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Background: Various graft materials have been used to repair nasoseptal perforation, but there is no standardized treatment method. The anterior maxillary sinus wall is flattened in appearance and can be easily obtained in a sufficient amount for a large-sized nasoseptal perforation. Objectives: The aim of this study is to determine whether the anterior maxillary sinus wall is suitable as an interpositional graft in the surgical repair of septal or nasoseptal perforation. Methods: This is a retrospective review of 21 patients who underwent repair of nasoseptal perforation using anterior maxillary sinus wall as an interpositional graft. The etiology, pre- and post-operative NOSE and GBI score, and perforation size were reviewed. The surgical outcome was considered successful if total closure was achieved after postoperative follow-up. Results: 19 of the 21 perforations were successfully repaired with anterior maxillary sinus wall. Failure of the repair was found in 2 patients. Causal etiology of perforation was previous septoplasty in 10 patients, and electrocautery in 1 case, but not identified in 10 cases. The largest size was 2.7 × 2.2 cm. The most common symptoms were epistaxis, crusting, and nasal obstruction. Closure of septal perforation resulted in improved subjective symptoms and quality of life which were evaluated with NOSE and GBI score. Conclusion: Anterior maxillary sinus wall as interpositional graft between mucoperichondrial flaps can be used to reliably repair nasoseptal perforations. [ABSTRACT FROM AUTHOR]

Problem description: Otorhinolaryngology services are not available in all hospitals and atraumatic epistaxis is a common presentation to Emergency Departments (ED). Not all ED staff are experienced in managing epistaxis and there appeared to be a high rate of re-bleeding after treatment provided. We aimed to improve outcome for ED patients presenting with atraumatic epistaxis and staff conditions by creating a Departmental pathway outlining a management plan and ensuring all equipment needed was readily available. Methods: A retrospective 6-month audit was done to assess current management and re-bleed percentage rates post nasal packing. A team was assembled, stocked a trolley, created an Atraumatic epistaxis ED pathway and promoted its use by staff. Repeated Plan-Do-Study-Act cycles were undertaken.Chosen measures were (1) Reduced re-bleed rates post nasal packing from initial audit levels; (2) Increased nasal packing duration; (3) Improved qualitative feedback by ED doctors (4) 100% E.N.T. trolley stock. Results: Audit showed minimal use of vasoconstrictor spray, a 7-hour mean nasal pack duration, a re-bleed rate post nasal packing of 39% and staff reports of difficulties accessing items required.After introduction of the E.N.T. trolley, there was positive staff feedback regarding improved availability of treatment items and full stocking of the trolley was achieved after repeated cycles.Following introduction of the Epistaxis pathway and staff education, average re-bleed rates post nasal packing dropped* from 39% to 20% in the first cycle; 21% in the third cycle; 25% in the fourth cycle and 14% in the fifth cycle- (*Isolated re-bleed average of 40% observed in the second cycle).Mean nasal packing duration increased from 7 h to 9, 10, 10, 12 and 8 h in the 2-monthly cycles successively. Conclusion: The project's aims of improving epistaxis patients' outcomes and improved convenience for ED staff were achieved.

Spontaneous epistaxis is a common cause of emergency department's (ED) visit. Considering ED's overcrowding, it seems interesting to study risk factors of hospitalisation or long length of stay to increase triage's quality. Thus, we performed a prospective analysis to assess average length of stay of patients with spontaneous epistaxis. Secondary objectives were to find putative risk factor of longer length of stay. From February 13th, 2023, to August 31st, 2023, a prospective observational study was performed in five EDs among patients who consult for spontaneous epistaxis. We collected the following time items - arrival, first contact with triage nurse, first medical contact, and discharged or admission time. We also collected sociodemographic, medical history, daily medications, and care in the ED. Among 106 patients, median length of stay in the ED was 144 min. No patient was discharged before 28 min and the longest duration was 625 min (10 h and 25 min. Half epistaxis was already dried up before their arrival in the ED. Main risks factors to long ED length of stay were the hour of admission between midnight and eight am, the need of a blood sample and a consult with an ORL. We did not find any impact of the location of care, hypertension, age, or blood thinners. Half of patient presenting in the ED for spontaneous epistaxis was discharged in 144 min. This duration is significantly prolonged during night shift, if blood was sampled, or if an ORL consult was needed., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

The article presents a case study of vasospastic angina (VSA) in a 13 year old boy with hereditary hemorrhagic telangiectasia (HHT). It is reported that HHT is characterized by telangiectasis and arteriovenous malformations (AVMs). It is further reported that the boy experienced intense nocturnal chest pain, ST-segment elevation on the electrocardiogram, and elevated cardiac troponin I levels.

A 7-year-old female presented to an outpatient eye clinic with a six-week history of left upper eyelid edema and erythema in the absence of trauma without compromise of visual acuity or extraocular muscle movements and was initially treated as a case of pre-septal cellulitis with antibiotic therapy. Failure of resolution with new onset nasal bleeding after two weeks prompted computed tomography (CT) and magnetic resonance imaging (MRI), showing an orbital mass with radiologic concern for lymphoma or rhabdomyosarcoma. Upon biopsy, the histopathological analysis diagnosed angiolymphoid hyperplasia with eosinophilia (ALHE), a rare condition that infrequently presents with ocular manifestations and more rarely presents in the pediatric population. Most therapeutic management for cutaneous and non-cutaneous ALHE have high rates of recurrence. This case was refractory to oral prednisone treatment but responded to a combination of methotrexate and adalimumab therapy with an 18.5% reduction in volume after three months. [ABSTRACT FROM AUTHOR]

Introduction: About 1% of psychiatric consultations are concerned with a factitious disorder. Unlike malingering, factitious disorder is a special psychiatric disorder that should be taken into consideration by the medical staff. Case Presentation: This case reports a woman with fever and epistaxis as a primary clinical manifestation of a factitious disorder which was diagnosed and treated after further investigation and psychiatric consultation. Conclusions: Procrastination of diagnosis usually leads to an increase in the length of stay for unnecessary clinical and paraclinical investigations. The purpose of this case presentation was to raise the issue of psychiatric problems and their importance alongside physical problems. [ABSTRACT FROM AUTHOR]

A case of delayed epistaxis from the mucosa behind the right side of the inferior nasal mucosa 11 days after orthognathic surgery by Le Fort I osteotomy is presented. The patient was a 31-year-old man who underwent orthognathic surgery under general anesthesia. No abnormal findings were found during or after the operation. The patient was discharged from the hospital 10 days postoperatively. However, bleeding from the right nasal cavity occurred suddenly on the night after discharge, and he presented to our hospital again. The epistaxis was stopped once by nasal packing containing 0.001% epinephrine and systemic infusion of carbazochrome sulfonic acid and tranexamic acid. However, when the nasal packing was removed the next day, right nasal epistaxis was observed again. Curvature of the nasal septum and thickening of the inferior turbinate mucosa were seen on inspection; although, no active bleeding point was identified. Decreased nasal mucosa thickening and bleeding were observed after nasal packing containing 0.02% epinephrine. When the inside of the nasal cavity was observed endoscopically, an approximately 2 mm laceration was found in the mucosa behind the side wall of the right inferior nasal mucosa, and bleeding from the same part was confirmed. After endoscopic cauterization for hemostasis of the nasal mucosa, no rebleeding was observed. Although delayed epistaxis after Le Fort I osteotomy are often performed CT angiography to confirm the bleeding site, endoscopic cauterization would be primarily useful because of less invasiveness. [ABSTRACT FROM AUTHOR]

The article explores A 61-year-old male patient was referred to our hospital due to prolonged epistaxis. He was found to have pancytopenia (hemoglobin: 5.8 g/dL, platelets: 3 × 109 /L, and white blood cells: 2 × 109 /L with 4% blasts). A bone marrow examination showed a hypercellular bone marrow (blast frequency: 67.8%). Bone marrow smears (Figure 1) demonstrated that some blasts had micronuclei, and other cells contained pseudo-Chédiak-Higashi granules.

Objectives: Procedures which utilize bilateral mucosal flaps with an interposition graft are frequently used when attempting closure of a septal perforation. Concurrent surgical management of the nasal valve or an aesthetic deformity may be indicated. The objective of this study is to report our experience using auricular perichondrium for the interposition graft when auricular cartilage is harvested for structural or aesthetic graft material. Methods: A retrospective medical record review was performed for septal perforation repairs performed at Mayo Clinic in Arizona from January 2010 through January 2020. Patients identified for this study underwent a procedure utilizing bilateral nasal mucosal flaps with an auricular perichondrium interposition graft. Results: Forty-four patients (31 females) with a mean age of 53.3 years met study criteria. The most common presenting symptoms were nasal obstruction, crusting, and epistaxis. Prior septal surgery was the most common perforation etiology (45.5%). Mean perforation length was 11.8 (range, 3-26) mm and height, 9.1 (range, 2-16) mm. Auricular cartilage was harvested for nasal valve surgery in 43 patients. Complete perforation closure was noted in 95.3% (41/43) of patients with a minimum post-operative follow-up of 3 (mean, 20.4) months. Four patients underwent revision surgery for persistent postoperative nasal obstruction. Conclusion: The ear can provide both cartilage and perichondrium for use in septal perforation surgery. Our study demonstrates the successful use of auricular perichondrium as the interposition graft for a perforation closure procedure utilizing bilateral nasal mucosal flaps. [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is a rare angiogenic disorder causing chronic gastrointestinal bleeding, epistaxis, and severe anemia. Pazopanib is an oral multi-kinase angiogenesis inhibitor with promise to treat bleeding in HHT. We analyzed outcomes of HHT patients with the most severe bleeding causing RBC transfusion dependence treated on a predefined institutional pazopanib treatment pathway (with data collected retrospectively). The primary endpoint was achievement of transfusion independence. Secondary endpoints included hemoglobin, epistaxis severity score, RBC transfusion and iron infusion requirements, number of local hemostatic procedures, ferritin and transferrin saturation, compared using paired and repeated measures mean tests. Thirteen transfusion-dependent HHT patients received pazopanib [median (range) dose 150 (25–300) mg daily)] for a median of 22 months. All patients achieved transfusion independence. Compared with pretreatment, pazopanib increased mean hemoglobin by 4.8 (95% CI, 3.6–5.9) g/dL (7.8 vs. 12.7 g/dL, P < 0.0001) and decreased mean epistaxis severity score by 4.77 (3.11–6.44) points (7.20 vs. 2.43 points, P < 0.0001) after 12 months of treatment. Compared with 3 months of pretreatment, RBC transfusions decreased by 93% (median of 16.0 vs. 0.0 units, P < 0.0001) and elemental iron infusion decreased by 92% (median of 4500 vs. 0 mg, P = 0.005) during the first 3 months of treatment; improvements were maintained over time. Pazopanib was well-tolerated: hypertension, lymphocytopenia, and fatigue were the most common TEAEs. In conclusion, pazopanib was safe and effective to manage severe bleeding in HHT, liberating all patients from transfusion dependence and normalizing hematologic parameters at doses lower than used to treat malignancies. These findings require confirmation in a randomized trial. [ABSTRACT FROM AUTHOR]

There is a consensus that arterial hypertension (AH) is associated with stroke. Therefore, this study aimed to evaluate the histology of the microvasculature associated with the mucosa of the posterior nasal cavity to identify possible factors related to vascular weakening and rupture. Histological sections were obtained from hypertensive and normotensive individuals, regardless of epistaxis. Our results showed that the group with AH had: (a) smaller median diameter of the lumen of arteries and arterioles; (b) increased thickness of the intimal arteries and arterioles, slight inflammatory infiltrate, and rupture of internal elastic lamina; (c) greater thickness of the middle tunica in arterioles; (d) lower percentage of histological sections with non-injured intimal layers in capillaries, arterioles, and small arteries; (e) lower percentage of histological sections with intact media tunic and/or myocytes juxtaposed in arteries and arterioles; (f) no difference between the diameters of small arteries or arterioles. The intima was thicker in individuals with severe epistaxis than in the normotensive group, but it did not differ from the AH group. Thus, hypertension may cause structural lesions in the vascular layers, and in the absence of tissue repair and the persistence of AH, these lesions may favour vascular rupture, especially during hypertensive peaks. [ABSTRACT FROM AUTHOR]

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is an inherited orphan disease, in which the absence of capillary beds between arterioles and venules lead to arteriovenous shunts. Epistaxis is the core symptom. Several case reports have described the nonselective beta-adrenergic receptor antagonist timolol as a successful treatment method of nosebleeds due in HHT patients. OBJECTIVE: TIM-HHT is a single-site, prospective, randomized, placebo-controlled, double-blind, cross-over study to investigate whether the efficacy of standard laser treatment of epistaxis in HHT patients can be increased by the additional use of timolol nasal spray (1 mg/d). METHODS: Twenty patients will be randomly allocated to one of two treatment sequences. Primary outcome is the severity of epistaxis determined by the Epistaxis Severity Score (ESS). Secondary outcomes are subjective satisfaction, quality of life, as well as the hemoglobin, ferritin, and transferrin levels of the participating patients. Safety outcome is assessed by means of pulse, blood pressure, and adverse events. CONCLUSION: TIM-HHT will evaluate the efficacy and safety of timolol as an additional treatment of epistaxis in HHT patients in a three-month trial period. Benzalkonium chloride is used as a placebo, which has no documented positive effect on the nasal mucosa and hence on epistaxis in HHT patients (in contrast to saline). TRIAL REGISTRATION: German Clinical Trials Register (DRKS), DRKS00020994. Registered on 10 March 2020 [ABSTRACT FROM AUTHOR]

Hereditary hemorrhagic telangiectasia (HHT) is a genetic disorder in which there is faulty development of the arteries. There is a high incidence of pulmonary hypertension (PH) in these patients, the pathophysiology of which is not fully known. An increase in cardiac output, causing high-output cardiac failure, and increased pulmonary vascular resistance secondary to genetic mutations are the main reasons. We report a 25-year-old male with HHT who presented with right heart failure secondary to PH in whom both the above mechanisms were operating. The coexistence of giant pulmonary arteriovenous malformations with severe PH is a rare scenario influencing management decisions that are discussed. In addition, this patient highlights the classical visceral vascular malformations in this rare disorder. [ABSTRACT FROM AUTHOR]

Purpose: Woodruff's plexus is a vascular network located on the posterior lateral wall of the inferior meatus of the nasal cavity and it is generally considered to be responsible for posterior epistaxis. Despite being initially identified in 1949 as a venous plexus, discrepancies exist within literature regarding this anatomical structure, particularly its arterial or venous nature and its association with posterior epistaxis. This systematic review aims to collate information pertaining to Woodruff's plexus and evaluate our current understanding of this vascular area. Methods: The systematic review was performed using published data in PubMed, Google Scholar, Scopus, EBSCO and Web of Science platforms using keywords such as 'Woodruff', 'posterior' and 'plexus'. Articles referring to Woodruff's plexus were collected and analysed by independent reviewers. Results: The search revealed 154 papers, out of which only 40 were included in the review. Out of this number only two papers were anatomical dissection studies, both of which identify the plexus as venous in nature. Seventeen studies describe the plexus as venous by citing these two papers. The remainder of the articles (23) consider Woodruff's plexus as arterial with variability in the reported arteries that supply it. Conclusion: Woodruff's original description of a venous plexus is supported by modern anatomical studies. There are a multitude of reports that Woodruff's plexus is arterial in nature, despite the absence of existing anatomical studies to support this notion. This misconception has likely arisen due to clinical associations in relation to posterior epistaxis. [ABSTRACT FROM AUTHOR]

Long-term care residents with novel coronavirus disease 2019 (COVID-19) experience high mortality rates and require frequent screening. Most resident testing occurs via nasopharyngeal swab that potentially causes epistaxis with rates of 5% to 8% in healthy populations. It is estimated that 48% of long-term care residents receive oral anticoagulation that increases risk of bleeding. A long-term care resident receiving oral anticoagulation experienced an episode of acute blood loss anemia after nasopharyngeal sampling. Current medications were not reviewed before testing, and oral anticoagulation was not held resulting in acute blood loss anemia. A medication review is indicated for skilled nursing and assisted living residents to identify oral anticoagulation before nasopharyngeal testing. Less invasive testing may be recommended or should bleeding occur, discontinuation of oral anticoagulation for a short term may be appropriate. [ABSTRACT FROM AUTHOR]

Introduction: It has been reported that inflammation may be a potential risk factor for the progression of epistaxis. Due to the major roles played by Th17 in the induction of inflammation, the present study aimed to assess the serum levels of Interleukin 17A (IL-17A) and IL-23, as the most important cytokines in the Th17 pathway, as well as IFN-γ, IL-4, and IL-10 serum levels, as regulatory cytokines for Th17 cells in patients with idiopathic epistaxis. Materials and Methods: The serum levels of IL-4, IL-10, IL-17A, IL-23, and IFN-γ were evaluated in 90 patients with idiopathic epistaxis and 90 healthy controls using enzyme-linked immunosorbent assay (ELISA) technique. Results: The obtained results pointed out that the serum levels of IL-17A and IL-10, but not IL-4 and IL-23, were significantly up-regulated, and IFN-γ serum levels were significantly down-regulated in patients with idiopathic epistaxis. Furthermore, female patients with epistaxis had higher IL-10 serum levels. Conclusions: As evidenced by the results of the present study, IL-17A is the main cytokine which participates in the pathogenesis of idiopathic epistaxis; moreover, in association with IL-10, it can be regarded as the suppressor of IFN-γ in patients. [ABSTRACT FROM AUTHOR]

Purpose: The main objective was to perform an image-guided (CT) assessment of the efficacy of the CAVI-T™ balloon to compress the sphenopalatine artery (SPA) on cadaver heads, for the management of epistaxis. The secondary objectives were to analyse the deployment and stability of this balloon according to the volume injected into the nasal cavity, to optimise its use. Methods: A descriptive anatomical study was performed. The catheterization of the SPA was performed on four fresh-frozen heads with a SPA approach through the maxillary sinus, leaving the nasal cavity unscathed. Computed Tomography images were acquired without and with the balloon, inflated by injections of progressive volumes of diluted iodine, for optimal contrast with the surrounding tissues. We evaluated the positioning of the balloon according to two predetermined markers on the device. Results: Out of 68 image-guided acquisitions, the CAVI-T™ balloon compressed the SPA in 88% of cases. The other nasal cavity structures were compressed in 86% to 100% of the cases, depending on the positioning of the CAVI-T™ balloon, therefore allowing a complete obstruction of the nasal cavity. The device remained stable upon inflation and did not obstruct the nasopharynx. Conclusion: The CAVI-T™ balloon provided effective compression of the SPA and the different structures of the nasal cavity. [ABSTRACT FROM AUTHOR]

What is known and objective: Prior to nasotracheal intubation (NTI), topical nasal vasoconstrictors are used to prevent NTI‐related epistaxis (NTIRE). Since we learned that there is no significant increase in NTIRE among hypertensive patients undergoing NTI with adequate lubrication but without vasoconstrictors, we initiated this randomized controlled study to assess the necessity of vasoconstrictor use in reducing NTIRE. Methods: Patients with the American Society of Anesthesiologists Physical Status Classification 1 and normal coagulation function, planned to undergo maxillofacial surgery with NTI were enrolled. Patients were randomly (1:1) assigned to each of the treatment groups: nasal treatment using pure oxybuprocaine gel with adequate lubrication (group G) or 1% ephedrine in addition to oxybuprocaine gel with adequate lubrication (group EG). In addition, the incidence and severity of NTIRE and intubation adjustments were studied. Results: A total of 844 patients, 429 and 415 (groups G and EG, respectively), were included in the analysis. No significant differences were observed in the NTIRE incidence rates in groups G (28%) and EG (27%; p = 0.75, relative risk [RR] = 0.95, 95% confidence interval [CI] 0.70–1.29). No significant differences in the NTIRE incidence rates between the two nostrils were observed in both groups (group G: left, 27.9% vs. right, 28% [p = 0.98, RR = 1.01, 95% CI 0.67–1.51]; group EG: left, 25.8% vs. right, 27.9% [p = 0.63, RR = 1.12, 95% CI 0.72–1.73]. No significant difference was observed in the severity of NTIRE (p = 0.74). In case of difficult advancement of the endotracheal tube, NTIRE incidence was 71% vs. 12% with smooth intubation (p < 0.01, RR = 18.33, 95% CI 12.55–26.77). What is new and conclusion: Well‐lubricated nasotracheal intubation does not require pretreatment with ephedrine to reduce NTIRE. [ABSTRACT FROM AUTHOR]

An 18‐month‐old male neutered Staffordshire Bull Terrier presented for chronic sneezing, left‐sided rhinorrhea and epistaxis associated with previous nasal planum depigmentation and pruritus. Physical examination did not demonstrate bone asymmetry or depigmentation, but showed reduced airflow through the left nostril. No neurologic abnormalities were present. CT identified severe destruction of the left nasal turbinates and defect of the left cribriform plate, with protrusion of the left olfactory lobe into the caudal part of the nasal cavity. Rhinoscopy did not identify fungal plaques or foreign material, and nasal biopsies were consistent with lymphoplasmacytic destructive rhinitis. Tissue cultures were negative. Clinical signs completely resolved after 2 weeks of doxycycline treatment and did not recur. There was no development of neurologic abnormalities in the 12 months after diagnosis. This is the first case report of canine meningoencephalocele presenting with rhinitis‐associated signs without detectable neurologic abnormalities. [ABSTRACT FROM AUTHOR]

This article discusses a technique for improving the process of nasotracheal intubation in young children under anesthesia. Nasotracheal intubation can be challenging due to complications such as epistaxis and anatomical variations. The authors propose using the patient's little finger to check the patency of the nostril and provide gradual nasal dilatation, which can facilitate the intubation process. They suggest that this technique is a simple and cost-free alternative to other methods that may cause airway trauma. The article also highlights the significance of the little finger in various aspects of anesthesia. [Extracted from the article]

We present a case of localized nasal endometriosis to contribute to the literature. A primiparous, primigravida, 37-year-old female was diagnosed with nasal septal endometriosis in the presence of history of periodic epistaxis, nasal pain, and nasal fullness. After a nasal biopsy for exclusion of malignancy, a comprehensive general screening was performed on the recommendation of a gynecologist, definitive endometriosis was diagnosed, and oral treatment was initiated. Significant relief was reported in her nasal symptoms during the 1-year follow-up period. We report this case to demonstrate the importance of clinical awareness of periodic cyclic perimenstrual epistaxis, nasal lesions, and nasal pain as a cause of nasal septal endometriosis. [ABSTRACT FROM AUTHOR]

Non skin malignant melanomas are known to be more aggressive than the skin counterpart. A 50-year lady with recurrent epistaxis, had mass in right sphenoid, which was resected by endoscopic sinus surgery. After histopathological confirmation of malignant melanoma radiotherapy was given. She later developed metastasis in liver. [ABSTRACT FROM AUTHOR]

An editorial is presented on the resource for ENT surgeons and physicians with responsibility for the care of older adults. It expresses the view that demographics of the developed world have changed during the late twentieth and early twenty-first centuries such that the care of older adults has assumed ever more importance. An overview of the Hearing loss in older adults is multifactorial, with the legacy of occupational hearing loss is presented.

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Importance: This is the first randomized study to compare the quality of life of patients undergoing endoscopic septoplasty compared to traditional trans-nasal trans-speculum (TNTS) septoplasty. Objective: To assess the clinical outcomes and quality of life results of endoscopic versus TNTS septoplasty in patients with septal deviation and nasal obstruction. Design: A prospective, randomized controlled trial comparing 2 approaches of septoplasty: endoscopic and TNTS septoplasty performed in a single institution during the years 2016 to2017. The follow-up time was 3 months. Setting: A single institution study in a tertiary health-care referral center. Participants: Patients who underwent primary surgery for repairing deviated nasal septum due to nasal obstruction, were older than 18 years old, and were eligible for study inclusion. Sixty-five patients were enrolled in this study, 34 in the endoscopic arm and 31 in the TNTS septoplasty arm. The overall follow-up rate was 94% at the first visit (2 weeks) and 92% at the last visit (12 weeks). Thus, the final cohort consisted of 60 patients, 30 in each study arm. The patients ranged in age from 18 to 71 years (mean 27 years) old. Main Outcomes and Measures: The primary outcome was the Sino-Nasal Outcome Test-22 (SNOT-22) score. Secondary outcomes were the Short Form 36 (SF36) QOL score and complication rates. Both questionnaires were administered at 2 weeks and 3 months following surgery. Results: Sixty patients completed this study, 30 in each study arm. Sino-Nasal Outcome Test-22 scores were improved after 3 months, with no difference between the study arms. There were no cases of septal perforation or profound bleeding requiring repeated surgery. Conclusions and Relevance: Endoscopic septoplasty and TNTS show similar results for treatment of nasal septum deviation. Trial Registration: Traditional Septoplasty versus Endoscopic Septoplasty for Treating Deviated Nasal Septum, NCT02653950. https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0005ZOR&selectaction=Edit&uid=U00021YC&ts=2&cx=-2w7hot. [ABSTRACT FROM AUTHOR]

Background: Transnasal endoscopy has recently become common in Japan. Although transnasal endoscopy has many advantages, nasal pain and epistaxis are common complaints. To reduce nasal pain and epistaxis, we developed a new tube sheath system for transnasal endoscopy. This new tube sheath system (outer sheath and inner tube), called the Nasal Slider, is produced by TOP Corporation, Japan. Methods: A tube sheath longer than the nasal concha is inserted to reduce pain along the nasal turbinate. Because the sheath is left in place, tubes can be passed through the nose multiple times without causing additional pain. A total of 34 consecutive patients (mean age 68.1 years; 22 men and 12 females) who had undergone transnasal endoscopy in the past were selected for transnasal endoscopy with the Nasal Slider. After the transnasal endoscopy was completed, patients who gave consent for use of the Nasal Slider were interviewed by using 3 questionnaires on nasal discomfort, nasal pain, and epistaxis. Results: Because the transnasal endoscope passes inside the sheath, epistaxis can be prevented. Thirty of 34 selected patients underwent transnasal endoscopy using the Nasal Slider. Twenty-seven and 28 patients reported feeling less nasal discomfort and pain, respectively, with the Nasal Slider than during examinations without the Nasal Slider. No epistaxis developed in any patient examined with the Nasal Slider. Conclusions: The Nasal Slider appears to reduce nasal pain and epistaxis during transnasal endoscopy and is currently used in many hospitals in Japan. [ABSTRACT FROM AUTHOR]

Aim: Nosebleed, more commonly called epistaxis is a general clinical problem, and the most of bleedings can be treated non-invasive approach. However, because of persistent and sometimes life-threatening bleeding, additional treatment such as super-selective embolization may be required. In this study, we report our data on the endovascular treatment of persistent epistaxis. Materials and Methods: Between January 2010 and December 2019, all patients who were followed up at Inonu University Turgut Ozal Medical Center Otorhinolaryngology Clinic due to recurrent persistent nosebleed and required endovascular treatment were retrospectively screened. Demographic data, cause of epistaxis, localization of the bleeding, the clinical significance of the bleeding, interventional approach, complications related to treatment, and results were evaluated. Results: All of 18 patients with intractable epistaxis were included in the study. Depending on the etiology of epistaxis, patients were determined into three groups: idiopathic epistaxis (10/18), iatrogenic or traumatic epistaxis (7/18), and nasopharyngeal cancer (1/18). Nine of 18 patients required blood transfusions. The internal maxillary artery was embolized unilaterally in 12 of 18 (66%) and bilaterally in 2 of 18 (11%) procedures. Four patients were not embolized because of bleeding originated from ethmoidal branches of the ophthalmic artery. These four patients were operated on (endoscopic ethmoidectomy and bleeding control). Long-term success rates of embolization were 14 of 14. Major complications (transient hemiparesis) occurred in one patient after embolization. Conclusion: Endovascular approach proves to be effective for intractable and fatal epistaxis. Embolization has a good risk-benefit ratio in persistent bleeding. However, if bleeding is originated by the ethmoidal branches of the ophthalmic artery, embolization may not be performed to avoid visual complications. [ABSTRACT FROM AUTHOR]

Introduction: In China, nasal cannula oxygen therapy is typically humidified. However, it is difficult to decide whether to suspend nasal cannula oxygen inhalation after the nosebleed has temporarily stopped. Therefore, we conducted a preliminary investigation on whether the use of humidified nasal cannulas in our hospital increases the incidence of epistaxis. Methods: We conducted a survey of 176,058 inpatients in our hospital and other city branches of our hospital over the past 3 years and obtained information concerning their use of humidified nasal cannulas for oxygen inhalation, nonhumidified nasal cannulas, anticoagulant and antiplatelet drugs, and oxygen inhalation flow rates. This information was compared with the data collected at consultation for epistaxis during these 3 years. Results: No significant difference was found between inpatients with humidified nasal cannulas and those without nasal cannula oxygen therapy in the incidence of consultations due to epistaxis (χ2 = 1.007, p > 0.05). The same trend was observed among hospitalized patients using anticoagulant and antiplatelet drugs (χ2 = 2.082, p > 0.05). Among the patients with an inhaled oxygen flow rate ≥5 L/min, the incidence of ear-nose-throat (ENT) consultations due to epistaxis was 0. No statistically significant difference was found between inpatients with a humidified oxygen inhalation flow rate <5 L/min and those without nasal cannula oxygen therapy in the incidence of ENT consultations due to epistaxis (χ2 = 0.838, p > 0.05). A statistically significant difference was observed in the incidence of ENT consultations due to epistaxis between the low-flow nonhumidified nasal cannula and nonnasal cannula oxygen inhalation groups (χ2 = 18.428, p < 0.001). The same trend was observed between the 2 groups of low-flow humidified and low-flow nonhumidified nasal cannula oxygen inhalation (χ2 = 26.194, p < 0.001). Discussion/Conclusion: Neither high-flow humidified nasal cannula oxygen inhalation nor low-flow humidified nasal cannula oxygen inhalation will increase the incidence of recurrent or serious epistaxis complications; the same trend was observed for patients who use anticoagulant and antiplatelet drugs. Humidification during low-flow nasal cannula oxygen inhalation can prevent severe and repeated epistaxis to a certain extent. [ABSTRACT FROM AUTHOR]

Purpose: Hereditary hemorrhagic telangiectasia (HHT) is a vascular disorder that presents with recurrent, intractable epistaxis. The aim of this study was to retrospectively analyze the efficacy of various treatment options for epistaxis in patients with HHT, over a period of 18 years, and to correlate these findings with available evidence in the literature. Methods: Records of patients with HHT, treated for epistaxis between 2000 and 2018 were analyzed. Treatment procedures carried out and their efficacy were extracted and analyzed. Results: Forty-three records were evaluated. All patients were given nasal humidifying ointments, 93% required acute treatment with bipolar electrocautery, and 60% underwent atraumatic nasal packing. Recurrent cases were treated medically with tranexamic acid (26%), oestrogen (19%), and bevacizumab (2%). Laser photocoagulation was done in selected cases (40%) and if unsuccessful, septal dermoplasty was performed (2.3%). Endovascular embolization was reserved for life-threatening emergencies (7%). Conclusion: Epistaxis in HHT is not curable, but can be managed by employing a comprehensive stepwise approach. An algorithm for effective and comprehensive management has been presented. [ABSTRACT FROM AUTHOR]

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common pediatric complaint, so we study its risk factors trying to control and decrease it among primary school children. Objectives: To determine frequency of epistaxis and to assess the risk factors of epistaxis in primary school children (8-12 years old). Patients and Methods: A cross-sectional study that was conducted on 312 children. Sample was collected by systematic random technique from the children attending to Family Health Center, Sanafa, Mit-Ghamr city, Dakahlia Governorate, Egypt. Participants’ data regarding socio-demographic characteristics, and risk factors were collected via predesigned questionnaire. Results: The study revealed that prevalence of epistaxis among the studied group was 32.4% and the most common risk factors among the studied group were smoking, head trauma, factory gases, chronic cough and upper respiratory tract infection (URTI) (56.7%, 45.8%, 35.6%, 32.7% & 30.1% respectively). Conclusion: Recurrent epistaxis can be troublesome and alarming for parents and children. so special attention must be given for it. [ABSTRACT FROM AUTHOR]

Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical. To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis. A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groups via negative pressure group (NPG) and control group (CG): The negative pressure suction device combined with an endoscope was used to re-explore the epistaxis. Nasal bleeding was induced using this method to help the operator locate the site of epistaxis accurately; the bleeding was then stopped using electrocoagulation with the suction electrode. The CG was treated with endoscopic re-exploration and selective tamponade. Compared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (all p <.05). Combining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis. [ABSTRACT FROM AUTHOR]

Oncocytic papillary cystadenoma (OPC) is a relatively rare benign tumor of the salivary glands, frequently seen in minor salivary glands, and occasionally in major salivary glands, such as the parotid gland. Patients only become symptomatic upon progression of the swelling, causing obstructive symptoms depending on its location. To our knowledge, there are no reports of presentation with bleeding tumor. Herein, we report a case of an OPC of the right torus tubarius in a 54-year-old man who presented with recurrent epistaxis. [ABSTRACT FROM AUTHOR]

Objective: Epistaxis, which is a common otorhinolaryngologic emergency, is not a disease itself but an important nose symptom. It affects 60% of the population at any given life stage. However, only 6% seek medical attention. This study aims to investigate the daily and monthly variations and frequency of epistaxis and to determine the relationship between bleeding foci and comorbidities. Materials and Methods: The study involves examining the retrospective records of patients who presented with epistaxis to Kahramanmaraş Sütçü İmam University, Medical Faculty's Otorhinolaryngological Unit. Parameters evaluated include age, sex, bleeding time, comorbidities, arterial blood pressure, bleeding site, and month of presentation. The bleeding occurrence time was categorized as morning (06:01-12:00), afternoon (12:01-18:00), evening (18:01-00:00), and night (00:01-06:00). Results: Seven hundred and thirty-five patients presented with epistaxis during March 2015-December 2019. One hundred and fourteen patients (19.6%) experienced epistaxis in the morning, 60 (8.2%) in the afternoon, 408 (55.5%) in the evening, and 123 (16.7%) in the night. Epistaxis was more common in the morning and evening in hypertensive patients and in the evening in other comorbidities (p=0.005). Bleeding rate was higher in the evening in all months (p=0.002). Increased epistaxis frequency in winter was statistically significant (p=0.027). Posterior epistaxis cases were the elderly, hypertensive, and having increased comorbidities (p>0.001). Conclusion: In general, bleeding cases were high in winter and in the evening. Comorbidities were found to be among the provocative factors for epistaxis, especially of posterior origin. This shows that circadian rhythm is effective in epistaxis. [ABSTRACT FROM AUTHOR]

Background: Selective endoscopic coagulation of a nasal bleeding vessel is an effective means of treating epistaxis. Precisely locating the bleeding site(s) is critical. Objective: To investigate the utility of combining a negative pressure suction device and endoscope in locating bleeding sites of refractory epistaxis. Methods: A total of 116 patients with refractory epistaxis, who underwent systematic endoscopic exploration under local anesthesia in the absence of identifiable sites of bleeding were randomizely divided into two groups via negative pressure group (NPG) and control group (CG): The negative pressure suction device combined with an endoscope was used to re-explore the epistaxis. Nasal bleeding was induced using this method to help the operator locate the site of epistaxis accurately; the bleeding was then stopped using electrocoagulation with the suction electrode. The CG was treated with endoscopic re-exploration and selective tamponade. Results: Compared with the CG, there were statistically significant differences in length of hospital stay, rebleeding, and postoperative pain and complications (all p<.05). Conclusion and significance: Combining a negative pressure suction device and endoscope was a safe and effective technique for accurately locating bleeding sites in patients with refractory epistaxis. [ABSTRACT FROM AUTHOR]

Introduction: There are multiple risk factors for the development of epistaxis and it can affect any age group, but it is the elderly population with their associated morbidity who often require more intensive treatment and subsequent admission. Treatment strategies have been broadly similar for decades. However, with the evolution of endoscopic technology, new ways of actively managing epistaxis are now available. Material and methods: A study was conducted in Department of Otorhinolaryngology at St. Stephen's Hospital, on 100 patients with epistaxis. Patients presenting in the ENT OPD or Casualty, or referred from other departments in St. Stephen's hospital, New Delhi. Hundred patients of both sexes and all age groups presenting with epistaxis were included in this study. Results: As per our study, anterior nasal packing was successful in 68% patients on initial attempt. In 18 (18%) out of 100 patients of bleeding could only be controlled by endoscopic cauterisation of the source of the bleeding. 1 (1%) patient, responded to posterior nasal packing. Surgical methods such as Nasal bone reduction and septoplasty were done in 10 (10%) of patients. Conclusion: We have shown intranasal endoscopic cautery procedure for epistaxis to be an effective treatment. In our study, it was associated with a significantly reduced hospital admission, complication rate and with no representations. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is one of the commonest rhinologic emergencies in E.N.T. units. This is because the nasal mucosa is a part of the body that is influenced by systemic, local, metabolic or hormonal disorders. Material and methods: A study was conducted in Department of Otorhinolaryngology at St. Stephen's Hospital, on 100 patients with epistaxis. Patients presenting in the ENT OPD or Casualty, or referred from other departments in St. Stephen's hospital, New Delhi. Hundred patients of both sexes and all age groups presenting with epistaxis were included in this study. Results: As per our study, epistaxis was found to be affecting males than females. Epistaxis usually occurred in population above 50 years of age. Most of the cases presented with bilateral epistaxis followed by unilateral epistaxis. Conclusion: More than 90% of the cases did not have any coagulation defect or any platelet abnormality. Major cause of epistaxis was found to be hypertension followed by trauma. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is defined as bleeding from the nose. Most epistaxis patients can be managed by simple conservative techniques such as nasal packing or cauterization of bleeding points directly or with the help of endoscopes. Material and methods: A study was conducted in Department of Otorhinolaryngology at St. Stephen's Hospital, on 100 patients with epistaxis. Patients presenting in the ENT OPD or Casualty, or referred from other departments in St. Stephen's hospital, New Delhi. Hundred patients of both sexes and all age groups presenting with epistaxis were included in this study. Results: As per our study, anterior nasal packing was successful in 68% patients on initial attempt. In 18 (18%) out of 100 patients of bleeding could only be controlled by endoscopic cauterisation of the source of the bleeding. 1 (1%) patient, responded to posterior nasal packing. Surgical methods such as Nasal bone reduction and septoplasty were done in 10 (10%) of patients. Conclusion: Majority of cases responded to anterior nasal packing. Rest of the cases were surgically managed which included endoscopic cauterisation of the source of the bleed which included cauterisation of Sphenopalatine artery in some cases. [ABSTRACT FROM AUTHOR]

Background: Nasal bleeding is the most common complication during nasotracheal intubation (NTI). To reduce nasal bleeding, the nasal mucosa is treated with vasoconstrictors (epinephrine [E] or tramazoline [T]) prior to NTI. This study aimed to determine whether E or T is more effective and safe for reducing nasal bleeding during NTI. Methods: This study was preregistered on UMIN-CTR after being approved by the IRB of the School of Dentistry at Aichi Gakuin University. Written consent was received from all the patients. Total 206 patients aged 20–70 years and classified as 1–2 on American Society of Anesthesiologists-physical status were scheduled to undergo general anesthesia with NTI. At last, 197 patients were randomly divided into two groups and treated with either E (n = 99; 3 patients were discontinued) or T (n = 98; 2 patient were discontinued). After induction of general anesthesia, each patient's nasal mucosa was treated using either E or T. The E used in this study was BOSMIN® SOLUTION 0.1% (Daiichi-Sankyo Co., Ltd., Tokyo), and the T used in this study was TRAMAZOLIN Nasal Solution 0.118% AFP, (Alfresa Pharma Corporation, Osaka). E was diluted five times according to the package insert (final concentration of E = 0.02%), and T was used in its original solution. After 2 min, NTI was performed via the right nostril. Primary outcome were the presence of nasal bleeding (if bleeding was recognized at the posterior pharyngeal wall via nasal cavity during intubation, it was defined as bleeding) and the degree of bleeding (classified as none, mild, moderate, or severe). Secondary outcomes were arrhythmia, and hemodynamic (mean atrial pressure and heart rate) changes associated with vasoconstrictors. Results: The presence of bleeding was comparable in both groups (12.5%, E; 14.5%, T; P = 0.63). No significant difference between the groups regarding the degree of bleeding (P = 0.78) was observed, with most patients having no bleeding (n = 84, E; n = 82, T). No severe bleeding and no arrhythmias induced by vasoconstrictor were observed in the two groups. Conclusions: Nasal treatment with E or T shows no difference in nasal bleeding during NTI. Although no arrhythmia associated with E was observed in this study, it has been reported in literature. Therefore, as frequency and degree of nasal bleeding were comparable, nasal treatment with T could reduce the risk of NTI. Trial registration: UMIN-CTR (Registration No. UMIN000037907). Registered (05/09/2019). [ABSTRACT FROM AUTHOR]

Objective: Rare disease Background: Epistaxis in children is a common problem encountered in outpatient clinics and emergency departments. A wide variety of conditions may cause recurrent epistaxis in children. We describe clinical, radiologic, and histologic features of a lobular capillary hemangioma presenting as a rapidly growing intranasal mass in a child with recurrent epistaxis. Case Report: A 16-year-old male presented with a 2-month history of recurrent unilateral epistaxis requiring multiple visits to the emergency department. The child had nasal obstruction, snoring, no recurrent sinus infections, no anosmia nor hyposmia, no weight loss, no night sweats, no fever, no decreased activity, and no easy bruising. He denied any history of local trauma. On physical examination, a fleshy violaceous mass was found, protruding from and obliterating the right nasal cavity. Magnetic resonance imaging documented an avidly enhancing mass centered at the right nasal vestibule. Upon resection, histologic evaluation indicated a pyogenic granuloma. At the 2-month followup, the surgical site was healed with no evidence of recurrent lesion. Conclusions: Lobular capillary hemangioma, although uncommon, should be considered in the differential diagnosis of recurrent epistaxis and intranasal mass in children. [ABSTRACT FROM AUTHOR]

Objectives: The study aims to investigate the possible side effects of isotretinoin use on the nasal mucosa with objective methods in the treatment of acne vulgaris. Methods: Before the treatment, nasal mucociliary clearance time (MCT) was measured in all patients. Also all patients were asked to complete the questionnaires about the nasal dryness (visual analog scale [VAS]), nasal obstruction (Nasal Obstruction Symptom Evaluation [NOSE]), and presence of epistaxis (Epistaxis Severity Score [ESS]). Both MCT and questionnaires were reevaluated in patients who completed the treatment. Results: The results of 101 patients were evaluated. Before treatment, mean duration of nasal mucociliary clearance (NMC) was 9.55 ± 1.30 minutes, nasal dryness (VAS) value was 2.7 ± 0.7, NOSE score was 2.1 ± 1.1, and ESS score was 1.2 ± 0.7; after treatment, the duration of NMC was 13.80 ± 2.29 minutes, VAS value was 3.3 ± 1.1, NOSE score was 3.2 ± 1.3, and ESS score was 2.1 ± 1.2 (P =.018,.150,.027,.011, respectively). Conclusion: The nasal mucosa is adversely affected in patients due to regular use of isotretinoin in the acne treatment, anamnesis should be checked in all nasal surgeries, and routine ear nose throat control should be recommended for these patients. [ABSTRACT FROM AUTHOR]

Summary: Current methods of creating sinus drainage and allowing egress of a sinus pack at the end of surgery create significant haemorrhage. Given that haemorrhage is already a concern in some sinus surgeries, the method described allows for a significant reduction in blood loss. The objective was to describe a method of enlarging the nasomaxillary aperture in horses to allow egress of a sinus pack, and subsequent endonasal treatment, without incurring significant haemorrhage. The bulla of the maxillary septum is depressed using a gloved finger (through a sinus flap or trephine hole) or using a long curved Peine instrument under sinoscopic control before fenestration. No major operative or post‐operative complications have been encountered. Satisfactory widening of the nasomaxillary aperture has been accomplished in all cases, although at times, when the bulla is under the floor of the dorsal conchal sinus, it can be difficult to compress. It is imperative that this procedure be performed before fenestration. If performed after fenestration, the most rostral edge of the fenestration can be difficult to identify, and this becomes an impediment to widening the nasomaxillary aperture. Enlarging the nasomaxillary aperture with a finger or blunt instrument allows improvements in sinus drainage without the complication of severe epistaxis. Depression of the bulla of the maxillary septum, before surgical fenestration into the rostral maxillary and ventral conchal sinuses, allows opening of the nasomaxillary aperture with minimal haemorrhage. Thereafter, the sinus pack can be egressed via this route, which is also large enough to perform sinus lavage and post‐operative treatments endonasally without the risk of disturbing the external surgical site. [ABSTRACT FROM AUTHOR]

Objectives: Epistaxis is frequently managed with intra‐nasal packing devices, traditionally requiring patient admission. Current COVID‐19 guidelines encourage ambulatory care where possible in this patient cohort. This paper aims to establish the impact of the Clinical Frailty Scale, anticoagulant/antiplatelet therapeutics and season variation on pre‐pandemic admissions to help identify patients suitable for ambulatory epistaxis management. Design: Retrospective cohort study Setting: Scottish Regional Health Board Participants: Adult patients attending secondary care with epistaxis between March 2019 and March 2020. Main outcome measures: Likelihood of epistaxis hospital admission based on Clinical Frailty Scale. Results: 299 epistaxis presentations were identified, of which 122 (40.8%) required admission. Clinical Frailty Scale of ≥4 had an increased likelihood of admission (OR 3.15 (95% CI:1.94–5.16), P <.05). In the majority of presentations (66.2%), patients were taking either an antiplatelet or anticoagulant. Of these presentations, the use of an anticoagulant (OR: 2.00 (95% CI: 1.20‐3.33), P <.05 and dual antiplatelet (OR: 2.82 (95% CI: 1.02‐7.86), P <.05) demonstrated increased likelihood of admission. Conclusions: We have shown that frailty increases the risk of admission in adult patients presenting with epistaxis. Clinical Frailty Scale (CFS) could be utilised in risk stratification to identify suitable patients for outpatient management. Patients with CFS ≤ 3 could be considered for outpatient management of their epistaxis. It is likely that patients with CFS ≥4 on anticoagulant or dual antiplatelet will require admission. [ABSTRACT FROM AUTHOR]