EVALUATION OF AETIOLOGY AND EFFICACY OF MANAGEMENT PROTOCOL OF EPISTAXIS

Authors

  • Gulshan Hussain
  • Mahid Iqbal
  • Shahid Ali Shah
  • Mohammad Said
  • Sana ullah
  • Sharafat Ali Khan
  • Muhammad Iqbal
  • Javed Zaman

Abstract

Background: Epistaxis is one of the commonest medical emergencies. It affects all age groups
and both sexes. The cause may be local or systemic but in majority it is spontaneous and
idiopathic. Trauma is considered to be a major aetiological factor. Various treatment protocols are
utilized to control epistaxis derpending upon the type, severity and cause of bleeding. Methods:
This descriptive study was designed to evaluate the aetiology and efficacy of management
protocol of epistaxis in a tertiary care setting. 313 patients underwent prospective evaluation by
consultant and non-consultant doctors with considerable experience in Ear, Nose & Throat (ENT)
emergencies management. Standard principles were followed in the management. Results: This
study demonstrated a bimodal distribution with incidence peaks in below 25 years & above 50
years of age. Males were affected twice more than the females (2.15:1.04). Anterior nasal bleeding
was noted in majority of the patients. Anterior nasal packing was the most effective method of
controlling anterior epistaxis. While posterior bleeding was controlled by posterior nasal packing
with Foley's catheter. The most common cause was found to be trauma, followed by hypertension.
Conclusion: It may be concluded from this study that epistaxis is the m ost common ENT
emergency, affecting all age groups. It has a bimodal age presentation and affects males twice
more than females. Anterior bleeding is more common than posterior bleeding. Epistaxis may be
controlled with chemical/electro-cautery if the bleeding point is visible. In case of failure to
localize or access a bleeding point or profuse bleeding, anterior nasal packing can effectively
control majority of epistaxis. Foley's catheter is a good option that can be used for posterior nasal
packing. Gelfoam may be used for controlling epistaxis in cases of bleeding disorders, when there
is mucosal ooze.
Key words: Epistaxis, Nasal packing, Foley's catheter.

References

Bradley F. Marple. Epistaxis. Practical Pediatric

Otolaryngology. Robit T. Cotton, Charles M. Myer (Eds).

Lippincott-Raven. 1999; 427-448.

Maqbool M, Ahmad I, Hameed A. Trauma: the most common

cause of epistaxis in children and young adults. Pakistan

Postgrad Med J 2000; 11(4):127-8.

Hanif M, Rizwan M, Rabbani MZ, Chaudhry MA. Common

causes of Epistaxis-A Two years Experience at Rawalpindi

General Hospital. J Surg Pakistan 2001; 6(2):2 -3.

Shaheen OH. Epistaxis in Scott Brown's Otolaryngology.5th

edn, vol 4, I.S. Mackay and T.R.Bull (eds), Butterworths

London 1987: 272-282.

Viehweg TL, Roberson JB, Hudson JW. Epistaxis: diagnosis

and t reatment. J Oral Maxillofac Surg 2006;64(3):511-8.

Kucik CJ, Clenney T. Management of epistaxis.

Am Fam Physician 2005;71(2):305-11

Mann GS, Philip R, Balachandran A. Intractable epistaxis

secondary to a post traumatic pseudoaneurysm. Med J Malaysia

;60(3):367-9.

Kucik CJ, Clenney T. Management of epsistaxis. Summary for

patients. Am Fam Physician 2005; 71(2):312.

Chaiyasate S, Roongrotwattanasiri K, Fooanan S, Sumitsawan

Y. Epistaxis in Chiang Mai University Hospital. J Med Assoc

Thai 2005;88(9):1282-6.

Awan MS, Ali MM, Hussain T, Mian MY. Management of

pediatrics Epistaxis; A prospective study of 100 cases.

Professional Med J 2001; 8(2):226-65.

Lee HM, Kang HJ, Lee SH. Metastatic renal cell carcinoma

presenting as epistaxis. Eur Arch Otorhinolaryngol 2005;

(1):69-71.

Nawaz G, Khan MR. Primary sinonasal tuberculosis in NorthWest Pakistan. J Coll Physicians Surg Pak 2004;14 (4):221-4.

Raza SN, Shabbir SMA, Haq A. Leech infestation and its

association with water drinking habits. J Coll Physicians Surg

Pak 2006;16(3):175-8.

Ahmed I, Raza SN, Bashir T, Arshad M. Pediatric Epistaxis.

Pakistan Postgrad Med J 2000;11(3):106-8.

Link TR, Conley SF,Flanary V, Kerschner JE. Bilateral

epistaxis in children: efficacy of bilateral septal cauterization

with silver nitrate. Int J Pediatr Otorhinolaryngol 2006;70(8):

-42.

Badran K, Arya AK. An innovative method of nasal chemical

cautery in active anterior epistaxis. J Laryngol Otol 2005;

(9):729-30.

Feusi B, Holzmann D, Steurer J. Posterior epistaxis: systematic

review on the effectiveness o f surgical therapies. Rhinology

;43(4):300-4.

Sadri M , Midwinter K, Ahmed A, Parker A. Assessment of

safety and efficacy of arterial embolization in the management

of intractable epistaxis. Eur Arch Otorhinolaryngol 2006;

(6): 560-6.

Mahadevia AA, Murphy KJ, Obray R, Gailloud P.

Embolization for intractable epistaxis. Tech Vasc Interv Radiol

; 8(3):134-8.

Bedogni A, McCombe D, Kennedy J, Morrison W. Resurfacing

the nasomaxillary cavity for management of epistaxis in OslerRendu-Weber disease. Br J Plast Surg 2005; 6.

Abbas N, Hussain I, Amjad M, Akhtar FP. Aetiological

incidence of Epistaxis in various Age Groups and Sex at Mayo

Hospital, Lahore. Ann King Edward Med Coll1998;4(4):18-9

Almeida GS, Diogenes CA, Pinheiro SD. Nasal endoscopy and

localization of the bleeding source in epistaxis: last decade's

revolution. Rev Bras Otorrinolaringol (Engl Ed) 2005;

(2):146-8.

Ali S, Mumtaz S, Saeed M. Epistaxis: Etiology and

management. Ann King Edward Med Coll 2003;9(4):272-4.

Badran K, Malik TH, Belloso A, Timms MS. Randomized

controlled trial comparing Merocel and RapidRhino packing in

the management of anterior epistaxis. Clin Otolaryngol 2005;

(4):333-7.

Brain D. The nasal septum. Scott Brown's Otolaryngology,

Rhinology 6th edn. Alan G. Kerr, Ian S. Mackay, T.R. Bull

(Eds). Butterworth 1997: 4/11/19.

Shah AG, Stachler RJ, Krouse JH. Endoscopic ligation of the

sphenopalatine artery as a primary management of severe

posterior epistaxis in patients with coagulopathy. Ear Nose

Throat J 2005;84(5):296-7,306.

Umapathy N, Quadri A, Skinner DW. Persistent epistaxis: what

is the best practice? Rhinology 2005;43(4):305-8.

Andersen PJ, Kjeldsen AD, Nepper-Rasmussen J. Selective

embolization in the treatment of intractable epistaxis. Acta

Otolaryngol 2005;125(3):293-7.

Daniel M, Raghavan U. Relation between epistaxis, external

nasal deformity, and septal deviation following nasal trauma.

Emerg Med J 2005;22(11):778-9.

Ahmed M, Amjed M, Hameed A. Control of Epistaxis in a

Teaching Hospital. Ann King Edward Med Coll 1997;3(4):88-

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How to Cite

Hussain, G., Iqbal, M., Shah, S. A., Said, M., ullah, S., Khan, S. A., … Zaman, J. (2006). EVALUATION OF AETIOLOGY AND EFFICACY OF MANAGEMENT PROTOCOL OF EPISTAXIS. Journal of Ayub Medical College Abbottabad, 18(4), 62–65. Retrieved from https://jamc.ayubmed.edu.pk/index.php/jamc/article/view/4273