Rodney J Schlosser
Clinical practice. Epistaxis.
N Engl J Med. 2009 Feb 19;360(8):784-9. doi: 10.1056/NEJMcp0807078.
Abstract/Text
Tor W Chiu, Gerry W McGarry
Prospective clinical study of bleeding sites in idiopathic adult posterior epistaxis.
Otolaryngol Head Neck Surg. 2007 Sep;137(3):390-3. doi: 10.1016/j.otohns.2006.10.035.
Abstract/Text
OBJECTIVES: The precise identification of the bleeding point is important to the efficient management of epistaxis. Our hypothesis was that the septum was the commonest bleeding site.
STUDY DESIGN AND SETTING: This was a prospective clinical study of 50 consecutive adult idiopathic posterior epistaxis patients carried out in a busy teaching hospital.
METHODS: The nasal cavity was inspected with endoscopy to identify the site of bleeding before any intervention. The location of bleeding sites was recorded on a proforma.
RESULTS: Of bleeding sites posterior to the piriform fossa, 94 percent were identifiable, with 70 percent arising from the septum.
CONCLUSIONS AND SIGNIFICANCE: This is the largest prospective study of the bleeding site in adult patients with posterior epistaxis and the only one with a well-defined population. The vast majority of posterior bleeding sites can be identified by endoscopy without general anesthesia. The septum should be examined closely in cases of idiopathic bleeding.
Louise Melia, Gerald W McGarry
Epistaxis: update on management.
Curr Opin Otolaryngol Head Neck Surg. 2011 Feb;19(1):30-5. doi: 10.1097/MOO.0b013e328341e1e9.
Abstract/Text
PURPOSE OF REVIEW: This article reviews the literature on epistaxis, with a focus on the past 12-18 month, and aims to classify the literature available for this very common otolaryngology emergency.
RECENT FINDINGS: Epistaxis can be classified into primary or secondary epistaxis based on cause. It can also be classified as childhood and adult epistaxis. These classifications are useful clinically, as the management of each group is different. Primary epistaxis should be managed by identification of the actual bleeding point and treated with chemical or electrocautery, bipolar diathermy or small packs placed directly over the bleeding point. Secondary epistaxis should be managed by identification of the cause, with application of appropriate nasal therapy and, importantly, corrective systemic medical management. We now have useful guidelines for the management of patients whose epistaxis is secondary to warfarin and a growing body of information regarding complementary medicines that may contribute to bleeding. The literature continues to support the role of antiplatelet drugs as important risk factors for epistaxis. Patients with continued epistaxis despite initial measures should be considered earlier, rather than later, for surgical ligation techniques or embolization. Children with epistaxis should be managed with topical antiseptic cream with or without septal cautery.
SUMMARY: Recent literature focuses on the cause and management of epistaxis. Although the level of evidence available for this topic is low, there have been many clinically useful studies that will contribute to an overall improvement in patient care.
Gerald McGarry
Nosebleeds in children.
Clin Evid. 2005 Dec;(14):399-402.
Abstract/Text
Henri Traboulsi, Elie Alam, Usamah Hadi
Changing Trends in the Management of Epistaxis.
Int J Otolaryngol. 2015;2015:263987. doi: 10.1155/2015/263987. Epub 2015 Aug 16.
Abstract/Text
Epistaxis is a very common complaint seen by many types of physicians including otolaryngologists, family physicians, and others. Management of epistaxis is often challenging and requires many types of intervention. The following review describes the different types of past and current treatment modalities including cautery, nasal packing, maxillary artery ligation, anterior artery ligation, and sphenopalatine artery ligation. The paper also proposes an algorithm for managing such cases.
Matthew I Trotter, Ranit De, Adrian Drake-Lee
Evidence-based management of epistaxis in adults.
Br J Hosp Med (Lond). 2006 Dec;67(12):651-3. doi: 10.12968/hmed.2006.67.12.22438.
Abstract/Text
Muhammad Shakeel, Aaron Trinidade, Neil McCluney, Brewis Clive
Complementary and alternative medicine in epistaxis: a point worth considering during the patient's history.
Eur J Emerg Med. 2010 Feb;17(1):17-9. doi: 10.1097/MEJ.0b013e32832b1679.
Abstract/Text
A large number of patients take complementary and alternative medicine (CAM) for a variety of reasons, but most do not inform their physicians. This has implications for safety, as many forms of herbal CAM are thought to have a variety of side-effects and may interact with conventional medicines with potentially adverse consequences. We present the case of an otherwise healthy 25-year-old man with difficult-to-control epistaxis. On further questioning, we learnt that he had recently started self-medicating with a combination of aspirin, garlic tablets and milk thistle. Garlic increases bleeding time and milk thistle alters the function of liver enzymes, both of which may have contributed to the difficulty in his management of epistaxis. This case highlights the importance of asking about CAM use when taking a patient's history, as it may have implications for management.
工藤典代：小児の鼻出血への対応．JOHNS 2005; 21(7): 1029-1032.
T Vimpel, J U Felding, P Bonding
The value of X-ray examination of the paranasal sinuses after epistaxis.
J Laryngol Otol. 1985 Mar;99(3):253-7.
Abstract/Text
In a number of Danish ENT departments, X-ray examination of the paranasal sinuses has been a routine procedure in cases of severe epistaxis of uncertain genesis, two to four weeks after its treatment has been completed. The object has been to rule out cancer of the nose and/or paranasal sinuses. In the present study, the value of this procedure was assessed.
竹内裕美：鼻出血の局所的要因．JOHNS 2005; 21(7): 965-968.
Smith J, Kim D, Siddiq S, et al.：Managing epistaxis in patients on warfarin. Clin Otolaryngol 2009; 34: 1-46.
Thomas O Gifford, Richard R Orlandi
Epistaxis.
Otolaryngol Clin North Am. 2008 Jun;41(3):525-36, viii. doi: 10.1016/j.otc.2008.01.003.
Abstract/Text
Epistaxis is a common occurrence. The estimated lifetime incidence of epistaxis is approximately 60% and it ranges in severity from a minor nuisance to a life-threatening hemorrhage. Evaluation of recurrent or severe cases includes a search for underlying causes, such as bleeding disorders and neoplasia. Many techniques, materials, and procedures treat nasal bleeding effectively and sometimes more than one treatment must be used. Otolaryngologists must be prepared to deal with severe or refractory bleeding through the use of medications, packing materials, and radiologic or surgical interventions. This article reviews nasal vascular anatomy, common causes of epistaxis, and treatments, including biomaterials and minimally invasive surgical techniques.
