Nasal endoscopy and localization of the bleeding source in epistaxis: last decade's revolution (original) (raw)
Related papers
A Study of Role of Nasal Endoscopy in the Diagnosis and Management of Epistaxis
Journal of Evolution of Medical and Dental Sciences, 2017
BACKGROUND Epistaxis is one of the most common emergencies in any ENT Department, which needs utmost attention and early intervention. If proper assessment on arrival of the patient is not done, a significant morbidity and mortality can occur. MATERIALS AND METHODS All epistaxis patients were subjected to nasal endoscopy under Local or General Anaesthesia on arrival in Emergency Ward. The most useful and definitive method to find out the bleeder in epistaxis is nasal endoscopy and electrocautery. A three-year retrospective clinical study of management of epistaxis with endoscopic cauterisation was done from July 2013 to July 2016 in the Department of ENT in MGM Medical College and LSK Hospital, Kishanganj, for 180 patients. RESULTS In most of the epistaxis patients, bleeding was controlled with nasal endoscopy and cautery successfully. CONCLUSION The study was conducted to establish the fact that the best way to manage epistaxis is by doing nasal endoscopy at the first outset to find out the bleeder and cauterise. It reduces cost, hospital stay and complications of nasal pack. Findings in our study for the site of bleeder will be a guide to the surgeon for successful control of epistaxis in a tense situation of active bleeding.
Common Sites of Bleeding in Epistaxis
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epistaxis has historically been classified into anterior and posterior, but no consistent landmark has been used to categories bleeding points. It is very important to know the exact site of bleeding in endoscopic cauterization. However, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Recent evidence suggests that this, combined with the use of stepwise management plans, should limit patient complications and the need for admission. METHODS This retrospective study was carried out among 102 patients of epistaxis during a 2-year period in the department of ENT. Diagnostic nasal endoscopy was performed in all cases to find the exact site of bleeding. Endoscopic cautery was done in operation theatre. RESULTS In our study, we found that most common site of epistaxis is nasal septum followed by inferior meatus. Then, diagnostic nasal endoscopy was performed with the help of 0-and 30-degree endoscopes. After finding the exact site of bleeding, endoscopic cauterization was done using bipolar cautery forceps. Patients were closely monitored for 24 hours for recurrence of bleeding. CONCLUSIONS Our knowledge of the most common sites of bleeding from nose in patients will help ENT surgeons to locate the site of epistaxis. Our study will help them in managing epistaxis. Epistaxis is a problem commonly encountered by otolaryngologists. The majority of cases is easily treated, but some may be life-threatening. Knowledge of the vascular anatomy is critical to determine the location of the bleed.
European Annals of Otorhinolaryngology, Head and Neck Diseases, 2017
ANORL-602; No. of Pages 5 2 E. Bequignon et al. / European Annals of Otorhinolaryngology, Head and Neck diseases xxx (2016) xxx-xxx is only feasible if the bleeding site is clearly visible. When the bleeding site is not identifiable or the first measures failed, anterior packing may be performed by a non-specialist physician. Epistaxis requires subsequent nasal endoscopy performed by an ENT specialist. Patients should be informed of the measures to be taken in case of epistaxis at home, and the risks associated with the various treatments.
Epistaxis management - our point of view and literature review
Romanian Journal of Rhinology, 2017
Nasal haemorrhage or epistaxis is the most common otolaryngologic emergency. It affects about 60% of the population and a percentage of 6% do not cease spontaneously, medical approach being needed. The management of epistaxis varies depending on its severity and etiology. The therapeutic conduct of this ENT emergency is based on three main principles: 1. local haemostasis; 2. detection and ceasing of the cause; 3. evaluation and correction of hypovolemia if necessary. Haemostasis can be done by chemical or electric cauterisation after identifying the bleeding source, by nasal packing, by endoscopic or external surgery or, in special cases, when none of the above methods returns any results, embolization. The current paper emphasizes our experience and a brief literature concerning epistaxis management in patients presented in the Emergency Room, in chronic cases of vascular intranasal tumors with recurrent bleeding, in iatrogenic haemorrhages, and none of the least we will bring int...
Rhinology, 2020
Background: Systematic endoscopic assessment (SEA) of bleeding sites is critical for topodiagnosis and treatment of severe epistaxis, which is not limited to the posterior region. A bleeding site originating from the ethmoidal vasculature, the S-point, has recently been described. The aim of this study is to ascertain the prevalence of each bleeding site in severe epistaxis using a SEA protocol that includes the S-point. Methodology: Prospective longitudinal study of 51 severe epistaxis patients who underwent 53 SEA under general anesthesia from April 2018 through March 2019. SEA consisted of use of a rigid nasal endoscope; no reduction in blood pressure; no use of topical vasoconstrictor; systematic search of all regions of the nose. Bleeding sites were assigned to either superior or posterior epistaxis. Results: At least one bleeding site was identified in 37 evaluations (69.8%). The S-point was the most common bleeding site (28.3%), followed by the lateral middle turbinate (9.4%), non-S-point upper septum (7.5%), nasal roof (7.5%), and upper lateral wall (7.5%). Superior epistaxis was identified in the most of cases (27 SEA, 50.9%), whereas only 14 SEA (26.4%) identified posterior epistaxis-fewer than the 16 SEA that did not identify any bleeding sites (30.2%). There were two recurrences (3.8%). Conclusions: Systematic endoscopic assessment effectively identified bleeding sites in 69.8% of severe epistaxis. The S-point was the most common bleeding site identified (28.3%). Finally, superior epistaxis corresponded to more than half of the identified bleeding sites, demonstrating the importance of examining this region judiciously in patients with severe epistaxis.
The Ochsner journal, 2010
A 70-year-old man presented with right-sided epistaxis that had been unrelieved by direct pressure for the past 90 minutes. His medical history was significant for hypertension (blood pressure was 180/ 100 mmHg on arrival), atrial fibrillation, and coronary artery disease. His current medications are aspirin, warfarin, enalapril, and metoprolol tartrate. On placement of an anterior nasal pack on the right side, the patient began bleeding heavily from the left side.
An Aetiopathological Study on Epistaxis in Adults and its Management
Bengal Journal of Otolaryngology and Head Neck Surgery
IntroductionEpistaxis is a common clinical problem in ENT practice. Idiopathic aetiology is said to be the most common.Aim of studyTo find out whether idiopathic epistaxis is the most common cause of primary adulthood epistaxis and to formulate the best treatment protocolMaterials & MethodsA prospective study was conducted in a tertiary healthcare setup from August 2013 to August 2014. 100 patients of more than 16 years of age of both sexes were studied. Patients presenting with active nasal bleeding in ENT ER and OPD were included.ResultsTruly idiopathic epistaxis was encountered in 37% of the study population followed by 20% cases in association with grossly deviated septum with septal spur(s). Most of the cases were managed by resuscitation alone with or without anterior nasal packing. Conclusion: With advances in endoscopy & imaging techniques, cause of the epistaxis can most often be elicited and by sticking to a management protocol recurrence can be reduced.
Clinical Profile of Idiopathic Epistaxis in a Hospital
Journal of Nepal Medical Association, 2012
Introduction: Epistaxis is a common otolaryngological emergency but most of the cases are idiopathic. This study was done to assess clinical profile in patients with idiopathic epistaxis. Methods: Patients presenting in ENT outpatient department or emergency with epistaxis and no definite cause were selected. Patients demographic data, present and past history was recorded. All patients underwent anterior rhinoscopy and rigid nasal endoscopy. Results: There were 142 patients with epistaxis without definite cause. Age ranged from 11 to 84 years with mean 32.8 years. Approximately two-third were male. Bleeding from right side was seen in 64 (45.0%) patients. Past history of bleeding was given by 79 (55.6%) patients and out of them 60 (75.9) % had bleeding from same side. Presentation was mostly in months of January to March. Bleeding point was seen in 65 patients. Most of them (37/65) was in Little’s area. Deviated nasal septum was seen in 102 patients. More than half of patients wi...
Evaluation of Local Causes of Epistaxis and Its Management Outcome in a Tertiary Care Hospital
Journal of Evolution of Medical and Dental Sciences
BACKGROUND Epistaxis is a very common problem. It may be a symptom of minor or serious ailments with underlying local or systemic causes. The objectives of this study are to evaluate various local causes of epistaxis and its management outcome. MATERIALS AND METHODS A descriptive study was conducted among 120 patients who presented with epistaxis of local causes. Individual sampling unit was selected using convenience sampling technique. Nasal pinching, anterior nasal packing and posterior nasal packing were performed in conservative management. Electrocauterisation, septal surgery, nasopharyngeal surgery and endoscopic arterial ligation were considered in surgical intervention. Descriptive statistics like proportion, mean and standard deviation were calculated. For inferential statistics, Chi-square test was performed wherever applicable. RESULTS Males were more compared to females with a male and female ratio of 1.2: 1. The number of patients were more in winter and autumn; and low during monsoon season. On rhinoscopic examination 53.33% cases had bleeding from the septum, out of which 81.25% was from anterior part and 18.75% was from posterior part of the septum. Most of the nasal trauma was due to road traffic accident. Hippocratic method was performed with a success rate of 80% to control bleeding. CONCLUSION Traumatic epistaxis was the most common local cause of epistaxis. Cold, dry and low humidity may lead to higher incidence of epistaxis in the winter season. The incidence of epistaxis was higher in young adults and middle-aged people. The anterior nasal packing had more convenient and higher control among all the conservative measures.