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With the widespread adoption of intranasal radiofrequency (RF) devices, our objective was to report national adverse events (AEs) associated with their use. The Food and Drug Administration's Manufacturer and User Facility Device Experience was queried. A total of 24 device-related AEs were reported, 11 (45.8%) for Celon® (Olympus), 3 (12.5%) for Vivaer® (Aerin), 2 (8.3%) for Neuromark® (Neurent), and 8 (33.3%) for Rhinaer® (Aerin). Seven (63.6%) of the Celon®-related complications were related to tissue necrosis (largely user error-related), but 1 (9.1%) episode of pediatric ocular palsy was also reported. Vivaer® complications included synechiae formation, a mucosal perforation, and a case of empty nose syndrome. Of the posterior nasal nerve ablating devices, 9 of 10 AEs were epistaxes, of which 7 (77.8%) required operative intervention. Surgeons should exercise vigilance and tissue-appropriate device settings when utilizing RF devices. Epistaxis and tissue necrosis may occur, as well as more rare, but devastating, complications.

Objective Design Methods and Results Conclusion To evaluate the feasibility of an improvised tamponade device allowing direct pressure to be applied to the canine nasopharynx.Proof‐of‐concept study using 8 canine cadavers.A tamponade device was made by placing a condom over a nasogastric tube and suturing it to match the length of the nasopharynx. The device was placed in the nasopharynx of canine cadavers via the nares and filled with diluted ioversol. Placement was then confirmed with radiography or computed tomography. Concentrated ioversol was infused into the rostral nasal cavity to assess for a nasopharyngeal seal, defined as no ioversol passing the device seen on imaging. Subjective assessment of adequate nasopharyngeal compression via digital palpation of the soft palate agreed with imaging findings. Repositioning was required in several cases, but with digital palpation, initial placement was more accurate. Subsequent effective placement and a nasopharyngeal seal were achieved in all 8 cadavers.This device can be placed in the canine nasopharynx, and an adequate nasopharyngeal seal can be achieved, allowing direct compression of the nasopharynx and filling of the nasal cavity with solution. Confirmation of placement was successful with digital palpation and imaging. Further studies are required to investigate the use of this device in live patients. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion It is often recommended that, in children with bilateral epistaxis, only one side of the nasal septum should be cauterised at a time in order to reduce the risk of septal perforation. This advice may have been reasonable when hot wire electrocautery was in common use. The risk of septal perforation after silver nitrate cautery is unknown but probably low.Retrospective case note review of children attending the nurse‐led epistaxis clinic between 2019 and 2022.Nine hundred and twenty children were seen in the nurse‐led clinic between January 2019 and December 2022. Six hundred and one children (79%) underwent nasal cautery. Simultaneous bilateral nasal cautery was carried out in 176 (29%) children. Our follow up period ranged between 303 and 1744 days, with a median of 809.5 days. No child presented to emergency or ENT services with septal perforation or any other complication of simultaneous bilateral nasal cautery.To the author's knowledge, this is the largest study assessing the safety of simultaneous bilateral nasal cautery with silver nitrate in children. No adverse results have been found after cauterising both sides of the septum at the same sitting, and doing so potentially saves time and money for patients and the health service. [ABSTRACT FROM AUTHOR]

A survey of otolaryngologists and advanced practice providers specializing in otolaryngology found that almost half of respondents always or almost always prescribed antibiotic prophylaxis after nasal packing for epistaxis, despite limited evidence supporting this practice. The frequency of antibiotic prescribing was not related to gender, degree, fellowship status, geographic region, or years of training. The results suggest a need for providers to carefully assess the appropriateness of routine antibiotic prescribing given the lack of benefits in the literature and potential serious adverse events. Shared decision-making with patients should play a greater role in prescribing practices until further research clarifies the uncertainty regarding antibiotic benefit. [Extracted from the article]

Background: While leeches as intranasal foreign bodies are not frequently encountered, they can be one of the causes of epistaxis. The aim of the study is to raise awareness among healthcare professionals about the possibility of patients from leech endemic regions presenting with epistaxis. Case presentation: We present a series of epistaxis cases due to intranasal leech infestation. In our series of 10 cases, there were 7 male and 3 female patients, aged between 2 and 53 years old. The duration of the complaint ranged from 1 to 5 weeks. All patients experienced with blood-stain nasal discharge or frank nasal bleeding at some point and most of them have a history of leech infestation from spring water as a local source. This article presents our approach to managing nasal leech infestation as epistaxis and outlines the precautionary measures taken for the retrieval of this living foreign body. Conclusion: Details of the history must be taken before concluding the diagnosis. Maintain a high index of suspicion of leech infestation as a hidden cause of epistaxis especially in patients coming from endemic areas. [ABSTRACT FROM AUTHOR]

Background: Nasotracheal intubation is associated with a risk of epistaxis. Several drugs, including cocaine and xylometazoline may be used as decongestants prior to nasotracheal intubation to prevent this. We hypothesized that xylometazoline would prevent epistaxis more effectively than cocaine, demonstrated by a lower proportion of patients with bleeding after nasotracheal intubation. Methods: We conducted a single‐center, outcome assessor and analyst‐blinded, clinical randomized controlled trial following approval from the local research ethics committee and the national medicine agency. Written informed consent was obtained from all patients. Patients scheduled for surgery under general anesthesia with nasotracheal intubation were randomized to receive either 2 mL 4% cocaine or 2 mL 0.05% xylometazoline prior to nasotracheal intubation. Immediately following intubation, epistaxis was evaluated by the blinded intubating anesthetist on a four‐point scale. We measured heart rate and blood pressure the first 5 min after drug administration. Adverse events were followed up after 24 h. Results: A total of 53 patients received cocaine and 49 patients received xylometazoline. Bleeding occurred in 32 patients receiving cocaine (60.4%) and in 34 patients receiving xylometazoline (69.4%) (p =.41, Fisher's exact test) with a difference of 9.0% (95% CI: −9.4% to 27%). There was no statistically significant difference between groups regarding the heart rate or blood pressure. No adverse cardiac events were recorded in either group. Conclusion: We found no statistically significant difference between cocaine and xylometazoline in preventing epistaxis after nasotracheal intubation, and the choice of vasoconstrictor should be based on other considerations, such as pricing, availability and medicolegal issues. [ABSTRACT FROM AUTHOR]

The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the "Grading of Recommendations, Assessment, Development, and Evaluations" approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes. [ABSTRACT FROM AUTHOR]

Objective(s): Pediatric epistaxis is a common, often non‐operative condition encountered by Otolaryngologists. The present study seeks to (1) describe our outcomes of epistaxis management, (2) estimate the associated healthcare burden, and (3) propose a clinical model to optimize care coordination with primary care and advanced practice providers. Methods: Retrospective case series of pediatric patients treated outpatient for epistaxis by a single otolaryngologist from 2021 to 2022. The primary outcome after treatment with nasal lubricants was defined as (1) refractory epistaxis, (2) improvement, or (3) complete resolution. Cost data for office versus operative nasal cautery were analyzed. Results: In total, 122 patients were included for analysis. Over a follow‐up duration of 20.5 months (IQR 8–36), 24.6% of patients experienced refractory epistaxis, 41.8% of patients found improvement, and 33.6% had complete resolution (n = 122). Refractory epistaxis was associated with a family history of coagulopathy (p =.007), daily epistaxis episodes (p =.043), and anemia (p <.001). Average direct hospital costs associated with nasal cautery were $187 for in‐office cauterization and $2179 for intraoperative cauterization. Estimated patient/third party payors savings were $1617 and $15,412 for in‐office and intraoperative procedures, respectively, and $541.59 for specialty office visits alone. The average charge for laboratory work‐up was $576. Conclusion: Approximately 75% of patients with epistaxis experienced improvement or resolution of symptoms with nasal lubrication alone. Refractory epistaxis was associated with a family history of coagulopathy, daily epistaxis episodes, and anemia. Otolaryngology visits for epistaxis were associated with a direct healthcare expense burden. Adaptation of our clinical model may mitigate these costs while improving patient care. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion. [ABSTRACT FROM AUTHOR]

Purpose: Epistaxis is a common condition that affects about 60% of the population in their lifetime, with 6% needing medical attention. Little is known about the epidemiology and risk factors of epistaxis outside the health care system. This study aimed to investigate the prevalence and risk factors of epistaxis in a rural Danish population using data from the Lolland-Falster Health Study (LOFUS). Methods: We conducted a cross-sectional survey based on data from LOFUS, a household-based, prospective cohort study in the rural provincial area of Lolland-Falster, Denmark. We enrolled 10,065 participants (≥ 50 years) and collected data on demographics, comorbidities, medication, lifestyle factors, and laboratory parameters. Logistic regressions were used to test for correlations between epistaxis and different risk factors. Results: In total 5.3% of the participants had experienced epistaxis within the past 30 days, and 7.9% had sought medical attention for epistaxis at some point in their lives. We identified several factors that were significantly correlated with increased odds of epistaxis, such as male gender, age group 50–59 years, high BMI (> 25), allergy, diabetes, hypertension, atherosclerosis, angina, and anticoagulant treatment. Excellent or good self-reported health was correlated to significantly lower odds of epistaxis. Conclusion: This study provides a comprehensive overview of the prevalence and risk factors of epistaxis outside the health care system. Our study suggests that preventive measures targeting these risk factors may reduce the incidence and severity of epistaxis in this population. [ABSTRACT FROM AUTHOR]

Background/Aim: There is a dearth of studies addressing the effects of next-generation anticoagulants on epistaxis. The aim of this investigation was to determine whether there are any differences between traditional and next-generation anticoagulants in the etiology of epistaxis. Methods: This retrospective cohort study focused on a total of 7,110 individuals (3,278 females (46.1%) and 3,832 males (53.9%)) diagnosed with epistaxis between 2018 and 2022; the mean age of the patients was 37.7 years. Patient data (age, gender, outpatient and inpatient treatments, relevant laboratory parameters, and treatment evidence) were retrospectively reviewed from a hospital database. The severity of epistaxis was assessed based on treatment notes. Patients with hypertension and those undergoing antiaggregant therapy were excluded from the study. International Classification of Diseases (ICD) codes from the automated system were examined retrospectively. The data were used to establish three patient groups: the first group consisted of individuals taking next-generation oral anticoagulants, the second group consisted of individuals taking traditional oral anticoagulants, and the third group consisted of healthy controls. Results: We found statistically significant differences among the groups in terms of age, the severity of epistaxis, the treatment modality, and laboratory findings (P<0.001); no statistically significant difference was found in terms of gender (P=0.954). Group 2 contained the largest number of hospitalized patients and patients with severe active nosebleeds. Conclusion: Next-generation anticoagulants are more reliable than traditional anticoagulants in terms of the severity of epistaxis, the need for hospitalization, and laboratory results. [ABSTRACT FROM AUTHOR]

Objective: Critical components of the nasal endoscopic examination have not been definitively established for either the normal examination or for clinical disorders. This study aimed to identify concordance among rhinologists regarding the importance of examination findings for various nasal pathologies. Study Design: A consortium of 19 expert rhinologists across the United States was asked to rank the importance of findings on nasal endoscopy for 5 different sinonasal symptom presentations. Setting: An online questionnaire was distributed in July 2023. Methods: The questionnaire utilized JotForm® software and featured 5 cases with a set of 4 identical questions per case, each covering a common indication for nasal endoscopy. Rankings were synthesized into Normalized Attention Scores (NASs) and Weighted Normalized Attention Scores (W‐NASs) to represent the perceived importance of each feature, scaled from 0 to 1. Results: General concordance was found for examination findings on nasal endoscopy within each case. The perceived features of importance differed between cases based on clinical presentation. For instance, in evaluating postnasal drip, the middle meatus was selected as the most important structure to examine (NAS, 0.73), with mucus selected as the most important abnormal finding (W‐NAS, 0.66). The primary feature of interest for mucus was whether it was purulent or not (W‐NAS, 0.67). Similar analyses were performed for features in each case. Conclusion: The implicit framework existing among rhinologists may help standardize examinations and improve diagnostic accuracy, augment the instruction of trainees, and inform the development of artificially intelligent algorithms to enhance clinical decision‐making during nasal endoscopy. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is the most common otorhinolaryngological emergency and historically there have been an important debate whether there is a cause-effect relationship with high blood pressure. Aim: This retrospective study explored whether hypertension is a significant risk factor for epistaxis in Emergency Department (ED) patients and examined associations between blood pressure levels and epistaxis episodes. Materials and Methods: Two groups were studied: Group A (patients with epistaxis) and Group B (control). Patient characteristics, comorbidities, and medication use were recorded. Blood pressure measurements were taken upon ED arrival and after specialist evaluation. Statistical analyses included descriptive statistics, T-test, χ2 test, and logistic regression. Results: Group A, enrolled from April 2014 to February 2015, included 102 patients, mean age 67, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 73%, decreasing to 26% after 30 minutes. Group B, enrolled from May 2023 to August 2023, included 126 patients, mean age 59, male-female ratio 2:1. Blood pressure on arrival was over 140/90 mmHg in 60%, decreasing to 23% after 30 minutes. Both groups showed reduced blood pressure post-evaluation. Logistic regression identified anticoagulant and/or antiplatelet therapy as the main independent risk factor for epistaxis. Age, sex, blood pressure levels, and hypertension did not significantly influence epistaxis occurrence. Conclusion: No significant correlation between hypertension and epistaxis was found. Anticoagulant and/or antiplatelet therapy was the primary independent risk factor, highlighting the importance of considering medication history in evaluating epistaxis. [ABSTRACT FROM AUTHOR]

Purpose: To assess the knowledge and confidence level regarding the basic first-aid for treating epistaxis among medical staff, including nurses and physicians across various medical disciplines. The study focused three aspects of first aid management: location of digital pressure, head position and duration of pressure. Methods: The study involved 597 participants, categorized into five groups according to their specialties: emergency medicine, internal medicine, surgery, pediatrics, and community-based healthcare. A paper-based multiple-choice questionnaire assessed knowledge of managing epistaxis. Correct answers were determined from literature review and expert consensus. Results: Most medical staff showed poor knowledge regarding the preferred site for applying digital pressure in epistaxis management. For head position, pediatricians and internal medicine physicians were most accurate (79.4% and 64.8%, respectively, p < 0.01), and nurses from the emergency department outperformed nurses from other disciplines; internal medicine, surgery, pediatrics, and community-based healthcare (61.1%, 41.5%, 43.5%, 60%, 45.6%, respectively, p < 0.05). While most medical staff were unfamiliar with the recommended duration for applying pressure on the nose, pediatricians and community clinic physicians were most accurate (47.1% and 46.0%, respectively, p < 0.01), while ER physicians were least accurate (14.9%, p < 0.01). Interestingly, a negative correlation was found between years of work experience and reported confidence level in managing epistaxis. Conclusions: Our findings indicate a significant lack of knowledge concerning epistaxis first-aid among medical staff, particularly physicians in emergency departments. This finding highlights the pressing need for education and training to enhance healthcare workers' knowledge in managing epistaxis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. Methods: We retrospectively reviewed the data of 646 hospitalized epistaxis patients. Results: The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50 years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. Conclusion: The bleeding sites can be identified in most epistaxis patients. Age > 50 years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans. [ABSTRACT FROM AUTHOR]

Epistaxis is a common problem that can affect the whole population and is the most common ENT presentation to the emergency department.1 The majority of cases are self-limiting and do not require any medical intervention, however epistaxis can be associated with morbidity and even death in very rare circumstances. If epistaxis does not resolve with first aid measures, or episodes are frequent, patients may require specialist assessment and treatment by ENT, either in the outpatient clinic or via an unscheduled (emergency) admission to the hospital. Here, we provide an overview of the management of epistaxis in the outpatient setting and during an emergency admission in both paediatric and adult patients. We highlight the key considerations in the history and management, covering the common and rare conditions that are associated with epistaxis. This article provides an update from our most recent version published in 2021 including updated resources from British Rhinology Society guidance and review of the recent literature regarding epistaxis management. [ABSTRACT FROM AUTHOR]

The clinical policy of the Emergency Medicine Association of Türkiye (EMAT) provides guidance on the use of tranexamic acid (TXA) in emergency settings. TXA, an antifibrinolytic drug, is used to control bleeding by inhibiting plasminogen. Its applications have expanded from hemophilia and severe menstrual bleeding to include various forms of trauma and surgery-related bleeding. Despite its potential benefits, the use of TXA in emergency settings must be carefully evaluated due to its associated risks, including venous thromboembolism. This policy aimed to offer evidence-based recommendations on the indications and contraindications of TXA in different clinical scenarios encountered in the emergency departments. The guidelines were developed using the “Grading of Recommendations, Assessment, Development, and Evaluations” approach, incorporating systematic literature reviews, and expert consensus from the EMAT Research Committee. This document focuses on critical clinical questions regarding the efficacy and safety of TXA in situations such as gastrointestinal bleeding, multitrauma, traumatic brain injury, nontraumatic intracranial hemorrhage, hemoptysis, and epistaxis. By addressing these issues, the policy seeks to assist emergency physicians in making informed decisions about the use of TXA, ultimately aiming to improve the patient outcomes.

Abstract Background While leeches as intranasal foreign bodies are not frequently encountered, they can be one of the causes of epistaxis. The aim of the study is to raise awareness among healthcare professionals about the possibility of patients from leech endemic regions presenting with epistaxis. Case presentation We present a series of epistaxis cases due to intranasal leech infestation. In our series of 10 cases, there were 7 male and 3 female patients, aged between 2 and 53 years old. The duration of the complaint ranged from 1 to 5 weeks. All patients experienced with blood-stain nasal discharge or frank nasal bleeding at some point and most of them have a history of leech infestation from spring water as a local source. This article presents our approach to managing nasal leech infestation as epistaxis and outlines the precautionary measures taken for the retrieval of this living foreign body. Conclusion Details of the history must be taken before concluding the diagnosis. Maintain a high index of suspicion of leech infestation as a hidden cause of epistaxis especially in patients coming from endemic areas.

Osler-Weber-Rendu disease (OWRD), also known as hereditary haemorrhagic telangiectasia (HHT), is an autosomal dominant genetic disorder characterised by arteriovenous malformations in several organs. Ischemic cholangitis is a rare life-threatening complication of OWRD, with only a few documented cases in the literature. A liver transplant is the main curative treatment. In this paper, we report a case of a 33-year-old woman with a history of recurrent epistaxis, admitted with abdominal pain and fever, physical examination found multiple cutaneous and mucosal telangiectasias and the biological workup showed cholestasis, abdominal imaging identified arterio-venous shunts and multiple cystic hepatic lesions, one of them seemed to communicate with an intrahepatic biliary duct, finally the diagnosis of ischemic cholangitis due to OWRD was retained and antibiotic treatment has been initiated. We review the various therapeutic options available to improve the management of this fatal complication.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare, locally aggressive, highly vascularized benign tumor classically found in males from 13 to 20 years old. The most common clinical presentations are recurrent epistaxis and nasal congestion. Imaging plays a significant role in differentiating and determining the extension of nasopharyngeal lesions. The case below highlights a 15-year-old male that presented with nasal congestion and recurrent epistaxis, who underwent nasal endoscopy and ablation. Persisting symptoms led to further evaluation by computed tomography and magnetic resonance imaging of the head; thus, the patient was diagnosed with JNA. Subsequently, the patient underwent angiographic embolization of the maxillary artery branches and eventually, endoscopic tumor resection. The presenting case is an example for physicians that might encounter an unsuspecting case of JNA to expedite diagnosis and care.

The Ewing sarcoma family of tumors (ESFT) stands for a group of rare and aggressive malignancies consisting of high grade poorly differentiated small round blue cells. In our case report, we aim to describe the clinical presentation, diagnosis and the treatment plan for our patient. A 16-year-old girl presented to the ENT outpatient department of the Mayo Hospital Lahore with the complaints of right nasal obstruction, epistaxis from right nose, swelling on the right cheek and headaches. Examination revealed a soft, tender swelling on her right cheek below the right eye. Imaging revealed a heterogeneous opacity in the right nose and right maxillary sinus with erosion of the sinus walls.Very few such cases have been reported in international literature. Being a rare case, our article will add insights to the literature regarding complex clinical presentation, diagnostic evaluation and treatment of the sinonasal Ewing sarcoma.

Aim: Nasopharyngeal carcinoma (NPC) is prevalent in certain regions, particularly Southeast Asia and Southern China. In Malaysia, it is notably frequent among the Bidayuh community. This study presents a comprehensive review of NPC cases diagnosed and treated at Sarawak General Hospital from 2010 to 2020. Method: A retrospective data collection was conducted using the clinical records of patients who were histopathologically diagnosed with NPC at the Otolaryngology-Head & Neck Clinic and the Radiotherapy & Oncology Clinic at Sarawak General Hospital. Result: The study comprised a total of 892 patients from 2010 to 2020. Males outnumbered females 3-to-1, with a mean age of 51 years (standard deviation: 13.9). The largest groups of patients were the Iban (34%) and the Bidayuh (21%), followed by the Chinese (19%) and the Malay (15%). The Bidayuh had the highest incidence rate with 81 cases per 100,000. Only 10% of the study population had a family history of NPC. The most common presentation was a neck lump (64.5%). Distant metastasis was discovered in 20% of patients. 82% of the cases were stage 3 or 4 at the time of presentation. The histological types of the 892 cases were mainly undifferentiated carcinoma (73%). Eighty-six patients developed recurrence, with 83% experiencing local recurrence, 10% developing distant metastasis, and 7% developing regional recurrence. Treatment for recurrence included nasopharyngectomy, neck dissection, and chemotherapy. Conclusion: The study highlights a significant incidence of NPC among the Bidayuh. Emphasis on screening and early detection is crucial for better outcomes, with lifelong follow-up recommended. [ABSTRACT FROM AUTHOR]

Purpose: The control of epistaxis has always posed a significant challenge for otolaryngologists. One of the most viable options to address refractory cases is the ligation or cauterization of the sphenopalatine artery. The objective of this study was to assess the efficacy, safety, and long-term outcomes of these interventions. Materials and methods: Two independent otolaryngologists conducted a comprehensive search for studies dealing with management of uncontrolled/recurrent epistaxis by consulting the main scientific databases on the web, including PubMed, Google Scholar, Medline, EMBASE, Web of Science, and the Cochrane Library. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The criteria for considering studies for the review were based on the population, intervention, comparison, outcome, timing and setting (PICOTS) framework. Results: Sixteen studies were included in the systematic review, comprising a total of 454 patients. Among these, 289 individuals underwent ligation of the sphenopalatine artery, while 100 underwent cauterization of the same artery. Additionally, 56 patients underwent both ligation and cauterization of the sphenopalatine artery during the same surgery. The incidence of rebleeding and complications was respectively 12.1% (55/454) and 3% (14/454), resulting in relatively low rates in both cases. Conclusions: Our review emphasizes the increasing importance of surgical approaches, specifically ligation or cauterization of the sphenopalatine artery, in addressing refractory cases. The low incidence of complications, predominantly temporary decreased lacrimation in patients undergoing ligation of the sphenopalatine artery, highlights the safety and feasibility of these interventions. [ABSTRACT FROM AUTHOR]

Introduction: Epistaxis is commonly referred to as nosebleeds. The age range in which it most frequently manifests itself is three to eight years old. One of the primary settings for pediatric epistaxis is schools since kids can get accidental injuries while playing. The security and welfare of the pupils in school are the teacher's concerns. So, the teachers must be aware of the correct basic first-aid protocols. This study aims to assess the awareness of handling of epistaxis first aid in schools. Methodology: The study participant's responses were gathered using a pre-tested semi-structured questionnaire. Statistical analysis was done and the significance of the results was assessed Results & Conclusion: The majority of participants felt confident when it came to managing epistaxis, despite the fact that they had not received any formal training and simply possessed only an average understanding of the subject, lacking detailed insights and intricacies related to its first aid treatment. This underscores the fact that they were overestimating their knowledge and expertise in this domain. Therefore, educators, who are typically the initial responders to pediatric epistaxis in schools, have a limited or inadequate understanding and familiarity with the appropriate first aid protocols. Further studies scaling larger populations and propagating awareness in institutes related to children especially through means of live demonstrations and workshops can advance first aid management during emergencies. [ABSTRACT FROM AUTHOR]

Rhinolith, commonly addressed as nasal stone is quite unusual and rare entity. It is actually a calcified mass that form within the nasal cavity, typically as a result of mineral deposits accumulating around a core of foreign material (which can be exogenous or endogenous in origin). Although often small and asymptomatic, rhinolith can occasionally grow to significant size, causing severe clinical symptoms. Case description: We report a case of this clinical entity, a tribal woman from interior Himalayan regions, where the lack of medical facilities and expertise led to missed diagnosis, years of suffering and a rhinolith of humongous proportions. Significance: Although a rare clinical entity, recurrent specific symptoms, as discussed in article should raise a suspicion of Rhinolithiasis too. If diagnosed at initial stages, it can save years of torment and complications to patient. [ABSTRACT FROM AUTHOR]

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. Key Messages: Length of stay in the ED for a patient that consult for spontaneous anterior epistaxis is 2 h and 20 min. Night and ORL consults increase this duration. Hypertension, age, or blood thinners do not increase this duration. [ABSTRACT FROM AUTHOR]

Abstract Background Exercise-induced pulmonary haemorrhage (EIPH) in athletic horses is characterized by the presence of blood from the lungs in the tracheobronchial tree after intense exercise. Despite the high prevalence of EIPH in horses, the primary aetiology remains unknown. Variants in the genes encoding CD39 and CD39L1 (ENTPD1 and ENTPD2, respectively) were previously reported as potential genetic causes involved in EIPH pathogenesis. However, the role of these variants in haemostatic functions is unknown. Results To investigate the association between EIPH and missense variants in the ENTPD1 (rs1152296272, rs68621348, and rs68621347) and ENTPD2 genes (rs782872967), 76 Thoroughbred horses diagnosed with EIPH and 56 without clinical signs of EIPH (control group) by trachea-bronchial endoscopy were genotyped. The rs1152296272 and rs68621347 variants were linked, which explained why the same results were found in all horses. Approximately 96% and 95% of the EIPH and control horses, respectively, carried at least one nonreference allele for these variants. In contrast, 100% of the control horses and 96% of the EIPH horses were homozygous for the reference allele for the rs68621348 variant. In the EIPH group, 1.5% of the horses were homozygotes and 24% were heterozygous for the nonreference allele of the rs782872967 variant. In the control group, the nonreference allele of this variant was observed only in heterozygotes (16%). There were no significant differences between groups for any of the variants. Conclusions The variants previously described in the genes encoding the CD39 and CD39L1 enzymes were highly present in the studied population. However, no association was found between the occurrence of EIPH and the presence of these variants in Thoroughbred horses in this study.

Extramedullary plasmacytoma (EMP) is an uncommon tumor marked by the monoclonal growth of plasma cells without the characteristics of multiple myeloma. EMP represents 3% of all plasma cell tumors. An 89-year-old male patient with hypertension was admitted to our tertiary care hospital with uncontrolled unilateral epistaxis. After a year and a half of recurring epistaxis, the patient's bleeding became more frequent and could no longer be controlled with nasal packing. Angiofibroma was suspected as the initial differential diagnosis, and angiofibroma embolization was performed. The patient experienced difficulty swallowing and slurred speech and was diagnosed with an ischemic stroke. However, antiplatelet and tranexamic acid medications were contraindicated due to bleeding risks. The patient underwent functional endoscopic sinus surgery, and unexpectedly, histology results revealed a plasmacytoma. After surgery, the patient remained stable and was discharged for further management.

Abstract Background Immunoglobulin G4-related disease is marked by extensive inflammation and fibrosis of an unknown autoimmune component, with an overall incidence ranging from 0.78 to 1.39 per 105 person-years. Sinonasal immunoglobulin G4-related disease is atypical and exceedingly uncommon in the existing literature, frequently manifesting clinically as chronic rhinosinusitis, epistaxis, and facial pain. Case presentation This report describes a 25-year-old Iraqi female who has been suffering from symptoms of chronic rhinosinusitis for 8 years. Despite undergoing several surgeries, there has been no improvement in her symptoms. A tissue biopsy that revealed dense lymphoplasmocytosis with noticeable plasma cell infiltration, storiform fibrosis, and obliterative angitis, along with positive immunohistochemical staining for Immunoglobulin G4 plasma cells, finally confirmed the diagnosis of sinonasal immunoglobulin G4-related disease. The patient responded well to oral prednisolone and methotrexate treatments. Conclusions The main objective of the current report is to raise awareness among physicians about the significance of promptly identifying and diagnosing this rarity, thus preventing the adverse consequences linked to delayed diagnosis and treatment initiation.

Introduction: It's approximated that 60% of the population globally experience epistaxis during lifetime. Despite epistaxis being prevalent in Tanzania, there are limited studies that have explored experience of participants on epistaxis. This study aims to determine knowledge on the causes, first aid management and practices of epistaxis among patients attending a health facility in Eastern Tanzania Methods: A descriptive cross-sectional study was conducted where 371 participants aged 15 years and above were interviewed using structured questionnaires. Data was analyzed using Statistical Package of Social Sciences version 23. Chi-square tests were performed and a p-value

Background: Exercise-induced pulmonary haemorrhage (EIPH) in athletic horses is characterized by the presence of blood from the lungs in the tracheobronchial tree after intense exercise. Despite the high prevalence of EIPH in horses, the primary aetiology remains unknown. Variants in the genes encoding CD39 and CD39L1 (ENTPD1 and ENTPD2, respectively) were previously reported as potential genetic causes involved in EIPH pathogenesis. However, the role of these variants in haemostatic functions is unknown. Results: To investigate the association between EIPH and missense variants in the ENTPD1 (rs1152296272, rs68621348, and rs68621347) and ENTPD2 genes (rs782872967), 76 Thoroughbred horses diagnosed with EIPH and 56 without clinical signs of EIPH (control group) by trachea-bronchial endoscopy were genotyped. The rs1152296272 and rs68621347 variants were linked, which explained why the same results were found in all horses. Approximately 96% and 95% of the EIPH and control horses, respectively, carried at least one nonreference allele for these variants. In contrast, 100% of the control horses and 96% of the EIPH horses were homozygous for the reference allele for the rs68621348 variant. In the EIPH group, 1.5% of the horses were homozygotes and 24% were heterozygous for the nonreference allele of the rs782872967 variant. In the control group, the nonreference allele of this variant was observed only in heterozygotes (16%). There were no significant differences between groups for any of the variants. Conclusions: The variants previously described in the genes encoding the CD39 and CD39L1 enzymes were highly present in the studied population. However, no association was found between the occurrence of EIPH and the presence of these variants in Thoroughbred horses in this study. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nosebleeds, or epistaxis, are a frequent emergency in the ear, nose, and throat (ENT) department.Epistaxis can arise from both local and systemic factors. Locally, bleeding can occur within the nasal cavity, either in the anterior or posterior region. The most common site of anterior epistaxis is Kiesselbach's plexus.Epistaxis management can be complex and requires a thoughtful approach, with most cases being successfully treated through conservative measures, while others may necessitate surgical intervention. MATERIALS AND METHODS: A hospital-basedprospective observational study was conducted in the Department of Otorhinolaryngology, Assam Medical College and Hospital for one year (1 st April 2023 to 31st March 2024) in patients presenting with epistaxis in Department of Otorhinolaryngology, AMCH. RESULTS: Most of the patients belonged to the age group of 41-50 years. Male: female ratio was 2.55%. Hypertension was the leading cause of nasal bleed in 28.125% of cases. This was followed by trauma in 25% of cases. Conservative management was the most common modality of treatment. CONCLUSION: This study provides insights into effective epistaxis management, emphasizing a tailored approach based on severity and cause, with conservative measures suitable for most cases and surgery reserved for a few. [ABSTRACT FROM AUTHOR]