Posterior epistaxis. A series review of 72 patients
Abstract Introduction and objetive: Nowadays there is not exhaustive consensus regarding posterior epistaxis management and different factors may vary the applied treatment. Method: 72 patients who were admitted to our center with a discharge diagnosis of posterior epistaxis between 2010 and 2015 were selected. The types of nasal packing, the invasive tratment needed, personal history associated with increase in incidence and/or mangement diffculties, age and gender were analyzed after applying the exclusion criteria. Results: The average age was 62 years old. 78% were men. 55.6% had a hypertension diagnosis, while 22.2% were diagnosed at admission. 31.9% were in oral anticoagulant therapy and 11.1% antiplatelet therapy. Bibalonated catheter was used in 60 patients (85.7%) as first nasal packing, anteroposterior nasal packing in 6 patients (8.6%). The mean time of the first tamponade was 3.74 days. 15 patients (20.8%) needed a second nasal packing and one patient needed the placement of a 3rd nasal packing. During admission, 5 patients (6.9%) required invasive treatment, in 2 of them without previous nasal packing. In 4 patients a surgical treatment was performed, and interventional treatment was performed in 2 patients. Conclusions: The bibalonated catheter is the first choice in our hospital. The nasal packing duration is lightly higher than described in the literature. After an exhaustive research about this topic, we can conclude that the therapeutic management of epistaxis is still a controversial point in Otorhinolaryngology.
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Acar B, Yavuz B, Y?ld?z E, Ozkan S, Ayturk M, Sen O et al. A possible cause of epistaxis: increased masked hypertension prevalence in patients with epistaxis. Braz J Otorhinolaryngol. 2017;83(1):45-9. - https://doi.org/10.1016/j.bjorl.2016.01.007. - PMid:27133905
Barnes M, Spielmann P, White P. Epistaxis: A Contemporary Evidence Based Approach. Otolaryngol Clin North Am. 2012;45(5):1005-17. - https://doi.org/10.1016/j.otc.2012.06.018. - PMid:22980681
Biggs T, Baruah P, Mainwaring J, Harries P, Salib R. Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients. J Laryngol Otol. 2013;127(05):483-8. - https://doi.org/10.1017/S0022215113000492. - PMid:23544790
Chacon J, Morales JM, Padilla M. Epistaxis y cuerpos extra-os nasales. En: Libro virtual de formación en ORL. SEORL (Madrid). http://seorl.net/libro-virtual/
García Callejo F, Mu-oz Fernández N, Achiques Martínez M, Frías Moya-Angeler S, Montoro Elena M, Algarra J. Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos. Acta Otorrinol Esp. 2010;61(3):196-201. - https://doi.org/10.1016/j.otorri.2009.11.005. - PMid:20137770
Hall A, Blanchford H, Chatrath P, Hopkins C. A multi-centre audit of epistaxis management in England: is there a case for a national review of practice? J Laryngol Otol. 2015;129(05):454-7. - https://doi.org/10.1017/S0022215115000596. - PMid:25816868
Hall A, Simons M, Pilgrim G, Theokli C, Roberts D, Hopkins C. Epistaxis management at Guy's Hospital, 2009–2011: full audit cycles. J Laryngol Otol. 2013;128(01):82-5. - https://doi.org/10.1017/S0022215113003137. - PMid:24290872
Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert J. Epidemiology of epistaxis admitted to a tertiary hospital. Acta Otorrinol Esp. 2010;61(1):41-7. - https://doi.org/10.1016/j.otorri.2009.09.003. - PMid:20004879
Page C, Biet A, Liabeuf S, Strunski V, Fournier A. Serious spontaneous epistaxis and hypertension in hospitalized patients. Eur Arch Otorhinolaryngol. 2011;268(12):1749-53. - https://doi.org/10.1007/s00405-011-1659-y. - PMid:21656167
Seno S, Arikata M, Sakurai H, Owaki S, Fukui J, Suzuki M et al. Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis. Am J Rhinol Allergy. 2009;23(2):197-9. - https://doi.org/10.2500/ajra.2009.23.3294. - PMid:19401049
Shargorodsky J, Bleier B, Holbrook E, Cohen J, Busaba N, Metson R et al. Outcomes Analysis in Epistaxis Management: Development of a Therapeutic Algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-8. - https://doi.org/10.1177/0194599813492949. - PMid:23764960
Sireci F, Speciale R, Sorrentino R, Turri-Zanoni M, Nicolotti M, Canevari FR. Nasal packing in sphenopalatine artery bleeding: therapeutic or harmful? Eur Arch Otorhinolaryngol. 2017;274(3):1501-5. - https://doi.org/10.1007/s00405-016-4381-y. - PMid:27837422
Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2010;125(01):38-42. - https://doi.org/10.1017/S0022215110001921. - PMid:20843406
Soyka M, Rufibach K, Huber A, Holzmann D. Is severe epistaxis associated with acetylsalicylic acid intake? Laryngoscope. 2010;120(1):200-7.. - PMid:19877246
Strach K, Schröck A, Wilhelm K, Greschus S, Tschampa H, Möhlenbruch M et al. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome. Cardiovasc Intervent Radiol. 2011;34(6):1190-8. - https://doi.org/10.1007/s00270-011-0155-5. - PMid:21472510
Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(07):744-9. - https://doi.org/10.1017/S0022215110000411. - PMid:20403223
Upile T, Jerjes W, Sipaul F, El Maaytah M, Nouraei S, Singh S et al. The role of surgical audit in improving patient management; nasal haemorrhage: an audit study. BMC Surg. 2007;7(1):19. - https://doi.org/10.1186/1471-2482-7-19. - PMid:17854499 PMCid:PMC2034528
Vermeeren L, Derks W, Fokkens W, Menger DJ. Complications of balloon packing in epistaxis. Eur Arch Otorhinolaryngol. 2015;272(10):3077-81. - https://doi.org/10.1007/s00405-015-3529-5. - PMid:25647471
Villwock J, Jones K. Recent Trends in Epistaxis Management in the United States. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1279-84. - https://doi.org/10.1001/jamaoto.2013.5220. - PMid:24136624
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Lancet 2007;370:1453-7. - https://doi.org/10.1016/S0140-6736(07)61602-X
Zarraonanadia I, Gras JR. Epistaxis. En: Llorente, Álvarez, Nú-ez, coordinadores. Manual clínico de Otorrinolaringología. Madrid: Panamericana; 2012. p.383-91.
Barnes M, Spielmann P, White P. Epistaxis: A Contemporary Evidence Based Approach. Otolaryngol Clin North Am. 2012;45(5):1005-17. - https://doi.org/10.1016/j.otc.2012.06.018. - PMid:22980681
Biggs T, Baruah P, Mainwaring J, Harries P, Salib R. Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients. J Laryngol Otol. 2013;127(05):483-8. - https://doi.org/10.1017/S0022215113000492. - PMid:23544790
Chacon J, Morales JM, Padilla M. Epistaxis y cuerpos extra-os nasales. En: Libro virtual de formación en ORL. SEORL (Madrid). http://seorl.net/libro-virtual/
García Callejo F, Mu-oz Fernández N, Achiques Martínez M, Frías Moya-Angeler S, Montoro Elena M, Algarra J. Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos. Acta Otorrinol Esp. 2010;61(3):196-201. - https://doi.org/10.1016/j.otorri.2009.11.005. - PMid:20137770
Hall A, Blanchford H, Chatrath P, Hopkins C. A multi-centre audit of epistaxis management in England: is there a case for a national review of practice? J Laryngol Otol. 2015;129(05):454-7. - https://doi.org/10.1017/S0022215115000596. - PMid:25816868
Hall A, Simons M, Pilgrim G, Theokli C, Roberts D, Hopkins C. Epistaxis management at Guy's Hospital, 2009–2011: full audit cycles. J Laryngol Otol. 2013;128(01):82-5. - https://doi.org/10.1017/S0022215113003137. - PMid:24290872
Monjas-Cánovas I, Hernández-García I, Mauri-Barberá J, Sanz-Romero B, Gras-Albert J. Epidemiology of epistaxis admitted to a tertiary hospital. Acta Otorrinol Esp. 2010;61(1):41-7. - https://doi.org/10.1016/j.otorri.2009.09.003. - PMid:20004879
Page C, Biet A, Liabeuf S, Strunski V, Fournier A. Serious spontaneous epistaxis and hypertension in hospitalized patients. Eur Arch Otorhinolaryngol. 2011;268(12):1749-53. - https://doi.org/10.1007/s00405-011-1659-y. - PMid:21656167
Seno S, Arikata M, Sakurai H, Owaki S, Fukui J, Suzuki M et al. Endoscopic ligation of the sphenopalatine artery and the maxillary artery for the treatment of intractable posterior epistaxis. Am J Rhinol Allergy. 2009;23(2):197-9. - https://doi.org/10.2500/ajra.2009.23.3294. - PMid:19401049
Shargorodsky J, Bleier B, Holbrook E, Cohen J, Busaba N, Metson R et al. Outcomes Analysis in Epistaxis Management: Development of a Therapeutic Algorithm. Otolaryngol Head Neck Surg. 2013;149(3):390-8. - https://doi.org/10.1177/0194599813492949. - PMid:23764960
Sireci F, Speciale R, Sorrentino R, Turri-Zanoni M, Nicolotti M, Canevari FR. Nasal packing in sphenopalatine artery bleeding: therapeutic or harmful? Eur Arch Otorhinolaryngol. 2017;274(3):1501-5. - https://doi.org/10.1007/s00405-016-4381-y. - PMid:27837422
Smith J, Siddiq S, Dyer C, Rainsbury J, Kim D. Epistaxis in patients taking oral anticoagulant and antiplatelet medication: prospective cohort study. J Laryngol Otol. 2010;125(01):38-42. - https://doi.org/10.1017/S0022215110001921. - PMid:20843406
Soyka M, Rufibach K, Huber A, Holzmann D. Is severe epistaxis associated with acetylsalicylic acid intake? Laryngoscope. 2010;120(1):200-7.. - PMid:19877246
Strach K, Schröck A, Wilhelm K, Greschus S, Tschampa H, Möhlenbruch M et al. Endovascular Treatment of Epistaxis: Indications, Management, and Outcome. Cardiovasc Intervent Radiol. 2011;34(6):1190-8. - https://doi.org/10.1007/s00270-011-0155-5. - PMid:21472510
Supriya M, Shakeel M, Veitch D, Ah-See K. Epistaxis: prospective evaluation of bleeding site and its impact on patient outcome. J Laryngol Otol. 2010;124(07):744-9. - https://doi.org/10.1017/S0022215110000411. - PMid:20403223
Upile T, Jerjes W, Sipaul F, El Maaytah M, Nouraei S, Singh S et al. The role of surgical audit in improving patient management; nasal haemorrhage: an audit study. BMC Surg. 2007;7(1):19. - https://doi.org/10.1186/1471-2482-7-19. - PMid:17854499 PMCid:PMC2034528
Vermeeren L, Derks W, Fokkens W, Menger DJ. Complications of balloon packing in epistaxis. Eur Arch Otorhinolaryngol. 2015;272(10):3077-81. - https://doi.org/10.1007/s00405-015-3529-5. - PMid:25647471
Villwock J, Jones K. Recent Trends in Epistaxis Management in the United States. JAMA Otolaryngol Head Neck Surg. 2013;139(12):1279-84. - https://doi.org/10.1001/jamaoto.2013.5220. - PMid:24136624
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Lancet 2007;370:1453-7. - https://doi.org/10.1016/S0140-6736(07)61602-X
Zarraonanadia I, Gras JR. Epistaxis. En: Llorente, Álvarez, Nú-ez, coordinadores. Manual clínico de Otorrinolaringología. Madrid: Panamericana; 2012. p.383-91.
Picher-Gómez, D. J., Nicolás-Martínez, P., Osete-Albadalejo, J. M., & Díaz-Manzano, J. A. (2019). Posterior epistaxis. A series review of 72 patients. Revista ORL, 10(1), 57–64. https://doi.org/10.14201/orl.18735
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