent; Adult; Aged; Anesthesia, Inhalation; Blood Gas Analysis; Catheterization; Epistaxis; Humans; Middle Aged; Nose; Time Factors

Topics: Adult; Anticoagulants; Arteries; Blood Coagulation Disorders; Craniocerebral Trauma; Epistaxis; Hematologic Diseases; Hemostasis; Humans; Hypertension; Liver Diseases; Methods; Nose; Nose Diseases; Tampons, Surgical

Topics: Adult; Epistaxis; Female; Foreign Bodies; Humans; Metals; Nose; Radiography; Sutures

Topics: Epistaxis; Fractures, Bone; Humans; Nose

Topics: Adult; Diathermy; Epistaxis; Humans; Male; Nasopharyngeal Neoplasms; Nose

Topics: Adult; Anesthesia, General; Child; Epistaxis; Gelatin Sponge, Absorbable; Hemostatics; Humans; Nose; Tampons, Surgical

Topics: Animals; Child; Drug Therapy; Epistaxis; Humans; Leeches; Nose; Parasitic Diseases; Tartrates

Topics: Blood Coagulation Disorders; Blood Coagulation Tests; Blood Platelet Disorders; Blood Transfusion; Capillaries; Epistaxis; Hemophilia A; Hemophilia B; Hemorrhage; Hemostasis; Hemostatics; Humans; Nose; Otolaryngology; Pharynx; Surgical Procedures, Operative; Tonsillectomy

Topics: Electrolysis; Epistaxis; Gases; Hot Temperature; Humans; Hypersensitivity; Metals; Nasal Mucosa; Nasal Septum; Nose; Nose Neoplasms; Occupational Diseases; Paint; Rhinitis; Smell; Steam; Wood

Topics: Arteries; Carotid Arteries; Epistaxis; Ethmoid Sinus; Humans; Ligation; Nose

Topics: Ear Deformities, Acquired; Ear, External; Epistaxis; Granulomatosis with Polyangiitis; Hoarseness; Humans; Nose; Nose Deformities, Acquired; Otitis Media; Otolaryngology; Polyarteritis Nodosa

Topics: Adenoidectomy; Cholesteatoma; Diagnosis, Differential; Epistaxis; Foreign Bodies; Hearing Disorders; Humans; Meningitis; Nose; Otitis; Pharyngitis; Tonsillectomy; Tonsillitis

Topics: Emergencies; Epistaxis; Humans; Labyrinth Diseases; Mastoiditis; Nose; Otitis Media; Otolaryngology; Respiratory Tract Diseases; Surgical Procedures, Operative; Vitamins

Topics: Epistaxis; Estrogens; Estrogens, Conjugated (USP); Hemorrhage; Hemostatics; Humans; Neck; Nose; Tonsillectomy

The instances in which nosebleed is potentially fatal are those in which there is a history of recent head injury, severe arteriosclerotic cardiovascular disease or an underlying vascular tumor in the nasal chambers. Fatal nasal bleeding has not been reported in children. An awareness on the part of the physician of the potentially fatal significance of his patient's nosebleed is the very best insurance against such an event. Intelligent history-taking, careful physical and x-ray examination, generous sedation, precise local cauterization and packing, estimation of hemoglobin mass and a search for bleeding and clotting disorders are the best weapons of the physician called to treat epistaxis. These procedures, coupled with adequate blood replacement and an informed attitude toward surgical interruption of the blood supply to the bleeding region should forestall death from fatal nosebleed.

Topics: Blood Coagulation Disorders; Cautery; Child; Epistaxis; Humans; Nose

Topics: Epistaxis; Humans; Nasal Surgical Procedures; Nose

Topics: Child; Disease; Epistaxis; Humans; Hypersensitivity; Immune System Diseases; Nose; Respiration Disorders; Respiratory System; Respiratory Tract Diseases

Topics: Epistaxis; Hemorrhage; Humans; Medical Records; Nose

Topics: Arteries; Cardiovascular System; Carotid Arteries; Epistaxis; Humans; Ligation; Nose

Topics: Bandages; Epistaxis; Humans; Nose; Nose Diseases

Topics: Diathermy; Electrocoagulation; Epistaxis; Humans; Nose

Topics: Epistaxis; Humans; Hypertension; Nose

Topics: Disease Management; Epistaxis; Humans; Nose

Topics: Epistaxis; Hemorrhagic Disorders; Humans; Medical Records; Nose; Postoperative Hemorrhage; von Willebrand Diseases

Topics: Epistaxis; Hemostasis; Humans; Nose

Topics: Disease Management; Epistaxis; Humans; Nose

Topics: Adrenochrome; Epistaxis; Hemorrhage; Neck; Nose; Pharynx; Sodium Salicylate; Staining and Labeling

Topics: Bronchi; Epistaxis; Humans; Inflammation; Lung Diseases; Nasal Cavity; Nose; Paranasal Sinuses

Topics: Epistaxis; Hemorrhage; Hospitals; Humans; Nose; Pharynx

Topics: Epistaxis; Humans; Nose; Ophthalmic Artery

Topics: Epistaxis; Hemorrhage; Humans; Nasopharynx; Nose

Topics: Adenoids; Epistaxis; Estrogens; Hemorrhage; Hemostatics; Humans; Nasopharynx; Nose; Palatine Tonsil

Topics: Adrenochrome; Epistaxis; Hemorrhage; Humans; North Carolina; Nose; Pharynx; Salicylates

Topics: Adenoids; Adrenochrome; Epistaxis; Hemorrhage; Neck; Nose; Palatine Tonsil; Pharynx; Staining and Labeling

Topics: Arteries; Epistaxis; Humans; Ligation; Nose; Ophthalmic Artery

Topics: Ear Diseases; Emergencies; Epistaxis; Fractures, Bone; Humans; Nose; Pharynx

Topics: Arteries; Carotid Arteries; Craniocerebral Trauma; Epistaxis; Humans; Ligation; Nose; Ophthalmic Artery

Topics: Epistaxis; Humans; Neck; Nose; Pharynx

Topics: Arteries; Epistaxis; Eye; Humans; Ligation; Nose; Ophthalmic Artery; Smell

Topics: Epistaxis; Humans; Nose; Postoperative Hemorrhage; Postoperative Period

Topics: Arteries; Epistaxis; Humans; Nose

Topics: Epistaxis; Hemorrhage; Humans; Nasopharynx; Neck; Nose; Pharynx

Topics: Disease Management; Epistaxis; Hemorrhage; Neck; Nose; Pharynx; Staining and Labeling

Topics: Emergencies; Epistaxis; Foreign Bodies; General Practitioners; Humans; Neck; Nose; Pharynx; Trachea

Topics: Carotid Arteries; Carotid Artery, External; Epistaxis; Humans; Ligation; Nose

Topics: Bandages; Epistaxis; Humans; Nose; Rubber

Topics: Epistaxis; Humans; Nose; Postoperative Hemorrhage; Postoperative Period

Topics: Arteries; Epistaxis; Humans; Ligation; Nose

Topics: Ear; Epistaxis; Hemorrhage; Humans; Neck; Nose; Pharynx

Topics: Epistaxis; Humans; Nose

Topics: Aircraft; Bandages; Epistaxis; Humans; Menstrual Hygiene Products; Nose; Tampons, Surgical

Topics: Epistaxis; Humans; Nose

Topics: Epistaxis; Humans; Nose

Topics: Epistaxis; Humans; Nasopharynx; Nose

Topics: Calcium-Binding Proteins; Epistaxis; Flavonoids; Humans; Nose; Organic Anion Transporters; Vitamins

Topics: Epistaxis; Humans; Nose; Purpura; Purpura, Thrombocytopenic; Purpura, Thrombocytopenic, Idiopathic

Topics: Epistaxis; Humans; Nose

Topics: Cardiovascular System; Epistaxis; Hemorrhage; Nose

Topics: Arteries; Epistaxis; Humans; Ligation; Nose

Topics: Epistaxis; Hemorrhage; Nose

Topics: Animals; Epistaxis; Hemorrhage; Nose; Porifera

Topics: Carotid Artery, External; Diathermy; Epistaxis; Hemorrhage; Humans; Ligation; Nose; Orbit

Topics: Epistaxis; Hemorrhage; Nose

Topics: Antifibrinolytic Agents; Ascorbic Acid; Epistaxis; Hemorrhage; Hemostatics; Humans; Nose; Prothrombin; Vitamin K; Vitamins

Topics: Epistaxis; Fistula; Hemorrhage; Humans; Nose; Paranasal Sinuses

Topics: Carotid Arteries; Carotid Artery, External; Epistaxis; Hemorrhage; Humans; Ligation; Nose

Topics: Epistaxis; Hemorrhage; Nose

Topics: Epistaxis; Hemorrhage; Humans; Nose

Topics: Epistaxis; Hemorrhage; Nose

Topics: Epistaxis; Humans; Nose

Topics: Epistaxis; Hemorrhage; Humans; Nose

Topics: Epistaxis; Fistula; Hemorrhage; Humans; Nose; Paranasal Sinuses

Topics: Epistaxis; Female; Hemorrhage; Humans; Nose; Pregnancy; Pregnancy Complications

Topics: Arteries; Epistaxis; Hemorrhage; Humans; Nose

Topics: Bandages; Cellulose; Cellulose, Oxidized; Epistaxis; Hemorrhage; Hemostasis; Humans; Nose

Topics: Epistaxis; Hemorrhage; Nose

Topics: Epistaxis; Hemorrhage; Humans; Nose

Topics: Disease; Epistaxis; Ethmoid Bone; Ethmoid Sinus; Hemorrhage; Humans; Nose; Paranasal Sinus Diseases

Topics: Arteries; Epistaxis; Hemorrhage; Humans; Ligation; Nose; Ophthalmic Artery