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Objective:To provide an update on the ever-increasing role that embolisation plays in the practice of otolaryngology.Method:A literature search was performed during November 2008. The Medline, Embase, PubMed and Cochrane databases were searched. This resulted in 285 papers relevant for review.Conclusion:The role of embolisation has expanded greatly to include the management of refractory epistaxis, pre-operative preparation of vascular tumours, vascular injuries and as an adjunct in skull base surgery. [ABSTRACT FROM PUBLISHER]

Objectives: Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery. laser coagulation, septoplasty, and etnbolization) have been described with various degrees of success. Methods: We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances. Results: Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment. Conclusions: To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia. [ABSTRACT FROM AUTHOR]

Objective:To evaluate endoscopic cauterisation of the sphenopalatine neurovascular bundle, as treatment for intractable posterior epistaxis, with regard to efficacy, safety and post-operative sequelae.Patients and methods:A prospective study reviewed 42 patients with severe posterior epistaxis who were treated with endoscopic cauterisation of the sphenopalatine neurovascular bundle, over a 17-month period.Results:Hypertension and hepatic disease were present as predisposing factors in 66.7 and 35.7 per cent of patients, respectively. Branching of the sphenopalatine artery at its foramen was present in more than 85 per cent of patients. The success rate was 100 per cent, with no recurrent epistaxis in the follow-up period. Severe nasal dryness was present in only four patients (9.5 per cent); hypoaesthesia was found in the nasal mucosa of eight patients, without any patient complaints.Conclusion:Endoscopic sphenopalatine neurovascular bundle cauterisation is an effective treatment for refractory posterior epistaxis. In this study, neurovascular bundle cauterisation did not cause any neurological deficits or major complications. [ABSTRACT FROM PUBLISHER]

Objective:To propose radiofrequency coblation as a potential treatment modality for mild to moderate epistaxis in patients with hereditary haemorrhagic telangiectasia.Method:Case reports and review of the world literature concerning coblation and other treatment modalities for epistaxis in patients with hereditary haemorrhagic telangiectasia.Results:Effective epistaxis control was achieved in four out of five cases of hereditary haemorrhagic telangiectasia. In the fifth case, we struggled to achieve haemostasis due to disease severity.Conclusion:Radiofrequency coblation is a novel technique, which was found to be a safe, effective, quick and well tolerated treatment option for epistaxis management in patients with hereditary haemorrhagic telangiectasia. [ABSTRACT FROM PUBLISHER]

Conclusions: 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). Objectives: 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. Methods: 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. Results: 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. [ABSTRACT FROM AUTHOR]

Abstract: Background: Epistaxis is an important emergency that can sometimes be life threatening without effective intervention. Persistent and recurrent bleeding can lead to aspiration, hypotension, hypoxia, or even severe and mortal cardiovascular complications. Providing prompt hemostasis is important, and the hemostatic method used must be easily and locally applicable, efficient, and inexpensive. Objective: The aim of this study was to assess the hemostatic efficacy of Ankaferd Blood Stopper (ABS) in an experimental epistaxis model and to determine the histopathologic alterations with topical ABS application. Methods: Twenty-eight New Zealand rabbits were evaluated in 4 study groups. Topical ABS, gelatin foam (GF), adrenalin + lidocaine (AL), and serum physiologic as negative control (C) were applied to the animals for controlling epistaxis. The bleeding was generated with a standard mucosal incision in all groups. Cotton pieces soaked with ABS, AL, C, and GF were applied to the nasal bleeding area. Time of hemostasis was recorded. Tissue samples were obtained after hemostasis for histopathologic examination. The samples were stained with hematoxylin and eosin (HE) and phosphotungstic acid hematoxylin (PTAH) and were examined under a light microscope. In this experimental study, the observers were blind to ABS, AL, and C but not to GF, because of its solid nature. Results: Median durations required for hemostasis in ABS, AL, GF, and C groups were recorded as 30, 90, 90, and 210 seconds, respectively. The time until termination of bleeding in the ABS group was significantly shorter than that in the AL, GF, and C groups (P = 0.002, P = 0.002, and P = 0.001, respectively). On histopathologic evaluation, after staining with HE, minimal fibrin at the incision edges and a few extravasated erythrocytes were observed in the C, AL, and GF groups. In the ABS group, a dark amorphous material surrounded by fibrin, filling the space between the edges of incisions, was noticed. Fibrin was determined in the C, GF, and AL groups with PTAH stain and in the positive control group. In the ABS group, it was observed that the amorphous substance surrounded by fibrin seen in the HE sections was not stained with PTAH. Conclusions: Topical nasal ABS application controlled epistaxis faster than C, GF, and AL in this animal bleeding model. The bleeding model used here might fail to replicate the type of injury that would be likely to result in life-threatening bleeding in humans, which should be considered a limitation of the present study. The histopathologic findings in the nasal incision area suggest that ABS might affect global hemostasis by inducing a unique protein network formation, potentially representing a different mechanism of action among conventional antihemorrhagic applications. [Copyright &y& Elsevier]

The project aimed at determining whether patients admitted to hospital for the treatment of epistaxis can be mobilised instead of the conventional regime of bed rest without increasing the risks of new bleeding episodes. A survey of nursing regimes for epistaxis patients has shown that patients were prescribed bed rest in 11 of 16 hospital departments. This prescription has been based on the assumption that bed rest reduces the risk of renewed bleeding. There is no scientific documentation of the need for bed rest demonstrating any reduced risks of new bleeding episodes. However, these patients are generally older and sustain an increased risk of further complications related to bed rest itself. The study was a prospective, randomised 1:1 parallel-group trial with 100 participants admitted to our department for the treatment of epistaxis. Participants were randomly assigned to mobilisation or bed rest. Further, general demographic baseline data were registered including treatment modalities, hypertension, haemophilic disorders, anticoagulant therapy and diabetes. In the study group (mobilisation), 21 participants experienced new bleeding episodes against 29 maintaining haemostasis. In the control group (immobilisation), 24 participants experienced new bleeding episodes against 26. The odds ratio for bleeding when mobilised was 0·784 with a confidence interval of (0·356-1·728). Thus, there was no statistically significant evidence that mobilisation increased the risk of new bleeding episodes. There was no statistical evidence to support the practice of bed rest to reduce the risk of renewed bleeding episodes in patients with primary epistaxis. This suggested that these patients can be mobilised without any increased risk of new haemorrhage. Mobilisation during hospital stay can maintain patients' levels of functionality, which will prevent both complications of bed rest and loss of self-esteem. [ABSTRACT FROM AUTHOR]

Background. Mycotic pseudoaneurysm from the cavernous segment of the internal carotid artery (ICA) secondary to an invasive aspergillus sinusitis is rare. Surgical intervention with ICA ligation is generally accepted for most mycotic aneurysms or pseudoaneurysms. When presented with massive epistaxis due to a fungal aspergillus ICA invasion, mortality rates are high. Methods. We present the case of a 76-year-old man who developed intractable epistaxis due to a mycotic pseudoaneurysm arising from the cavernous segment of the right ICA. Results. The patient was successfully treated by endovascular embolization at the orifice of the pseudoaneurysm followed by the total ICA trapping technique using electrolytically Guglielmi detachable coils (GDCs) and injection of N-butyl-2- cyanoacrylate (n-BCA). The patient survived for 7 months but eventually died of urosepsis and cardiorespiratory failure. Conclusion. Endovascular embolization is a feasible and lifesaving approach for emergent management of massive intractable epistaxis secondary to a complicated invasive fungal sinusitis. [ABSTRACT FROM AUTHOR]

Objectives:Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet therapy. This prospective study assessed the prevalence of epistaxis in patients taking anticoagulant and antiplatelet medication, and monitored differences in patients’ clinical courses.Method:Prospective data were collected for consecutive patients referred with epistaxis from the emergency department over a seven-month period. Emergency department records were used to investigate prevalence and referral rates.Results:Over the study period, 290 patients presented to the emergency department with epistaxis; this represented 0.9 per cent of all emergency attendances. Of these patients, 119 (39 per cent) were referred on to the ENT department, 62 per cent of whom were currently taking anticoagulant or antiplatelet medication. Patients taking anticoagulant and antiplatelet medication were a significantly older group (relative risk 1.50 (1.08–2.28), p = 0.01) requiring longer in-patient stays (relative risk 2.50 (1.01–4.97), p = 0.01) and more aggressive local haemostasis measures. Most patients taking warfarin had an international normalised ratio outside the appropriate range for their disease. Hypertension was not a factor in these patients’ clinical course.Conclusion:Increasingly, emergency and ENT departments are being presented with epistaxis in patients taking anticoagulant or antiplatelet medication. A better understanding of such medication and its effects may enable more effective management of these patients. [ABSTRACT FROM PUBLISHER]

Abstract: Objectives/hypothesis: Primary outcome measure: to evaluate which concentration of silver nitrate cauterization was more efficacious in the management of idiopathic childhood epistaxis. Secondary outcome measures: to evaluate side effects and pain scores of the differing concentrations. Study design: Prospective double blind randomized clinical trial. Participants and setting: All children 16 years of age or younger referred by the accident and emergency department or general practitioner, with recurrent idiopathic epistaxis, who met the inclusion criteria entered the trial. Patients were randomized to receive either the 75% or 95% silver nitrate cauterization. Patients were reviewed at two weeks and eight weeks post cauterization. Pain scores, side effects and success of each treatments were recorded at the follow up clinic. Results: 101 patients completed the trial. 52 patients were randomized to receive the 95% concentration, and 49 patients were randomized to receive the 75% cauterization. In the 75% concentration group, 98% of patients had total resolution of their symptoms at the eight-week follow up. Mean pain scores in this group was 1 out of 10. In the 95% group, 90% had total resolution of their symptoms at the eight-week follow up. Mean pain scores in this group was 5 out of 10. There was a statistical difference in efficacy and pain scores (0.01 and 0.001). Conclusion: We would recommend the use of 75% silver nitrate cauterization in the management of childhood epistaxis, it appears to be more efficacious, has fewer side effects and is better tolerated. [ABSTRACT FROM AUTHOR]

Conclusion: Endoscopic cauterization of the sphenopalatine artery and anterior ethmoid artery is a first-line standard of care in managing intractable epistaxis, after the failure of previous packing. Epistaxis occurs in 12% of the population. Treatment is often based on nasal packing that could be poorly effective in the treatment of severe posterior epistaxis. Objective: To evaluate the effectiveness of the endoscopic approach for posterior epistaxis. Methods: We report the experience of endoscopic cauterization in two metropolitan hospitals in Italy: 48 patients with at least one nasal packing in the 3 weeks before hospital admission. They underwent endoscopic cauterization of the sphenopalatine artery or of the anterior ethmoid artery. Results: The patients' mean age was 58.7 years; the mean hospital stay was 2.97 days. In 42 cases (87.5%), cauterization of the sphenopalatine artery was performed, and 6 (12.5%) were subjected to anterior ethmoid artery treatment. Epistaxis control was achieved in 93% of cases; 3 patients had a recurrent nasal bleeding, and were treated with anterior nasal packing. Minor complications occurred in 27.1%. We achieved a shorter hospital stay compared with patients who underwent anteroposterior packing. [ABSTRACT FROM AUTHOR]

The article discusses the medical management of epistaxis. Epistaxis, commonly referred to as a nose bleed, can be an otolaryngologic emergency. The risk factors of anterior and posterior epistaxis include anticoagulation therapy, Olser-Weber-Rendu disease, neoplasm and platelet disorders such as hemophilia. Clinical management of epistaxis is described and includes the application of pressure, cautery and nasal packing.

We present a case of a Rendu-Osler-Weber disease patient with recurrent life threatening epistaxis demanding multiple blood transfusions despite of repetitive endoscopic laser and electrocoagulations, endovascular embolisation, septodermoplasty, and long-term intranasal dressings. As alternative treatment modalities repeatedly failed and the patient became almost permanently dependent on nasal dressing, we performed a highly conformal intensity-modulated radiotherapy of the nasal cavity; a total dose of 50Gy in 2Gy single fractions was applied. The therapy was very well tolerated, no acute toxicities occurred. Two weeks after the last radiation dose had been applied, the nasal dressing could be removed without problems. Endoscopical control revealed an almost avascular white mucosa without any trace of bleeding spots; previously existing hemangiomas and crusts had disappeared. After a 1-year-follow up, the patient had no significant recurrent epistaxis. [ABSTRACT FROM AUTHOR]

The article presents an overview of epistaxis, which is commonly called nosebleed and effects approximately 60% of all people across the globe at some point in their lives. A discussion of the anatomical features of epistaxis and its causes is presented. Its treatment and associated conditions which may contribute to it are discussed. The case of a 61 year old man who presented to an emergency room with left sided epistaxis that had continued for one hour and was successfully treated, is presented and examined.

The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 70-year-old man with acute epistaxis of the left nostril. Endoscopic examination showed a blood vessel on the upper anterior middle turbinate surface, with acute epistaxis occurring as light suction was applied on it. Suction cautery was applied to the bleeding source and no further episodes of epistaxis were reported at follow-up.

Intractable posterior epistaxis (PE) is a frequent emergency for which different treatment modalities are available. While nasal packing causes extreme discomfort and angiography with consecutive selective embolization is not available everywhere, recent studies emphasize the value of sphenopalatine artery (SPA) occlusion by different techniques and indicate success rates of 13–33%. In our institution, previously endoscopic management of PE consisted either of isolated coagulation of an identified bleeding source (group A) or cutting and coagulation of arterial branches running through the sphenopalatine foramen (SPF) (group B). According to our neuroradiological and rhinological experience we developed a modification of SPA transsection and coagulation following identification of the division in conchal and septal branches of the SPA (group C). During a 26-month period the success rates of these three techniques in 95 patients were compared prospectively. The three modalities revealed a re-bleeding rate of 3 out of 21 (21%) in group A, 1 in 6 (16.7%) in group B and 3 in 69 (4.3%) in group C. At the level of the SPF, 36 out of 69 patients had one conchal branch, whereas 30 (43.5%) had two and 3 (4.4%) had three. If SPA transsection and coagulation for intractable PE is adopted the anatomic varieties of the SPA with its division in conchal and septal branches have to be taken into account. According to our experience the septal branch of the SPA plays a major role in PE. Its occlusion significantly improves the success rate of PE treatment. [ABSTRACT FROM AUTHOR]

Angiographic embolization for the treatment of severe recurrent epistaxis was added to the traditional treatment options--nasal packing, cauterization, and surgical vessel ligation--in 1974. Since then, clinical experience has shown that this procedure is safe and effective. When epistaxis cannot be controlled with cautery, nasal packing is the most common next step. As such, it is often performed by emergency physicians and other clinicians who are not otolaryngologists. We report two cases in which intranasal neoplasms were obscured as a result of a significant distortion of the normal anatomy. This distortion was secondary to emergency-room treatment of severe epistaxis by repeated nasal packing followed by angiographic embolization. Pre-embolization angiographic studies and subsequent postembolization endoscopic evaluations did not reveal the presence of the occult neoplasms because of the presence of inflammation and edema after treatment. Clinicians should be aware that nasal packing and embolization can obscure the underlying source of epistaxis, and follow-up radiologic studies and endoscopic evaluations are essential to avoid delays in diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To determine the action of the Foley catheter in the posterior nasal cavity in relation to balloon volume, and to deduce its implications in the treatment of posterior epistaxis. Design: Human cadaveric study. Materials: Twenty nasal fossae of 10 adult cadavers. Interventions: A Foley catheter (size 14) was inserted into the nasopharynx via each nostril. The catheter balloon was inflated to its recommended maximum volume with 15 mL of water. Firm traction was applied to the catheter. Colored liquid was instilled into the ipsilateral aspect of the nasal cavity, and liquid leakage into the contralateral side was monitored using a nasoendoscope. The balloon was reduced in volume by 1-mL steps, and the same fluid infusion and documentation procedures were performed for each reduced volume until the balloon slipped out of the nose. The procedure was repeated in the opposite nostril. Main Outcome Measures: Successful choanal sealing and anterior balloon shift into the nasal fossa in relation to the balloon size. Results: The Foley catheter balloon sealed the choana without any leakage of infused liquid into the contralateral side at appropriate inflation volumes in 17 (85%) of 20 nasal fossae. Complete sealing between volumes of 12 and 15 mL was achieved in 13 fossae (65%), between 11 and 15 mL in 10 nasal fossae (50%), and between 5 and 15 mL in 3 nasal fossae (15%). Failure to seal at any volume occurred in 3 nasal fossae (15%). Bimodal seal (ie, complete seal at high [15 mL] and low volumes [4-7 mL], but leakage in intermediate volumes) occurred in 3 nasal fossae (15%). The balloon remained in the nasopharynx under traction and did not slip past the choanal rim to encroach on the middle and inferior turbinates until the balloon volume was reduced to between 4 and 7 mL. The balloon slid out of the nose at a volume of 5 mL or less. The inflation volumes ranging from 8 to 12 mL were statistically more effective in sealing the choana than lower volume... [ABSTRACT FROM AUTHOR]

The danger to healthcare personnel of acquiring a blood-borne infection accidentally transmitted by a patient is well known. Such an infection can have serious and career-altering implications. Epistaxis, which is the most common emergency seen in ENT practice, poses a great risk of contaminated blood being spattered on the face of the attending medical provider. Areas of possible contamination include the mucosa of the nasal passages, oralcavity, and conjunctiva. Various strategies to prevent contamination have been described in the literature, most of which involve the wearing of protective equipment by the healthcare provider. We conducted a prospective, randomized study of 60 epistaxis patients to determine if a simple surgical mask warn by the patient over his or her mouth would protect the treating physician from aerosolized blood contamination. We found evidence of significant blood splashes on the physician in 8 of the 30 cases (26.7%) in which the patient did not wear a mask, compared with only 4 cases (13.3%) when the mouth mask was worn. We therefore conclude that a patient mouth mask is a simple, inexpensive, and effective way to minimize the risk of aerosolized blood contamination during the treatment of epistaxis. [ABSTRACT FROM AUTHOR]

The present report describes Ehrlichia canis infection in six thrombocytopenic dogs and role of Tranexamic acid in controlling bleeding. Dogs with history of epistaxis, dullness, depression, anorexia and high fever were observed with tachycardia, enlarged pre scapular lymph nodes and pale mucus membranes. Diagnosis was confirmed by heamatobiochemistry and microscopic examination of peripheral blood smears. All dogs were successfully treated with Doxycycline, Prednisolone, Tranexamic acid and supportive therapy. Tranexamic acid was found to be effective haemostatic drug in controlling nasal bleeding in canine ehrlichiosis without any adverse effect along with Doxycyline. [ABSTRACT FROM AUTHOR]

We have used cryotherapy as an office treatment for severe posterior nasal epistaxis for 15 years. In 1971 we reported a retrospective study on 42 consecutive patients with severe posterior nasal bleeding; 26 had cryotherapy and 16 had anterior and posterior nasal packing. Our data showed that cryotherapy controlled epistaxis with less morbidity. We have now used cryotherapy for posterior epistaxis in over 450 patients. In this presentation we review the history of cryotherapy, rationale for treatment with cryotherapy, experimental tissue changes in cryotherapy, and the method for freezing in cryotherapy. We then discuss 50 recent patients with severe posterior nasal bleeding whom we have treated with cryotherapy. We have found that cryotherapy is a successful way to manage patients with severe posterior nasal bleeding. [ABSTRACT FROM AUTHOR]

Increased mortality and arterial hypoxemia have long been associated with posterior nasal packs placed for control of severe epistaxis. Several authors have postulated a nasopulmonary reflex to partially explain this clinically observed phenomenon. In ten young, healthy subjects, using a multiparameter pulmonary evaluation, posterior nasal packs were placed and no significant changes were observed in lung volumes, flow and alveolar gas exchange, especially oxygenation. These findings suggest that aspiration, sedation, and degeneration of pulmonary function with age, not a nasopulmonary reflex, have not been adequately emphasized in previously performed studies. [ABSTRACT FROM AUTHOR]

Describes the procedure called septal dermoplasty and proposes its use in the permanent control of nosebleed in patients with hereditary hemorrhagic telangiectasia. Genetics and pathology of the disorder; Symptoms; Older treatments.

Recurrent epistaxis (nose bleeds) are common in children. The vast majority of nose bleeds are self-resolving and do not require medical input. Clinicians get involved in cases where the nose bleeds are more severe, frequent and take a longer time to resolve. Emergency management involves basic resuscitation and first aid measures. A holistic approach is required, when dealing with non-emergency cases of frequent nose bleeds, including the exclusion of systemic illness. In this article we outline the basic history, examination, investigation and management aspects of evaluating a paediatric patient with epistaxis. We aim to provide a brief road map for clinicians dealing with cases of recurrent epistaxis in the pediatric population. [ABSTRACT FROM AUTHOR]

Objectives:To report a case of life-threatening epistaxis in a pregnant patient, describe the links between pregnancy and epistaxis, and discuss the management of such cases. Life-threatening epistaxis in pregnancy is rare, and there are no specific evidence-based guidelines regarding the management of these patients.Case report:A 31-year-old primigravida presented with severe epistaxis in the second trimester of her pregnancy. Conservative measures failed, thereby necessitating surgical intervention.Conclusion:This case illustrates the importance of a multidisciplinary approach in the management of a pregnant patient presenting with severe epistaxis, and highlights the surgical challenges presented in such a situation. [ABSTRACT FROM PUBLISHER]

Abstract: Dyskeratosis congenita, an inherited disorder of telomere accretion primarily affects ectoderm, manifesting as skin, nail and mucosal changes. We here present a novel association of dyskeratosis congenita with systemic lupus erythematosus in a 10-year-old female. The patient had classical triad of lacy reticular skin pigmentations, nail dystrophy and mucosal leukoplakia. Also, she had pancytopenia, blepharitis, nasolacrimal duct obstruction, dental decay with gingival recession, tooth loss, hirsutism and atrophic scarring of palms. On funduscopy, pre-retinal and superficial flame shaped haemorrhages were present. Anti-double stranded DNA antibody and antinuclear antibodies were positive. On treatment with steroids, partial response was seen. It is further emphasized the need to investigate for markers of systemic lupus erythematosus in every case presenting as dyskeratosis congenita to establish the causal relationship between dyskeratosis congenita and systemic lupus erythematosus. [Copyright &y& Elsevier]

Objective:We report a case of traumatic cerebrospinal fluid rhinorrhoea following nasal packing with a Rapid Rhino inflatable balloon pack, as treatment for epistaxis.Method:Case report and review of the literature regarding this complication.Results:A thorough literature search was performed using PubMed. To our best knowledge, there have been no previous reports of cerebrospinal fluid rhinorrhoea following nasal packing. In our case, cerebrospinal fluid leakage occurred due to fracture of the middle turbinate at its superior skull base insertion. The cerebrospinal fluid leak resolved spontaneously without the need for surgical intervention.Conclusion:This case report highlights not only the need for an appreciation of sinonasal anatomy and the potential risks associated with nasal packing, but also the need for adequate training in the use of commercially available nasal packs by medical practitioners attending patients with epistaxis. [ABSTRACT FROM PUBLISHER]

The management of intractable posterior epistaxis is challenging for any physician. Nasal packing, often combined with use of an endonasal balloon system, is painful for the patient, and torturous to maintain for two to three days. If conservative treatment fails, the most commonly used treatment options are currently invasive procedures such as endoscopic coagulation of bleeding arteries, external ligation and, rarely, embolisation. This paper describes a simple, non-invasive technique of treating posterior epistaxis with hot water irrigation. Technical information is presented, and the benefits of the method are discussed. [ABSTRACT FROM PUBLISHER]

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients--43 men and 31 women (mean age: 64.4 yr)--who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients. [ABSTRACT FROM AUTHOR]

Olfactory neuroblastoma (esthesioneuro - blastoma) is a rare malignant tumor of neuroectodermal origin. With only about 1,000 cases reported, there are no clear guidelines regarding management of this disease. Intracranial extension and orbital involvement have been shown to be independent risk factors associated with poorer outcomes. We hereby report a case of a 46-year old male presented with an 8-month history of progressive nasal obstruction and intermittent right-sided epistaxis associated with anosmia and increased pressure sensation in and around the right eye. Further evaluation revealed a large enhancing heterogeneous cystic and solid mass in the right nasal cavity measuring 5.0×5.3×4.6 cm with extension superiorly into the anterior cranial fossa and frontal lobes, ethmoid and sphenoid sinuses. A biopsy of this mass confirmed high grade olfactory neuroblastoma. Because of the intra-cranial extension, a decision was made to start neoadjuvant chemotherapy with cisplatin and etoposide.The patient had very good response to this treatment on a repeat imaging study and wenton to have resection of this mass. Post-operatively, he received radiation therapy to the tumor bed and 2 more cycles of chemotherapy. He has been followed now for more than 8 months with no evidence of disease recurrence. [ABSTRACT FROM AUTHOR]

Maxiller artery embolisation with polyvinyl alcohol is used for the treatment of interactable epistaxis as a safe and effective procedure. In this paper, a rare but devastating complication of this procedure is reported. [ABSTRACT FROM AUTHOR]

AbstractObjective:We present a rare and clinically relevant anomaly of the sphenopalatine artery in relation to its blood supply of the nasal mucosa, with implications for the management of epistaxis.Method:Case report and review of the world literature, using Medline through Pub Med (1950?2005), EMBASE (1980?2005) and Ovid (1958?2005), searching for papers using a combination of terms including ?spheno-palatine artery?, ?anterior ethmoidal artery? and ?epistaxis?.Results:In the presented case of refractory epistaxis, endoscopic and subsequent endovascular management failed to identify a significant supply from the sphenopalatine arteries bilaterally. The main supply was found to be from the anterior ethmoidal arteries.Conclusion:After a detailed search, the authors failed to locate any similar case in the English literature. [ABSTRACT FROM AUTHOR]

AbstractIntroduction:After treatment of epistaxis, patients are routinely supplied with an intranasal bactericidal cream containing neomycin. Neomycin cream is effective in preventing recurrent paediatric epistaxis. This study aimed to assess whether there is an increased rate of nasal bacterial infections in adult epistaxis patients.Methods:Between October 2004 and April 2005, nasal swabs were taken from adult patients presenting with epistaxis, and from a control group comprising elective ENT patients.Results:There were 23 controls and 26 epistaxis patients. Staphylococcus aureuswas grown in 21 per cent and 23 per cent, respectively. There was no significant difference in bacterial carriage rates between the epistaxis and control groups.Conclusions:The epistaxis and control groups demonstrated the same bacterial species and the same proportion of bacterial carriage. Although the majority of bacterial species encountered were sensitive to neomycin, a significant proportion was not. These results do not support the routine use of neomycin in the prevention of recurrent adult epistaxis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the guidelines on managing idiopathic epistaxis in adults.

The article offers information on the publication on nosebleed that was endorsed by the American Academy of Pediatrics (AAP) in January 2020.

The article mentions new clinical practice guidelines of 14 key actions for managing epistaxis in emergency department (ED) encounters as of April 2020.

Embolization of external carotid vessels in the treatment of intractable epistaxis is not well documented in Australasia. The aim of the present retrospective study was to audit our experience with the technique, and to compare it with other centres.Retrospective review.Twenty-nine embolizations were performed in 28 patients. Embolization was successful in 24 out of 28 patients (86%). Three patients required ligation of the anterior ethmoidal arteries, one of whom subsequently underwent successful repeat embolization. There were minor complications in 6/29 procedures (21%), and no major complications.Our outcomes compare favourably with those of larger centres. Embolization is an effective tool in the management of patients with intractable epistaxis. [ABSTRACT FROM AUTHOR]

teymoortash a., sesterhenn a., kress r., sapundzhiev n. & werner j. a. (2003) Clin. Otolaryngol. 28, 545–547 There are no uniformly accepted criteria for the management of epistaxis. The usefulness of ice application in the treatment of epistaxis as a first aid method is not generally accepted, but is widespread. In order to evaluate the effect of cold application on the blood vessels of the nasal mucosa, their blood flow and blood content were investigated on 56 healthy volunteers before and after exposure to cold in the neck area. Nasal mucosal microcirculatory blood flow was measured directly by non-invasive laser Doppler flowmetry in Kiesselbach's area. Changes in the nasal mucosal blood content were estimated using a conventional computer-aided rhinomanometer by measuring alterations in nasal airflow. After ice application in the neck area, no statistically significant effects on the blood vessels of the nasal mucosa were seen. These results do not support the usefulness of this manoeuvre in the treatment of epistaxis. [ABSTRACT FROM AUTHOR]

The article reports on topics related to nosebleed trainer using three dimensional (3D) printing. Topics mentioned include the development of 3D printing, the computed tomography (CT) scanning, and the importance of 3D printing nosebleed training in nosebleed practice treatment and diagnosis. Also mentioned was the importance of computer simulation in nosebleed trainer.

The article offers information on the national audit of epistaxis management, which mention that the team decided the standards de novo to audit care based on a suite of comprehensive literature reviews.

Reports on the use of internal maxillary artery embolization as the definitive treatment of epistaxis in the pediatric patient. Therapeutic modalities in children; Failure rate in internal maxillary artery ligation.

Several clinical studies have associated nasal packing in the treatment of epistaxis with hypoxemia on the basis of a possible nasopulmonary reflex. In 10 patients with epistaxis using a pneumatic nasal pack with central airway that allows a limited airflow, no changes in arterial blood gas tensions were observed. Forced expiratory volume measures were also without significant changes. The results indicate that the nasal packs used do not cause any clinically important alveolar hypoventilation or changes in arterial oxygenation. None of the patients had chronic obstructive pulmonary disease, and it is therefore still important to be aware of hypoxemia as a possible complication to nasal packing, especially in old patients with chronic obstructive pulmonary disease, irrespective of the kind of nasal pack used. [ABSTRACT FROM AUTHOR]

Focuses on the laser treatment of recurrent epistaxis in hereditary hemorrhagic telangiectasia (HHT). Role of laser photocoagulation in telangiectatic vessels; Use of the Nd:YAG laser to treat individuals suffering from HHT; Focus on the results of Nd:YAG laser irradiation in view of all treatment modalities proposed for the treatment of recurrent epistaxis in HHT.

The article focuses on the description of anterior-posterior nasal packing for patients suffering from epistaxis. It notes the advantages of the Rapid Rhino inflatable device, Foley urinary catheter for posterior technique, and using oxymetazoline (Afrin) preventing the potential cardiovascular effects of phenylephrine and concentrated epinephrine.