Presentasi Journal Reading

Oleh: Adhi Pasha Dwitama (FK UKRIDA) Hanny Novia Rini (FK UPN) Pembimbing: dr. Khairan I., M.Kes, Sp.THT-KL

Causes and Management of Epistaxis at a District Hospital

Muhammad Ismail Khan, Muhammad Marwat,
Rafique Ahmad Khattak

Departments of Otorhinolaryngology and Ophthalmology, Mufti Mehmood Memorial Teaching Hospital. Gomal Medical College, DI Khan and Department of Otorhinolarygology, Khalifa Gulnawaz Teaching Hospital, Bannu, Pakistan

.6 in 10.  Occur in 60% of persons worldwide during their lifetime  Approximately 6% of those with nosebleeds seek medical treatment  1.INTRODUCTION  Epistaxis is rarely severe and seldom requires hospital admission.000 requiring hospitalization.

Anterior epistaxis (more common) .Major etiologies included: Idiopathic. inhaled medications.Posterior epistaxis (less common and more severe) Most cases of epistaxis are managed conservatively with chemical cautry or nasal packing . mucosal breakdown caused by infiltration by malignancy or granulomatous disease and nasal trauma Two types of epistaxis: .

The objective of this study was to determine the causes. types. laterality. need for hospital admission and success rate of treatment modalities of epistaxis .

Pakistan from September 2010 to June 2012 to any cause were included spontaneously and did not need any intervention were excluded . Dera Ismail Khan. Mufti Mehmood Memorial Teaching Hospital.METHODOLOGY This descriptive study at All patients of acute epistaxis due All those in whom bleeding stopped Department of ENT.

 The data for the following nine variables was collected: – Gender – Age in years – Age group – Causes – Type and laterality of epistaxis – Need for hospital admission – Success rate of treatment modalities .

it appeared as a red dot on the nasal mucosa If the vessel was still bleeding. active oozing was visible Mean while blood samples were taken and sent for Haemoglobin estimation. nose was re-examined and if any offending vessel has stopped bleeding.Bleeding point was identified as any blood clots in the nose were sucked out Soaked cotton balls (1-2) in a mixture of 2% lidocaine and 1:1000 epinephrine were put into the bleeding nostril for 10 minutes to achieve local anaesthesia as well as vasoconstriction After removing the cotton balls. and blood grouping and cross matching where indicated .

 ANP was done with ribbon gauze impregnated with antibiotic ointment – in patients where bleeding point was not visible and if the ooze was generalized or bleeding was profused . Patients were treated with SNC if – the bleeding point was visible and unilateral.

 PNP was done with Folly's catheter – when the ANP did not work in controlling bleeding  Pack was left in for 24-48 hours  Spongeston (Gelfoam) was used in patients with bleeding diathesis – To avoid mucosal trauma associated with nasal packing .

no recurrence of bleeding after SNC or removal of pack within one week  All those patients who rebleeded after removal of pack. nasal packing was repeated and left for another 48 hours . Successful treatment was defined as.

3 0±23 . 199 (64%) were male and 76 (36%) female  Mean age of the patients was 38.RESULT  Out of 275 patients.

65) 19 (06.00) 24 (08.70) 19 (06.80) 44 (16.45) 12 (4.00) 36(13.35) 11 (04.90) 33 (12.25) 29 (10.20) 176 (64) 18 (6.55) 12 (04.40) 275 (100) .35) 17 (6.10) 17 (06.Table l: Demographic characteristics of study population (n=275) Age Groups (years) Male N (%) Female N (%) Total N (%) 05-10 11-20 21-30 31-40 41-50 51-60 61-70 >70 Total 31 (11.90) 12 (4.35) 08 (2.10) 23 (08.20) 11 (4.20) 99 (36) 49 (17.00) 21 (07.00) 06 (2.55) 15 (5.10) 47 (17.90) 36(13.

80%) treatment modality followed by ANP (31.9%) cause of epistaxis followed by hypertension (26.3%)  No mortality occurred in this study . Trauma was the commonest (46.45%) than posterior type (20.75%)  SNC was the commonest (57.9%)  Anterior epistaxis was more common (61.

management and outcome (n=275) Characteristics Type of epistaxis Anterior Posterior Mixed Laterality Unilateral Number % 169 57 49 61.10 Bilateral Needed hospital admission .80 192 83 113 69.20 41.80 30.Table 2: Causes.45 20.75 17.

Causes of epistaxis Trauma Hypertension Upper respiratory tract infections Bleeding diathesis Sino-nasal malignancy Maggots Pregnancy 129 74 21 20 11 5 5 4 3 3 46.30 4.80 1.80 1.90 7.65 7.00 1.10 Renal disorders Hepatic disorders Bleeding polyp .10 1.90 26.45 1.

45 5.80 31.00 53.33 159 86 15 15 57.80 78.60 100.30 5.45 .Treatment modality Silver nitrate cautry Anterior nasal packing Posterior nasal packing Spongeston (Gelfoam) packing Success rate Silver nitrate cautry Anterior nasal packing Posterior nasal packing Spongeston (Gelfoam) packing 146 66 15 8 91.

 A study by Awan et al. . all of the patients were from pediatric age group.DISCUSSION  Epistaxis is the manifestation of multiple local and other systemic disorders of the body.  In this study results showed a bimodal presentation of epistaxis among the patients.  The age range of our patients is almost similar to that reported in local and foreign literature.

 The increased incidence of epistaxis in younger age is because of sports injuries and road traffic accidents due to their aggressive life style  The increased incidence in old age is probably due to vascular pathologies. hypertension and malignancy  This study is consistent with other studies in showing male preponderance .

is almost similar to that reported by Hussain et al (38. . The present series regarding patients who needed hospitalization (41%).  The need for hospitalization was – patients with copious bleeding – patients aged over 65 years – cases with head or maxillo-facial injuries.01%). But higher than that reported by Timsit et al (11%).

75%). The commonest cause of epistaxis was trauma (46.9%). This finding is in tandem with existing literature .45%) than posterior type (20. as supported by national and international literature  A study by Hanif et al has reported hypertension to be the commonest cause  Anterior epistaxis was more common (61.

 3 conservative modalities were used – SNC if bleeding point was visible – ANP if bleeding was profuse – PNP if ANP failed  The same approach to control epistaxis was also followed by Rope et al as well. .

 SNC was used in 57.07%).5% of his patients with success rate of 92.5% .3% patients with success rate of 78%  Gilyoma et al had used ANP for 38.8% patients – The overall success rate for cauterization was higher (92%) than that reported by Razdan et al (72.  Anterior nasal packing was used in 31.

 Spongeston (gelfoam) was used for nasal packing in patients (5. associated with paraffin soaked gauze. as supported by another study  No surgical ligation of vessel was required in this study . Ribbon gauze impregnated with antibiotic (furacin) ointment for ANP – to minimize the risk of toxic shock syndrome.45%) with bleeding diathesis.

 Arterial ligation is necessary in intractable cases of epistaxis when conservative measures fail  Endoscopic approach and intervention radiology have made arterial ligation safer and faster in the management of epistaxis  There was no mortality recorded in this series  A mortality rate of 1. .9% was reported in a study in Nigeria due to severe epistaxis.

 Carrying a good success rate.CONCLUSIONS  Trauma is the leading cause of epistaxis.  Experience shows that conservative approach is arguably sufficient in the management of most cases of epistaxis without the need for arterial ligation. . SNC is a preferred choice for treatment of anterior epistaxsis.