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Copyright of Polish Otorhinolaryngological Review / Polski Przegląd Otorynolaryngologiczny (Index Copernicus) is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

About one in seven accidents involving children occurs at school. Roughly 70% of these accidents involve children under the age of 12 years. Thus, primary school teachers may be confronted with accidents where first aid could improve the outcome. Despite the importance of first-aid knowledge among teachers, little is known about this topic. To fill this gap, we conducted case-based survey research on the objective and subjective first-aid knowledge of primary school and kindergarten teachers in Flanders, Belgium. An online survey was distributed to primary school and kindergarten teachers. It included 14 hypothetical first-aid scenarios in a primary school context to assess objective knowledge, along with one item to assess subjective knowledge. A total of 361 primary school and kindergarten teachers completed the questionnaire. The participants achieved an average knowledge score of 66%. Those who had completed a first-aid course had significantly higher scores. Knowledge regarding child CPR was amongst the lowest, with only 40% correct answers. Structural equation modeling showed that only previous first-aid training, recent experience with first aid, and subjective first-aid knowledge were linked to teachers' objective first-aid knowledge—particularly for basic first aid. This study shows that completing a first-aid course and completing a refresher course can predict objective first-aid knowledge. We therefore recommend that first-aid training and regular refresher courses should be mandatory in teacher training, given that a large share of teachers may need to apply first aid to a pupil at some point during their career. [ABSTRACT FROM AUTHOR]

Background and Objectives: Epistaxis is one of the most common emergencies in otolaryngology, and the recently developed Rapid Rhino nasal pack, a balloon-type nasal packing device, is widely used in emergency departments. Rebleeding after initial treatment increases patients' discomfort and medical costs. The aim of this study was to investigate risk factors for rebleeding in patients treated with Rapid Rhino packing. Methods: In this retrospective study, 93 patients with epistaxis treated with Rapid Rhino from January 2020 to November 2022 were divided into the well-controlled group (39 patients) and the rebleeding group (54 patients), and the baseline characteristics, management methods, and complications were compared between these groups. The rebleeding group was divided according to whether patients experienced a single episode of rebleeding (38 patients) or multiple rebleeding episodes (16 patients), and the differences between these two groups were compared. Results: Oral anticoagulation therapy was associated with a higher risk of rebleeding after Rapid Rhino packing (odds ratio [OR]= 8.41, p=0.047). A history of nasal surgery was associated with multiple rebleeding (OR=22.55, p=0.009). Age, sex, the management method, complications, and the site of bleeding were not found to be related to rebleeding. Conclusion: Patients with rebleeding after Rapid Rhino nasal packing had a higher rate of concurrent oral anticoagulation therapy. A history of nasal surgery was strongly associated with multiple episodes of rebleeding. A detailed medical history can be important for assessing the risk of rebleeding in epistaxis patients treated with Rapid Rhino packing. [ABSTRACT FROM AUTHOR]

Background: Risk factors and outcomes associated with severe epistaxis are not well understood. This study explores the associations between epistaxis severity, comorbidities, use of antiplatelets or anticoagulants and management outcomes. Methods: This is a retrospective cross‐sectional study of all epistaxis cases presenting to the emergency department at a tertiary academic hospital from January 2016 to December 2019. Epistaxis severity was defined as mild (no intervention), moderate (required cautery and/or packing) and severe (clinical instability with reversal products, surgical or radiological intervention). Univariable and multivariable regression analyses were undertaken, with risk factors and management outcomes analysed according to severity. Results: A total of 543 patients with epistaxis (54.2% male, mean age 74.4 ± 15.7 years) were included in this study, with 14.7% (80) having severe epistaxis. Of these presentations 216 (39.8%) were on antiplatelets, while 207 (38.1%) were on anticoagulants. In univariate analyses, clopidogrel use, hereditary haemorrhagic telangiectasia (HHT), haematological malignancy, bleeding disorders and chronic liver disease (CLD) were associated with moderate to severe epistaxis (P < 0.05), while the use of rivaroxaban was inversely associated severity (P = 0.002). Only HHT, haematological malignancy and CLD remained significant in multivariate models. Cautery as first‐line management was infrequently utilized while anticoagulation was frequently withheld. A longer length of stay (1.1 days vs. 4.3 days; P < 0.001) and higher 2‐week readmission rates (2.2% vs. 12.5%; P < 0.001) were noted with severe epistaxis compared with mild presentations. Conclusion: Epistaxis severity is associated with certain clinical conditions and poor outcomes. Despite recommended guidelines, variations in first‐line management were evident. [ABSTRACT FROM AUTHOR]

The purpose of this study is to (1) to determine if treatment of underlying allergic rhinitis (AR) in children will affect epistaxis outcome, (2) to compare efficacy of three outpatient AR treatment regimens in epistaxis outcomes, and (3) to investigate potential factors in the pathogenesis of epistaxis with underlying AR. A single-blind randomized-controlled study was conducted in the Otolaryngology clinic in KK Women's and Children's Hospital. Sixty children aged below 18 years with underlying untreated AR, with first presentation of epistaxis, were randomized to three different AR treatments: treatment 1, antihistamine (20 patients); treatment 2, nasal steroid spray (20 patients); and treatment 3, both antihistamine and nasal steroid spray (20 patients). Epistaxis severity and frequency were assessed. Pre-treatment, 95% of patients within each of the three treatment groups described epistaxis symptoms. Post-treatment, there was improvement in epistaxis outcome (resolution of epistaxis) with 20% (4/20), 40% (8/20), and 60% (12/20) of patients in treatment groups 1 (antihistamine), 2 (nasal steroid spray), and 3 (combined therapy) respectively, who reported resolution of epistaxis. Treatment regimens containing nasal steroid spray resulted in greater improvement of epistaxis severity and frequency. Combined therapy (treatment 3) resulted in the best epistaxis outcome at 1-month follow-up. Majority (90%) reported nose-picking/rubbing behavior. Conclusions: Intranasal corticosteroids are superior to oral antihistamines in relieving itch or rhinorrhea in AR. Intranasal corticosteroids may be important in treating epistaxis with underlying AR, because digital trauma from itch/rhinorrhea-related nose-picking/rubbing frequently leads to epistaxis. Results from this study will be important to primary and emergency physicians, community pediatricians, and pediatric allergists and otolaryngologists. What is Known: • Childhood epistaxis commonly co-exists with allergic rhinitis (AR), causing significant symptoms and distress to patients. • There are currently no studies reporti ng on epistaxis outcome aft er treatment of underlying AR. What is New: • This is a single-blind randomized-controlled study of 60 children aged below 18 years with underlying untreated AR, with first presentation of epistaxis to a children's hospital in Singapore Patients were randomized to three different regimens to treat AR: treatment 1, antihistamine; treatment 2, nasal steroid spray; and treatment 3, both antihistamine and nasal steroid spray. • Treatment regimens containing nasal steroid spray improved epistaxis outcomes, with combined therapy of antihistamine and nasal steroid spray resulting in the best outcome for resolution of epistaxis among the three treatment regimens. [ABSTRACT FROM AUTHOR]

Study Design: Cross sectional. Background: Epistaxis is one of the most common otorhinolaryngological emergencies affecting the majority of the population in their lifetime, with some of population requiring serious medical attention. This study aimed to assess the prevalence and associated factors of epistaxis among random people lives in Asser region in Saudi Arabia. Method: A cross-sectional study of Saudi community in Asser region. This study intended to assess the prevalence of Epistaxis among male and female. Other objectives, included exploring any associated risk factors of Epistaxis among Saudi community in Asser region. Data were collected through pre-tested interviewee administered questionnaire divided into several sections. Result: 400 participants, 80.3% of them were female and 19.7% of them were male. The overall epistaxis prevalence was 22.9%. This study found a link between epistaxis and duration, frequency of epistaxis, seasons, psychological stress, a family history of epistaxis, high blood pressure, cardiac disease, hematological disease, smoking, allergy, use of nasal spray, and head trauma. and duration of epistaxis. Conclusion: This study revealed that the level of epistaxis among Asser region population is significantly associated with summer season, hypertension, cardiac diseases, hematological diseases, face trauma, allergy, stress and smoking. It is better to work on increase the awareness about the meaning of epistaxis and identify the main and important causes and factors may lead to it. [ABSTRACT FROM AUTHOR]

Background: Nasopharyngeal bleeding (epistaxis) could really occur in the anterior and posterior components of something like the respiratory system, with medial and lateral internal bleeding amplifies from the rich vasculature extravascular space of something like the mucus (Kiesselbach's plexus), and is more common in teens and young adults, whereas anterolateral epistaxis (bleeding first from nasal passages) does seem to be more prevalent in the elderly. Methods: The collected data were coded and analysed by using a database software program, Statistical Package for Social Science. Quantitative variables were expressed as the mean ± standard deviation (SD) while the qualitative variables were expressed as a number and percentage. The statistical method was used for comparing the percentage of more than two groups and the student was used for comparing between two groups. The results will be considered statistically significant when the significant probability. Results: It was very clear that the participants from both male and female are largely from the age group of 19 to 29 years. In this age group the number of male participants was 406 and the number of female participants 998. The age group 50 consisted of 55 male participants and 69 female participants in the survey group. The legs from 18 or less than 18 age group. Conclusion: The major technique of data acquisition assured that the participants' privacy was respected. All data obtained was used solely for research purposes; the investigator also has no personal interest inside the information. The material was saved in the researcher's smartphone's personal databases and was kept remain until the study trial or sentencing was finished. [ABSTRACT FROM AUTHOR]

Objectives: We assessed the effects and safety of endoscopic septoplasty in patients with nasal septal deviations (NSD), compared with those of conventional septoplasty. Design and Setting: Systematic review and meta‐analysis. Participants: Patients who have undergone various endoscopic septoplasty procedure, such as hemitransfixion incision, incision at the deviated site and Killian incision, and conventional septoplasty. Main Outcome Measures: Six databases were searched up to April 2022. We analysed studies comparing improvements in NSD‐related symptoms and post‐operative complications between endoscopic septoplasty and control (conventional septoplasty) groups. Results: A total of 38 articles with 2733 individuals were included. There were no significant differences in operative time (−0.4354, 95% confidence interval [CI: −1.1670; 0.2962]) or intra‐operative bleeding (−1.3011 [−2.8003; 0.1981]) between the two groups. In the endoscopic septoplasty group, the change in nasal obstruction symptom evaluation score (9.5143 [5.4613; 13.5674] was statistically higher and the incidence of mucosal tearing (0.2766 [0.1889; 0.4049]) was lower. The incidences of full relief from symptoms such as headache (2.1996 [1.6896; 2.8634]), hyposmia (4.4468 [2.6806; 7.3767]), nasal obstruction (5.9871 [4.3292; 8.2800]), post‐nasal drip (4.7241 [3.4086; 6.5472]) and snoring (2.9980 [1.2622; 7.1211]) were significantly higher in the endoscopic septoplasty group. In terms of post‐operative endoscopic findings, epistaxis (0.3043 [0.1969; 0.4703]), hematoma (0.2022 [0.0785; 0.5213]), nasal obstruction 0.3373 [0.1334; 0.8527]), residual posterior septal deviation (0.1562 [0.0921; 0.2650]), septal perforation (0.2286 [0.1069; 0.4889]), residual spur (0.1294 [0.0602; 0.2780]) and synechia (0.2537 [0.1849; 0.3483]) were significantly less common in the endoscopic septoplasty group. Conclusion: Endoscopic septoplasty better relieved NSD‐related symptoms and reduced surgery‐related complications compared to conventional septoplasty. [ABSTRACT FROM AUTHOR]

Septal perforation is a nasal condition discovered incidentally during an ENT clinical examination. Sometimes, patients may experiment epistaxis, septal crusts at the edge of perforation, nasal obstruction, whistling, rhinorrhea or even pain. Doctors should be familiarized with the etiology of septal perforations in order to apply the best treatment possible. This etiology includes some of the following: iatrogenic, self-injury, drugs, inflammatory diseases, etc. A very good anamnesis and clinical examination should be performed. Also, paraclinical investigations are required depending on the particular situation. Treatment should be individualized and may include conservational techniques or applying of grafts/flaps for closing the septal perforation. In this article, some of the most frequent causes of septal perforation are reviewed, with some examples from our clinic and short reminder of steps to be taken in this case. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Food Safety & Food Quality / Archiv für Lebensmittelhygiene is the property of Presse Dienstleistungsges. mbH & Co. KG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hemophilic pseudotumor is a rare, yet dangerous complication of hemophilia. It has been reported previously at sites prone to recurrent trauma like long bones and pelvis. However, in the field of otorhinolaryngology, few cases are reported and therefore there is no established protocol for management. We hereby report a case of a 2-year-old boy, a known case of hemophilia A (factor VIII deficiency), who presented with recurrent epistaxis not responding to medical management. Imaging was done and revealed a heterogenous nasal mass compressing the left orbital wall, extending to the sphenoid sinus, and causing skull base erosion. The patient was successfully managed by evacuation and drainage of the pseudotumor via endoscopic endonasal approach and replacement of factor VII pre-and post-operatively. To our knowledge, this is the first case of nasal hemophilic pseudotumor managed by evacuation and drainage through an endoscopic endonasal approach, which was deemed successful. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 6-year-old girl with Fanconi anaemia who developed miliaria crystallina-type rash as an unusual presentation of acute graft versus host disease (GVHD) following hematopoietic stem cell transplant (HSCT). Topics include the clinical presentation, management, and implications of miliaria crystallina as a manifestation of acute GVHD post-HSCT, underscoring the importance of recognition and treatment of atypical skin manifestations in transplant recipients.

Introduction and Objective: Angiomatous nasal polyps are distinct variants, constituting only 2%--5% of all sinonasal polyps. The heretofore-reported case of angiomyomatous nasal polyp is a unique entity and is infrequently reported in the literature. Case Report: A 56-year-old male presented with chief complaints of intermittent epistaxis, progressive obstruction of the left nasal cavity, and discharge for 8 months. An endoscopic examination of the nasal cavity was performed, which showed a soft, fleshy polypoid mass in the left lateral wall posterior to the posterior end of the middle meatus with no active bleeding. The clinical findings led to a provisional diagnosis of an antrochoanal polyp, whereas computed tomography gave an impression of an angiomatous polyp, and then the patient was taken up for endoscopically-assisted excision of the nasal mass. The surgery was performed under general anesthesia. Histopathological examination reported it to be an angiomyomatous nasal polyp. The patient's recovery was uneventful, and follow-up revealed no remission. Conclusion: Angiomyomatous nasal polyps are a unique entity that can be difficult to diagnose with differentials. Endoscopic resection is the treatment of choice, and local recurrence is unlikely. [ABSTRACT FROM AUTHOR]

Objective: Epistaxis is one of the most common emergencies presenting to the ENT service, and silver nitrate cautery is the mainstay of epistaxis treatment in most centres worldwide. This review aimed to ascertain the historical evidence behind current common practice. Method: A review was conducted of historical published literature pertaining to epistaxis management. Results: Silver in medicine dates back to 4000 BC, with silver nitrate first being used in 69 BC. Modern medical use for epistaxis is documented in case reports over the last 200 years. Conclusion: The precise origin and evidence-based practice of using silver nitrate for epistaxis is not well-established or understood. The mechanism of action is questionable; novel research of silver nitrate for this common ENT emergency presentation may be required. [ABSTRACT FROM AUTHOR]

Purpose: COVID-19 pandemic transformed the health system response worldwide. The aim of this study is to report changes about numbers and reason for ENT consultations in emergency department (ED) during COVID-19 pandemic comparing with those occurred the previous year (2019). Methods: Data about patients admitted to adult and pediatric ED were collected from March 1 to May 31, 2019 and 2020. Patients referred for urgency from general practitioners were excluded from the study. Results: Global ED admission (except for dyspnea or COVID-19–related symptoms) dramatically decreased during pandemic (−50.9% among adults and −71.4% among pediatrics). At the same time, ENT consultancy significantly reduced too, by 71.5% (P <.01) among adults and 45.1% (P <.01) for pediatrics. Among adults, it was reported a statistically significant decrease in consultation for ear problems (−88.5%, P =.0146). Reduction in ENT referral for bone fracture (−40%, P =.059), vertigo (−77.8%, P =.637), and tonsillitis (−87.5%, P =.688) was consistent, but not significant. Among pediatric patients, it was observed an increase by 25% about foreign bodies (12 vs 15, P <.01). A reduction in numbers of consults for ear problem (−90.8%; P =.045), epistaxis (−80%; P =.196), and nasal fracture (−70%; P =.36) was also observed. Conclusion: Fear of infection and the forced lock down caused a significant decrease in the number of ED accesses and in ENT consultancy. These data may suggest that some ED referral usually could be deferred, but on the other hand, pandemic will cause a great diagnostic delay. [ABSTRACT FROM AUTHOR]

A painless and effective treatment of childhood epistaxis is needed. To observe the effectiveness of low-intensity diode (Lid) laser in treating epistaxis complicated with allergic rhinitis in children. Our study is a prospective, randomized, controlled, registry trial (NO. 202001201) involving 44 recurrent epistaxis children (<14 years old) with or without Allergic Rhinitis (AR) in our hospital. They were divided randomly into the Laser and Control groups. The Laser group was treated with Lid laser (wavelength 635 nm, power 15mW) for 10 min after nasal mucosa was moistened with normal saline (NS). The Control group moistened their nasal cavities with NS only. Children in two groups complicated with AR were given nasal glucocorticoids for 2 weeks. The effectiveness of Lid laser in treating epistaxis and AR were compared between the two groups after treatment. After treatment, the effective rate of the Laser group in epistaxis (23/24, 95.8%) was higher than the Control group (16/20, 80%) (p <.05). The VAS scores of the children complicated with AR in the two groups both improved after treatment, however, the variation of VAS score (3.02 ± 1.50) in the Laser group was greater than the Control group (1.83 ± 1.56) (p <.05). As a safe and efficient method, Lid laser treatment can effectively alleviate epistaxis and inhibit symptoms of AR in children. [ABSTRACT FROM AUTHOR]

Soft tissue mineralization and epithelial ulceration are common findings in dogs with uremia, being commonly reported in the gastrointestinal tract, lungs and pleura. This report described a case of nasal mucosal mineralization and ulceration contributing to recurrent epistaxis in a dog with chronic renal failure and uremia. A dog with recurrent epistaxis accompanied by elevated urea and creatinine was hospitalized. Platelet count and coagulation tests were within normal limits. Chronic renal failure was diagnosed, and the dog was euthanized. On necropsy, the kidneys were small, with an irregular capsular surface. The nasal conchae were slightly reddish. Histopathology revealed chronic glomerulonephritis, with gastric mineralization and bilateral parathyroid hyperplasia. Vascular and basal lamina mineralization, epithelial ulceration and hemorrhage were seen in the nasal conchae. The observed findings indicated that nasal mineralization and ulceration were caused by uremia. The severity of histopathological findings suggested that nasal mineralization/ulceration may have caused or at least contributed to epistaxis in this dog. We hope to stimulate further investigations into possible association between uremia, nasal mucosa mineralization/ulceration and epistaxis in dogs. [ABSTRACT FROM AUTHOR]

Objectives: Hereditary hemorrhagic telangiectasia (HHT) is a common inherited condition characterized by mucosal telangiectasias, recurrent epistaxis, and arteriovenous malformations. HHT results in detriment to quality of life. Morbidity and mortality result from severe anemia. Conventional interventions for HHT-related epistaxis include nasal packing, diathermy, lasers, coblation, microdebridement, bevacizumab (topical and systemic), as well as septodermoplasty and nasal closure. Sclerotherapy has been recently described in the literature as a novel approach to HHT-related epistaxis. We hypothesize that sclerotherapy is an effective treatment for HHT-related epistaxis and improves upon the current standard of care for this disease. Methods: A systematic review was conducted to study sclerotherapy for treating HHT-related epistaxis. Ovid MEDLINE, Ovid EMBASE, Scopus, and Web of Science were searched. Articles were evaluated and excluded according to PRISMA guidelines and reviewed by 2 authors. Reported variables included number of injections, months of follow up, changes in Epistaxis Severity Score, previous treatments used to control epistaxis, and post-injection side effects. Results: Seven studies with a total of 196 patients met inclusion criteria. Three studies reported significant improvement as measured by the Epistaxis Severity Score scale. One reported improvement through subjective patient surveys and others used the Bergler-Sadick scale to measure frequency and intensity of epistaxis. All studies reported improvement in HHT-related epistaxis. The lack of uniform reporting measures however precluded formal meta-analysis. Conclusions: Based on limited data, sclerotherapy appears to be effective for treating HHT-related epistaxis and offers promise for treating this recalcitrant condition. However, larger, prospective, multi-centered studies using universally validated instruments for epistaxis are needed to definitively evaluate outcomes from sclerotherapy. [ABSTRACT FROM AUTHOR]

Objective: To perform a systematic review to investigate the common presenting symptoms of barosinusitis, the incidence of those findings, the methods for diagnosis, as well as the medical and surgical treatment options. Methods: A review of PubMed/MEDLINE, EMBASE, and Cochrane Library for articles published between 1967 and 2020 was conducted with the following search term: aerosinusitis OR "sinus squeeze" OR barosinusitis OR (barotrauma AND sinusitis) OR (barotrauma AND rhinosinusitis). Twenty-seven articles encompassing 232 patients met inclusion criteria and were queried for demographics, etiology, presentation, and medical and surgical treatments. Results: Mean age of patients was 33.3 years, where 21.7% were females and 78.3% were males. Causes of barotrauma include diving (57.3%), airplane descent (26.7%), and general anesthesia (0.4%). The most common presentations were frontal pain (44.0%), epistaxis (25.4%), and maxillary pain (10.3%). Most patients received topical steroids (44.0%), oral steroids (28.4%), decongestants (20.7%), and antibiotics (15.5%). For surgical treatment, most patients received functional endoscopic sinus surgery (FESS) (49.6%). Adjunctive surgeries include middle meatal or maxillary antrostomy (20.7%), septoplasty (15.5%), and turbinate surgery (9.1%). The most efficacious medical treatments are as follows: 63.6% success rate with oral steroids (66 treated), 50.0% success rate with topical steroids (102 treated), and 50.0% success rate analgesics (10 treated). For surgical treatments received by greater than 10% of the sample, the most efficacious was FESS (91.5% success rate, 108 treated). Conclusion: Oral and topical steroids should be first line therapies. If refractory, then functional endoscopic sinus surgery is an effective treatment. [ABSTRACT FROM AUTHOR]

Background: Although recent studies have identified an association between race and adverse outcomes in head and neck surgeries, there are limited data examining the impact of racial disparities on adult inpatient outcomes following epistaxis management procedures. Objective: To analyze the association between race and adverse outcomes in hospitalized patients undergoing epistaxis treatment. Methods: This retrospective cohort analysis utilized the 2003 to 2014 National Inpatient Sample. International Classification of Diseases, Ninth Revision codes were used to identify cases with a primary diagnosis of epistaxis that underwent a procedure for epistaxis control. Cases with missing data were excluded. Higher total charges and prolonged length of stay (LOS) were indicated by values greater than the 75th percentile. Demographics, hospital characteristics, Elixhauser comorbidity score, and complications were compared among race cohorts using univariate chi-square analysis and one-way analysis of variance (ANOVA). The independent effect of race on adverse outcomes was analyzed using multivariate binary logistic regression while adjusting for the aforementioned variables. Results: Of the 83 356 cases of epistaxis included, 80.3% were White, 12.5% Black, and 7.2% Hispanic. Black patients had increased odds of urinary/renal complications (odds ratio [OR] 2.148, 95% confidence interval [CI] 1.797-2.569, P <.001) compared to White patients. Additionally, Black patients experienced higher odds of prolonged LOS (OR 1.227, 95% CI 1.101-1.367, P <.001) and higher total charges (OR 1.257, 95% CI 1.109-1.426, P <.001) compared to White patients. Similarly, Hispanic patients were more likely to experience urinary/renal complications (OR 1.605, 95% CI 1.244-2.071, P <.001), higher total charges (OR 1.519, 95% CI 1.302-1.772, P <.001), and prolonged LOS (OR 1.157, 95% CI 1.007-1.331, P =.040) compared to White patients. Conclusion: Race is an important factor associated with an increased incidence of complications in hospitalized patients treated for epistaxis. [ABSTRACT FROM AUTHOR]

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients (52.9%), and oroantral fistula was noted in 37 patients (55.9%). Additionally, 67 (95.7%) of the patients complained of nasal obstruction. Similarly, facial asymmetry was observed in 69 (98.6%) of the patients and double vision was observed in 24 (34.4%). Tumors of the maxillary sinus have a very insidious course of spread and uncertain clinical signs and symptoms. What makes diagnosis worse is the fact that the symptoms of these tumors are so well hidden in the sponge-like nature of the midfacial region that they are easily misinterpreted by patients. Therefore, diagnoses must be made early, dentists must be vigilant, and patients must be fully investigated at the slightest suspicion of a tumor, albeit benign. [ABSTRACT FROM AUTHOR]

Background: Louse-borne relapsing fever (LBRF) remains a cause of sporadic illness and occasional outbreaks in Ethiopia and other east African countries in overcrowded and unhygienic settings. In this article, we present clinical profiles and treatment outcome of patients treated as confirmed or probable cases of LBRF at Jimma Medical Center (JMC) in southwest Ethiopia. Methods: Patients treated as confirmed or probable cases of LBRF at JMC during a period of May–July 2022 were prospectively followed during their course of hospital stay. All patients were evaluated with blood film for hemoparasites, complete blood count, and liver enzymes on hospital presentation. They were followed with daily clinical evaluation during their hospital stay. Result: Thirty-six patients were treated as cases of LBRF. All patients except one were from Jimma Main Prison in Jimma Town, Ethiopia. All the patients were male with mean age of 28.7 years (SD = 12.7). The diagnosis of LBRF was confirmed by detection of B. recurrentis in blood film of 14 (38.9%) of the patients; the rest were treated as presumptive case of LBRF. Fever, reported by all patients, and an acute onset epistaxis, 30 (83.3%), were the major reasons for healthcare visits. Twenty-two (61.1%) patients were having thrombocytopenia with a platelet count < 150,000/μL; nine (25%) of which had severe forms (<50,000/μL). All patients were treated with oral doxycycline and discharged with improvement after a mean length of hospital stay of 4.25 days (SD = 0.77), range 2–6 days. Public health emergency was activated within two days of the first cases and helped in delousing all the cases and their contacts. Conclusion: LBRF remains a public health problem in Ethiopia in settings with poor personal hygiene. Patients with LBRF may present with severe thrombocytopenia and life-threatening bleeding. Early detection and treatment initiation prevents outbreak propagation and improves treatment outcome. [ABSTRACT FROM AUTHOR]

The differential effect of meteorological factors and air pollutants on pediatric epistaxis in younger and older children has not been evaluated. We evaluated the distribution of pediatric epistaxis cases between younger (0–5 years) and older children (6–18 years). Subsequently, we assessed and compared the effects of meteorological variables and the concentration of particulate matter measuring ≤ 10 μm in diameter (PM10) on hospital epistaxis presentation in younger and older children. This retrospective study included pediatric patients (n = 326) who presented with spontaneous epistaxis between January 2015 and August 2019. Meteorological conditions and PM10 concentration were the exposure variables, and data were obtained from Korea Meteorological Administration 75. The presence and cumulative number of epistaxis presentations per day were considered outcome variables. Air temperature, wind speed, sunshine duration, and PM10 concentration in younger children, and sunshine duration and air pressure in older children, significantly correlated with the presence of and cumulative number of epistaxis presentations per day. The PM10 concentration was not a significant factor in older children. Thus, meteorological factors and PM10 concentration may differentially affect epistaxis in younger (0–5-year-olds) and older (6–18-year-olds) children. Risk factors for pediatric epistaxis should be considered according to age. [ABSTRACT FROM AUTHOR]

Duloxetine is indicated for the treatment of chemotherapy-induced neuropathic pain in adults. It is also indicated for anxiety, depression, and fibromyalgia in children. A rare side effect of syndrome of inappropriate antidiuretic hormone (SIADH) secretion has been reported in adults, but not in pediatrics or pediatric oncology patients. We present the case of a 10-year-old child with acute lymphoblastic leukemia, who developed SIADH after duloxetine was given for chemotherapy-induced neuropathic pain and comorbid anxiety. The SIADH resolved after duloxetine was stopped. This case highlights a rare side effect of duloxetine and caution should be taken when prescribing duloxetine to children. [ABSTRACT FROM AUTHOR]

A child presented with anxiety and weight gain which were overlooked until she had epistaxis. She was found to have hypertension secondary to paraganglioma. She was managed with curative surgery involving multidisciplinary care. The tumor removal led to the amelioration of symptoms and marked control of hypertension. [ABSTRACT FROM AUTHOR]

The article presents a case study of a heart transplant recipient who developed thrombotic microangiopathy (TMA) following a Covid-19 infection and was successfully treated with the complement inhibitor eculizumab. It highlights the potential efficacy and safety of eculizumab in managing TMA associated with transplant and Covid-19, demonstrating improved renal function and resolution of TMA markers after treatment.

We utilized a case control study to determine if novel oral anticoagulants were associated with a higher risk of inpatient epistaxis admission. Adult patients admitted with a principal diagnosis of epistaxis in 2019–2021 were identified as well as a control group of patients matched 1:1 for age, sex, race, and medical comorbidities. For both cohorts, the presence or absence of an oral anticoagulant, classified as vitamin K inhibitors, direct oral anticoagulants (DOAC) or platelet inhibitors, was identified. 158 adult unique inpatient admissions with a principal diagnosis of epistaxis were identified. Vitamin K inhibition was present in 5.7% of cases versus 0.6% of controls (p = 0.02; OR 9.48, range 1.19‐75.77), DOACs in 4.4% of cases versus 5.1% of controls (p = 1.0) and platelet inhibitors in 2.5% of cases versus 3.8% of controls (p = 0.75). We concluded vitamin K inhibitors, compared to DOACs and platelet inhibitors, may be associated with higher likelihood of epistaxis admission. [ABSTRACT FROM AUTHOR]

Purpose: To verify whether lateral sinus floor elevation (LSFE) with the vertical height of the osteotomy decreased to 3 to 5 mm can achieve improvement compared with a conventional lateral window in terms of implant survival, graft stability, and related complications. Materials and Methods: Of the 49 patients who were selected for inclusion in this retrospective study, 25 patients were in the test group and 24 were in the control group based on the vertical height of the lateral window. Each patient received the LSFE treatment using deproteinized bovine bone mineral (DBBM) based on the two different vertical heights of the lateral window (test group: 3 to 5 mm; control group: 6 to 8 mm in vertical height). Residual bone dimensions were measured preoperatively, and graft dimensions were measured immediately after the procedure (baseline), 6 months (T1), and 1 year (T2) postoperatively on the basis of cone beam computed tomography (CBCT) scans. CBCT scan data at the baseline were analyzed with image processing software to evaluate the volume of augmented material, and they were transformed into three-dimensional reconstruction images to calibrate the window dimension. Implant failure and recorded intraoperative and postoperative complications were counted. Results: A prominent augmented graft height was obtained in both groups (test group: 9.48 ± 3.27 mm; control group: 10.44 ± 3.01 mm) with no significant difference; likewise, no difference was observed concerning augmented graft volume. Neither cumulative survival rate (CSR) nor augmented graft height decrement had any statistical intergroup difference during each follow-up interval. CSRs were detected as 100% for the test group and 94.28% and 91.67% for the control group based on implants and patients, respectively. Intraoperative membrane perforation was reported in two cases with a few nosebleeds the first night in the test group, while one case occurred in the control group. All the perforations were successfully sealed intraoperatively by a collagen membrane. Conclusion: Osteotomy of LSFE with decreased vertical height yielded similar results to the control group with conventional dimensions in terms of implant survival, graft stability, and related complications with 1 year of follow-up. Notwithstanding, a prospective split-mouth randomized controlled trial with long-term observation is imperative to further investigate the influence of decreased vertical height of the lateral window on maturation and consolidation of DBBM. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing oral and maxillofacial surgeries under general anesthesia usually require nasotracheal intubation. When presented with patients with equally patent nostrils, selection of the nostril to use for intubation is an important decision for facilitating intubation. The objective of this trial is to determine whether choice of nostril impacts nasotracheal intubation when using a video rigid stylet in patients undergoing oral and maxillofacial surgery. Methods: Fifty patients scheduled for elective oral and maxillofacial surgery requiring nasotracheal intubation were randomly allocated into two groups to undergo nasotracheal intubation through the left nostril (Group L, n = 25) or the right nostril (Group R, n = 25). Intubation was performed by experienced anesthesiologists using a video rigid stylet. The primary endpoint was time to successful intubation, which was defined as the duration from when the tip of the stylet-tube assembly entered the selected nostril to when the tube entered the trachea. Secondary outcomes included: length of time for device insertion; length of time for tube insertion; total success rate; first-attempt success rate; number of intubation attempts; requirement of airway assisted maneuvers; incidence and severity of epistaxis. Intubation-related adverse events were monitored for up to postoperative 24 h. Results: Median time (interquartile range) to tracheal intubation was 25.3 seconds (20.7 to 27.6) in Group L and 26.8 seconds (22.5 to 30.0) in Group R (median difference (MD) = 1.9; 95% confidence interval (CI) –1.8 to 5.7, P = 0.248). Nasotracheal intubation was successful in all patients in both groups and the first-attempt success rates in both groups were similar (Group L: 96% (24/25); Group R: 96% (24/25); relative risk (RR) 1.0; 95% CI 0.9 to 1.1; P > 0.999). No significant difference of requirement of assisted maneuvers was noted between the two groups (Group L: 36% (9/25); Group R: 28% (7/25); RR 0.8; 95% CI 0.3–1.8; P = 0.544). Furthermore, all patients showed a high quality of visualization of the glottis (Cormack and Lehane Grade I). For safety outcomes, the incidence and severity of epistaxis during intubation was comparable between the two groups. There were no significant differences between the selection of nostrils and intubation-related adverse events up to 24 h after surgery. Conclusions: When considering which nostril to use for intubation with video rigid stylet, either nostril can be used similarly. Trial registration: Clinicaltrials.gov. Identifier: NCT05218590. [ABSTRACT FROM AUTHOR]

To date, there is no approved local therapeutic agent for the treatment of epistaxis due to hereditary hemorrhagic telangiectasia (HHT). Several case reports suggest the topical use of timolol. This monocentric, prospective, randomized, placebo-controlled, double-blinded, cross-over study investigated whether the effectiveness of the standard treatment with a pulsed diode laser can be increased by also using timolol nasal spray. The primary outcome was severity of epistaxis after three months, while the main secondary outcome was severity of epistaxis and subjective satisfaction after one month. Twenty patients were allocated and treated, of which 18 patients completed both 3-month treatment sequences. Timolol was well tolerated by all patients. Epistaxis Severity Score after three months, the primary outcome measure, showed a beneficial, but statistically nonsignificant (p = 0.084), effect of additional timolol application. Epistaxis Severity Score (p = 0.010) and patients' satisfaction with their nosebleeds after one month (p = 0.050) showed statistically significant benefits. This placebo-controlled, randomized trial provides some evidence that timolol nasal spray positively impacts epistaxis severity and subjective satisfaction in HHT patients when additively applied to standard laser therapy after one month. However, the effect of timolol was observed to diminish over time. Trials with larger sample sizes are warranted to confirm these findings. [ABSTRACT FROM AUTHOR]

Background: Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease affecting 1 in 5000 individuals. Epistaxis is seen in more than 90% of patients with HHT. Severe recurrent epistaxis can significantly decrease quality of life and may be resistant to standard treatment measures. Dysregulation of angiogenesis has been shown to cause the proliferation of abnormal blood vessels. As such, antiangiogenic treatments have been investigated including beta-blockers. Objective: A systematic review of the efficacy of beta-blockers in topical treatment of epistaxis in patients with HHT based on epistaxis duration, frequency, and severity. Methods: A systematic search was performed using the PubMed, Embase via Ovid, and Cochrane databases. The Preferred Items for Systematic Reviews and Meta-Analyses guidelines were followed. Studies that measured the efficacy of beta-blocker treatment of epistaxis in patients with HHT were included for qualitative analysis. Results: Five studies (3 randomized controlled trials and 2 case series) with a total of 132 patients were included. Administration (systemically or topically via a spray or gel) of timolol and propranolol showed mixed evidence of improvement in epistaxis frequency, severity, and duration when compared with control groups. The evidence for propranolol appears more promising than timolol. Conclusion: There are significant limitations in the included studies, and further investigation with larger longitudinal or randomized prospective trials is recommended. The available evidence suggests that beta-blocker treatment may have a positive effect on HHT-related epistaxis. [ABSTRACT FROM AUTHOR]

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Epistaxis is a commonly occurring phenomenon which is defined as "bleeding from inside the nose" and often presents as an emergency. The management of epistaxis involves many factors with regard to the treatment and ultimate control of the condition. Each patient presenting with epistaxis should be well assessed clinically and managed accordingly. Endoscopic sphenopalatine artery cauterization is a safe, simple and effective procedure in the management of refractory epistaxis. Moreover, in view of minimal morbidity, higher success rate, shorter hospital stays and higher patient satisfaction, our current practice is to consider this treatment option in the management of cases not responding to conservative treatment modalities. A total of 11 patients (8 males and 3 females) underwent sphenopalatine artery cauterization during the study period. All patients were hypertensive and were refractory to treatment with general measures, anterior nasal packing and Foley catheter. The mean age of the study population was 58.36 and the range was 39–70 years. The epistaxis was rapidly controlled in all patients without any intraoperative or postoperative complications. The follow up period was 60–90 days. Strict control of hypertension was done throughout the follow up period. None of the patients developed epistaxis in the follow up period. The sphenopalatine artery cauterization technique using nasal endoscope was safe, simple, fast and effective with low rates of morbidity and complications for the management of refractory epistaxis. It was concluded that endoscopic sphenopalatine artery cauterization should be considered as an immediate second line treatment where conservative measures fail and it is proved to be of low morbidity and cost effective. [ABSTRACT FROM AUTHOR]

Rhinosporidiosis is a chronic granulomatous disease involving the mucous membranes of nose and nasopharynx caused by Rhinosporidium seeberi. Rhinosporidiosis involving the eye is known as Oculosporidiosis. Usually affected patients present with nasal obstruction with an associated mass, epistaxis and watery discharge. In our case, there was involvement of the nasolacrimal duct which resulted in bloody discharge from the punctum. [ABSTRACT FROM AUTHOR]

Epistaxis is one of the most common emergencies. Topical agents such as silver nitrate, is known to be a strong oxidizing agent and have been widely used, especially in recurrent and refractory cases. The extent of depth of coagulative necrosis is dependent on time of exposure and concentration. 2 mm wide bar of nasal septum from 30 patients was taken and AgNO3 was applied for 10, 20, 40 s. H&E staining was then performed to see depth of penetration and intensity of stain deposits. It was observed that with increase time of application, depth of penetration and density of deposits were increased for both 75% and 100% concentration of solution. Distribution in depth of penetration was significant when 75% concentration was applied for more than 20 s. But when 100% concentration was used, similar findings were found even after 10 s in young age group. Our study shows that when silver nitrate is used for chemical cauterization in different concentrations and for different times, their penetration is different. Moreover, the depth of penetration depends more on the time of contact than concentration of silver nitrate. We would recommend using 75% solution for use with a contact time not more than 20 s in adults and 10 s in children. [ABSTRACT FROM AUTHOR]

The presence of ectopic (supernumerary) teeth is common odontogenic problem in clinical practice. Its presence in dentate region is common but rare in the non dentate areas such as nose and maxillary sinus. The intranasal teeth generally remain asymptomatic but can get misdiagnosed for foreign body, or may present as complications like headache, epistaxis, nasal obstruction, rhinolith formation, oroantral fistula and sinusitis. Here, we discuss a case of intranasal tooth as a rare cause of profuse and recurrent epistaxis. The clinical, radiological findings and surgical treatment via endoscopic approach of this rare entity has been discussed. This interesting case report highlights the need to look beyond nose as cause for epistaxis. Endoscopic removal for this entity can be a preferred option to help minimize complications. [ABSTRACT FROM AUTHOR]

Epistaxis is one of the most common emergencies encountered by otorhinolaryngologist. Although anterior epistaxis is easy to manage but posterior epistaxis is usually refractory. Transnasal endoscopic sphenopalatine artery ligation (TESPAL) is now a well established surgical technique for the management of refractory epistaxis. Electrocauterization and clipping are the most common methods used for ligation. Coblation is an upcoming tool with promising results in endoscopic skull base surgeries and tonsillectomies but has not been explored much in TESPAL. It was a randomised observational study.50 patients of refractory epistaxis were included in the study. The patients were divided into 2 groups. Group A underwent TESPAL using electrocauterization while Group B underwent TESPAL using coblation. The data was collected and analysed for various parameters like experience of the surgeon, time taken for surgery, episodes of rebleeding and postoperative crusting. Out of 50 cases in our study 27 were males and 23 were females. Most common age group was 60–70 years (68%). Most common cause was hypertension (86%). Surgeons were happy 21/25 times in coblation group compared to 9/25 times in electrocauterization group. There were 4/25 rebleeding episodes in electrocauterization group compared to none in coblation group. Post-operative crusting was also less in coblation group compared to electrocauterization. Though electrocauterization is a well established method for TESPAL our experience with coblation in TESPAL has been extremely satisfying. We suggest our colleagues to conduct more research studies on use of coblation in TESPAL to reach a consensus. [ABSTRACT FROM AUTHOR]

Objective  Daily aspirin, started in the first trimester of pregnancy, is commonly used for the prevention of preeclampsia and fetal growth restriction in multiple gestation. However, the optimal dose remains controversial and the evidence for the use of aspirin in multiple pregnancies is scarce. We aimed to estimate the impact of 80 mg of aspirin in twin pregnancies. Study Design  We performed a pilot double-blind randomized trial of women with twin pregnancies recruited between 8 and 14 weeks of gestation. Fifty participants (25 in each group) were randomized to 80 mg of aspirin daily at bedtime or a placebo from randomization until 36 weeks of gestation. Primary and secondary outcomes included the birth weight of live infants, preeclampsia, and aspirin responsiveness evaluated by a platelet aggregation test (platelet function assay [PFA]-100). Results  All participants were followed until birth, including 48 and 47 live newborns in the aspirin and the placebo groups, respectively. The mean birth weight difference between the aspirin (2,385 ± 529 g) and placebo (2,224 ± 706 g) groups was of 179 g (95% confidence interval [CI]: −172–531 g, p  = 0.32). We observed two (8%) cases of preeclampsia in the aspirin group and no case with placebo (p  = 0.49). Most importantly,16 of 24 participants who received aspirin (67%; 95% CI: 45–84%) had a normal PFA-100 test at 22 to 23 weeks, including the two cases of preeclampsia, suggesting that the majority of the participants were nonresponsive to 80 mg of aspirin. Conclusion  Our results suggest that the majority of women with twin pregnancies showed a lack of response to a daily dose of 80 mg of aspirin according to the PFA-100 test, compared with the expected 29% of nonresponsiveness in singleton pregnancies. A daily dose of 80 mg of aspirin is likely to be insufficient for the prevention of preeclampsia and other placenta-mediated complications in twin pregnancies. Key Points Most women with twin pregnancies are nonresponsive to a daily dose of 80-mg aspirin. An 80 mg aspirin dose is insufficient to prevent placenta-mediated complications in twin pregnancies. Randomized trials using 100 to 160 mg of aspirin in twin pregnancies are needed. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is the commonest otolarangyngological emergency affecting 60 % of population in their life time .If un-treated may affect hemodynamic status. Method: 92 Epistaxic patients of different age groups were treated conservatively after routine blood examination and serum electrolyte, Urea, S. Creatinine, Urine routine examination, Blood group, Coagulation profile, CT scan was done in selected patients to rule out neoplasm of the nose, PNS and nasopharynx. Moreover chest-x-ray, ECG was performed for fitness procedure required for general anaesthesia. Results: In clinical manifestations of infective and non-infective epistaxis 32 (34.7%) were idiopathic, 19 (20.6%) were due to trauma, 14 (15.2%) rhinitis, 15 (16.3%) HTN/Atherosclerosis, 2 (2.17%) due to tumours, 2 (2.17%) Iatrogenic, 3 (3.26%) foreign bed, 2 (2.17%) blood dyscrasis, 1 (1.08%) congenital heart disease, 2 (2.17%) during pregnancy, 30 (32.1%) were non-infective, 62 (67.3%) were infective epistaxic. Out of 92 patients 36 (39.1%) had non-infective bleeding sites and 56 (60.8%) had infective bleeding sites. Out of 6 (6.52%), 5 (5.43%) complications were observed in non-infective epistaxis. Conclusion: Though epistaxis is idiopathic it is classified as local or systemic but it is difficult to classify. Hence 80-90% were idiopathic (non-infective) Majority of the epistaxis were managed with conservative (non-surgical) treatment such as nasal packing and local cauterization. It is safe and cost effective surgery will be the lost resort to cure epistaxis. [ABSTRACT FROM AUTHOR]

Background: Although epistaxis is one of the most common side effects of oral anticoagulation, it is unclear whether epistaxis rates vary between different oral anticoagulants (OAC). Objective: To compare rates of clinically relevant epistaxis between OAC. Methods: Epistaxis event rates were compared between new users of apixaban, dabigatran, rivaroxaban, and warfarin in a nationwide population‐based cohort study over a 5‐year study period, 2014–2019. Data was collected from the Icelandic Medicine Registry and the five major hospitals in Iceland. Inverse probability weighting (IPW) was used to yield balanced baseline characteristics, and epistaxis rates were compared using Kaplan–Meier survival estimates and Cox regression. Results: During the study period, 2098 patients received apixaban, 474 dabigatran, 3106 rivaroxaban, and 1403 warfarin. In total, 93 patients presented with clinically relevant epistaxis, including 11 (12%) major epistaxis events and one fatal epistaxis episode. Furthermore, seven patients (9%) with non‐major epistaxis later presented with major bleeding during the follow‐up period. Warfarin use was associated with higher rates of epistaxis compared to apixaban (2.2 events per 100‐person years (events/100‐py) vs. 0.6 events/100‐py, hazard ratio [HR] 4.22, 95% confidence interval [CI] 2.08–8.59, p < 0.001), rivaroxaban (2.2 events/100‐py vs. 1.0 events/100‐py, HR 2.26, 95% CI 1.28–4.01, p = 0.005), and dabigatran (2.2 events/100‐py vs. no events, HR n/a, p < 0.001). Conclusion: Warfarin treatment was associated with higher rates of clinically relevant epistaxis compared to direct oral anticoagulants. [ABSTRACT FROM AUTHOR]

Objective: To evaluate retrospectively the incidence of complications during fiberoptic endoscopic evaluation of swallowing (FEES) in 5,680 examinations.Patients and Methods: 5,680 patients were evaluated at the Department of Otorhinolaryngology, Audiology and Phoniatrics of Pisa University Hospital between January 2014 and December 2018, involving both inpatients and outpatients. Most common comorbidities included neurological pathologies such as stroke (11.8%), neurodegenerative diseases (28.9%) and a history of previous head and neck surgery (24.6%). The evaluation was conducted by clinicians with experience in swallowing for a minimum of 10 years with the assistance of one or more speech-language pathologists. Results: In all patients studied the endoscope insertion was tolerated, and it was possible to visualize the pharyngolaryngeal structures. Three subjects refused to undergo the procedure after being informed regarding the protocol and were therefore not included in this study. Most patients reported discomfort (70.1%) and gagging (20.8%). In a minority of patients complications were recorded, such as anterior epistaxis (0.1%), posterior epistaxis (0.02%), vasovagal crises (0.08%) and laryngospasm (0.04%). Especially laryngospasm was recorded in patients affected by amyotrophic lateral sclerosis. Multivariate binary logistic regression showed that discomfort (OR 9.944; CI 7.643−12.937), chronic gastrointestinal diseases (OR 2.003; CI 1.518−2.644), neurodegenerative diseases (OR 1.550; CI 1.302−1.846) and brain tumors (OR 1.577; CI 1.179−2.111) were risk factors associated with minor complications. Conclusions: FEES proved to be easy to perform, well tolerated by the patients and cost-effective. It can be performed at the patient's bedside, and it is characterized by a low rate of complications. As a matter of fact, normally only discomfort, gagging and/or vomiting are reported. Complications occurred only rarely, such as anterior or posterior epistaxis episodes or vasovagal crises, but these are still easily managed. Exceptionally, more severe complications are reported: adverse drug reactions to substances such as blue dye (methylene blue) and local anesthetics (not used in our protocol), and laryngospasm. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is the most common otolaryngological condition, affecting up to 60% of the population during their lifetime, with 6% requiring medical attention. This study aimed to compare effectiveness of Conservative, medical and Surgical treatment modalities in epistaxis in Indian set up. Methods: A prospective study was conducted in our tertiary care hospital. These patients were admitted from the emergency department (ER), from the outpatient department (OPD), or as referrals from other departments. Patients of all ages were included. All epistaxis patients presenting to the hospital during the study period, were wilfully included only. These patients were compared effectiveness of Conservative, Medical and Surgical treatment modalities in epistaxis in Indian set up. Results: In our study, regarding treatment modalities, conservative/nonsurgical method was sufficient to control epistaxis in most of our patients. Among the conservative methods, observation alone without active intervention was carried out in 8 % patients. However, 61% patients were treated with anterior nasal packing. Anterior nasal pack was kept in situ for 48 hours while posterior nasal pack was removed after 72 hours. Broad spectrum antibiotic was used in patients with nasal packing to prevent infectious complications. Conclusion: Anterior nasal packing (Medical management) was the most common treatment method applied in these patients. Broad spectrum antibiotics found supportive role in prevention of infection. [ABSTRACT FROM AUTHOR]

Statement of the Problem: The surgical repair of nasal septal perforation (NSP) has always been a challenging procedure and no consensus has been made about a definitive protocol. Purpose: In the current study, we investigated the use of cryopreserved amniotic membrane with mucosal rotational flap for the surgical repair of NSPs. Materials and Method: In this prospective clinical study, 12 patients with symptomatic NSP underwent primary surgical repair, between December 2018 and October 2019. The surgical procedure comprised of a rotational flap on one side of the defect and cryopreserved amniotic membrane as an interpositional graft in the mucoperichondrial pocket on the other side. The patency of defect was checked at a follow-up appointment at least 3 months after surgery. Results: Successful repair was perceived in 10 of 12 (83%) of patients. Reperforation occurred in two patients but the size of the defect was smaller than the original one. All of the patients reported elimination of all symptoms associated with NSP. Conclusion: The use of cryopreserved amniotic membrane as an interpositional graft accompanied by a mucosal rotational flap seems to be efficient in alleviating the symptoms of NSP and closure of the defect. [ABSTRACT FROM AUTHOR]