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Lucas JP, Shaffer A, Rushchak M, Stapleton A, Padia R. Environmental impact on pediatric epistaxis and the utility of diagnostic studies: A single-institutional review. Int J Pediatr Otorhinolaryngol 2024; 176:111827. [PMID: 38128356 DOI: 10.1016/j.ijporl.2023.111827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/23/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Pediatric epistaxis is a multifactorial disease entity. The objective of this study is to determine the socioeconomic and air-quality contributions to pediatric epistaxis. The study also evaluates the utility of diagnostic lab work as a predictor of bleeding rates and need for operative intervention. METHODS A case series of pediatric patients treated in an outpatient Otolaryngology clinic at a tertiary care children's hospital in 2021 for epistaxis was performed. Patients with nasal bone trauma (n = 8), consult while inpatient (n = 7), and those with nasal masses (n = 2) were excluded; 181 patients met inclusion criteria. Demographic, clinical, socioeconomic, and air quality (tropospheric ozone, particulate matter) data were recorded. Associations with persistent bleeding and operative interventions were evaluated using logistic regression, Wilcoxon rank-sum, and Spearman rank correlation. RESULTS Of the 181 patients, 75 (41.4%) were female. Forty-six of 181 (25.4%) had associated allergic symptoms. Twenty-six patients had allergy testing; 14/26 (53.8%) of these had positive results. Re-bleeding was more common in those with allergic symptoms (OR: 2.42, 95% CI: 1.22-4.78, p = 0.01). Patients with re-bleeding lived in counties with more days with ozone over the US standard (median 5 days, range 0-32 days) compared with those with no re-bleeding (median 3 days, range 0-32 days, p = 0.007). There was also an association between the number of visits for re-bleed and percent below poverty level (ρ = 0.259, p = 0.03) as well as the number of days with particulate matter levels over the US standard (ρ = 0.343, p = 0.01). Coagulopathy was present in 9/54 (16.7%) patients, with the majority being Von Willebrand disease (5/54, 9.3%). Easy bruising was not significantly associated with positive lab results. CONCLUSIONS Environmental pollution, living in a zip code with more residents below the poverty level, and allergic rhinitis were positively associated with recurrent epistaxis. Understanding the geographic background of presenting patients may help direct workup and treatment options.
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Affiliation(s)
- Jordyn P Lucas
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States; Eastern Virginia Medical School, Department of Otolaryngology, 600 Gresham Dr. #1100, Norfolk, VA, 23507, United States; Children's Hospital of the King's Daughter, Department of Pediatric Otolaryngology, 601 Children's Lane, Norfolk, VA, 23507, United States.
| | - Amber Shaffer
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Marina Rushchak
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Amanda Stapleton
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States
| | - Reema Padia
- Department of Pediatric Otolaryngology, Children's Hospital of Pittsburgh, 4401 Penn Ave, Pittsburgh, PA, 15224, United States; Department of Otolaryngology, University of Pittsburgh School of Medicine, United States; University of Utah, Department of Otolaryngology, Primary Children's Hospital, 100 Mario Capecchi Dr, Salt Lake City, UT, 84113, United States
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Particulate Matter 10 (PM 10) Is Associated with Epistaxis in Children and Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094809. [PMID: 33946392 PMCID: PMC8124263 DOI: 10.3390/ijerph18094809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/20/2022]
Abstract
The impact of atmospheric concentration of particulate matter ≤10 μm in diameter (PM10) continues to attract research attention. This study aimed to evaluate the effects of meteorological factors, including PM10 concentration, on epistaxis presentation in children and adults. We reviewed the data from 1557 days and 2273 cases of epistaxis between January 2015 and December 2019. Eligible patients were stratified by age into the children (age ≤17 years) and adult groups. The main outcome was the incidence and cumulative number of epistaxis presentations in hospital per day and month. Meteorological factors and PM10 concentration data were obtained from the Korea Meteorological Administration. Several meteorological factors were associated with epistaxis presentation in hospital; however, these associations differed between children and adults. Only PM10 concentration was consistently associated with daily epistaxis presentation in hospital among both children and adults. Additionally, PM10 concentration was associated with the daily cumulative number of epistaxis presentations in hospital in children and adults. Furthermore, the monthly mean PM10 concentration was significantly associated with the total number of epistaxis presentations in the corresponding month. PM10 concentration should be regarded as an important environmental factor that may affect epistaxis in both children and adults.
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Akdoğan MV, Hızal E, Semiz M, Topal Ö, Akkaş H, Kabataş A, Erbek SS. The role of meteorologic factors and air pollution on the frequency of pediatric epistaxis. EAR, NOSE & THROAT JOURNAL 2019; 97:E1-E5. [PMID: 30273433 DOI: 10.1177/014556131809700901] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Fluctuations in atmospheric temperature, humidity, and air pollution are associated with the incidence of epistaxis. To date, no study in the literature has evaluated the effect of air pollution and meteorologic conditions on the pediatric population. We aimed to evaluate the effect of meteorologic factors and air pollution on the frequency of epistaxis in children. Children presenting to an outpatient clinical setting at a tertiary care hospital during a 5-year period (July 1, 2009, to June 30, 2014) and diagnosed with epistaxis formed the study population. Daily temperature and humidity parameters and average daily atmospheric water vapor pressure, average daily concentration of particulate matter <10 μm in diameter, and sulfur dioxide readings were obtained. The distribution of daily parameters was analyzed. Of the 1,559 children with the primary diagnosis of epistaxis, data from 1,330 children were analyzed after excluding patients with coexisting pathologies. Positive correlations were found between the frequency of epistaxis and both the average daily temperature and the difference between the maximum and minimum daily temperature. There was a negative correlation between the epistaxis frequency and the average daily humidity, the difference between the maximum and minimum daily humidity, the average daily concentration of particulate matter, and the sulfur dioxide levels. Our findings suggest that epistaxis in children is related to high temperatures and low humidity.
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Affiliation(s)
- M Volkan Akdoğan
- Department of Otorhinolaryngology, Baskent University Konya Research and Teaching Center, Saray Caddesi No:1 Selcuklu, Konya, 42080 Turkey.
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Johnson N, Faria J, Behar P. A Comparison of Bipolar Electrocautery and Chemical Cautery for Control of Pediatric Recurrent Anterior Epistaxis. Otolaryngol Head Neck Surg 2015; 153:851-6. [PMID: 26129737 DOI: 10.1177/0194599815589583] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the outcome of children with anterior epistaxis treated intraoperatively with either bipolar electrocautery or silver nitrate chemical cautery. STUDY DESIGN Case series with chart review. SETTING Tertiary-care pediatric otolaryngology practice. SUBJECTS Children aged 2 to 18 years treated with either intraoperative bipolar electrocautery or silver nitrate chemical cautery of the anterior nasal septum for recurrent anterior epistaxis. METHODS Any reported bleeding event after surgery was recorded. The mean time from surgery to recurrent epistaxis was compared between groups. RESULTS Fifty patients underwent bipolar electrocautery, while 60 patients underwent silver nitrate chemical cautery. Within 2 years, 1 (2%) patient in the bipolar electrocautery group and 13 (22%) patients in the silver nitrate chemical cautery group had recurrent epistaxis (P = .003). Two years after treatment, there was no difference between treatment groups. Overall, 4 patients (8%) had recurrent epistaxis postoperatively in the bipolar electrocautery group at a mean of 4.34 years after treatment, while 17 (28.3%) patients recurred after a mean of 1.53 years of treatment in the silver nitrate chemical cautery group (P = .01). CONCLUSION Compared to those treated with chemical cautery, those treated with bipolar electrocautery had a longer nosebleed-free period and a lower incidence of recurrent epistaxis within 2 years of treatment. Beyond 2 years, the treatment methods are equivocal. Bipolar electrocautery may be a superior treatment in children who will not tolerate in-office chemical cautery, in those with a risk of severe bleeding, or when it can be combined with other operative procedures.
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Affiliation(s)
- Nathan Johnson
- Department of Otolaryngology, University at Buffalo, Buffalo, New York, USA
| | - John Faria
- Department of Otolaryngology, University at Buffalo, Buffalo, New York, USA
| | - Philomena Behar
- Department of Otolaryngology, University at Buffalo, Buffalo, New York, USA Pediatric Ear, Nose and Throat Associates, Amherst, New York, USA
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Siddiq S, Grainger J. Fifteen-minute consultation: investigation and management of childhood epistaxis. Arch Dis Child Educ Pract Ed 2015; 100:2-5. [PMID: 25035314 DOI: 10.1136/archdischild-2013-304931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Recurrent epistaxis is very common in children, and the majority of cases are self-limiting with simple first aid measures. However, recurrent episodes are a source of distress and anxiety for child and parent alike, and commonly result in hospital referral. We present a structured approach highlighting initial assessment, examination and management including when to refer to ear, nose and throat (ENT) surgery.
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Affiliation(s)
- Somiah Siddiq
- Department of ENT, Birmingham Childrens Hospital NHS Foundation Trust, Birmingham, UK
| | - Joe Grainger
- Department of ENT, Birmingham Childrens Hospital NHS Foundation Trust, Birmingham, UK
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Abdel Wahab MS, Fathy H, Ismail R, Mahmoud N. Recurrent epistaxis in children: When should we suspect coagulopathy? THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2014. [DOI: 10.4103/1012-5574.133207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Elden L, Reinders M, Witmer C. Predictors of bleeding disorders in children with epistaxis: value of preoperative tests and clinical screening. Int J Pediatr Otorhinolaryngol 2012; 76:767-71. [PMID: 22459034 DOI: 10.1016/j.ijporl.2012.02.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify prevalence of previously undiagnosed bleeding disorders in children with severe epistaxis who failed medical therapy requiring intraoperative nasal cautery. STUDY DESIGN Retrospective chart review 10/15/2006-12/31/2010. SETTING Single provider outpatient otolaryngology clinic. INCLUSION CRITERIA children (<19 years) with epistaxis referred to otolaryngology, no known bleeding disorder, failed medical therapy and received surgical nasal cautery. DATA COLLECTED duration/severity of epistaxis, bleeding history, family history of bleeding. A screening CBC, PT and PTT were performed on all patients. RESULTS Of 248 subjects referred for epistaxis, 47(19%) met inclusion criteria (mean age 9.2±0.5 years; 61.7% male). 31.9% (15/47) had abnormal coagulation studies but on repeat testing only 2 patients had persistent coagulation abnormalities. 15 patients were referred to hematology, 5 were diagnosed with a bleeding disorder (3 - type 1 von Willebrand's disease, 1 - platelet aggregation disorder, 1 - mild factor VII deficiency). Out of the entire cohort 10.6% (5/47) had a bleeding diathesis. Clinical predictive factors for having a bleeding diathesis were explored and included previous emergency room visits for epistaxis (p=0.04). A trend was found in those presenting with epistaxis at a younger age (p=0.07). CONCLUSION Children with recurrent epistaxis despite medical therapy are at higher risk of having a bleeding disorder. In this highly selected group of patients 10.6% (5/47) were found to have a bleeding disorder. Screening coagulation studies (PT, PTT) only revealed 20% (1/5) of patients with a bleeding disorder. Only a subsequent comprehensive hematology evaluation revealed the diagnosis in the majority of patients.
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Affiliation(s)
- Lisa Elden
- Division of Otolaryngology in the Department of Surgery, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 1 Wood Center,Philadelphia, PA 19104, USA.
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Eladl HM, Khafagy YW, Abu-Samra M. Endoscopic cauterization of the sphenopalatine artery in pediatric intractable posterior epistaxis. Int J Pediatr Otorhinolaryngol 2011; 75:1545-8. [PMID: 21955526 DOI: 10.1016/j.ijporl.2011.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/03/2011] [Accepted: 09/04/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the rule of endoscopic sphenopalatine artery cauterization in posterior intractable epistaxis in pediatric age group as regard technical difficulty, efficacy, and safety in children. STUDY DESIGN Retrospective study. PATIENTS AND METHODS From March 2008 to February 2011, 7 children (4 male, 3 female) with idiopathic intractable posterior epistaxis, patients' age ranged from 8 to 14 years (10.7 average). All patients underwent preoperative laboratory investigations to exclude bleeding or coagulation disorders and CT paranasal sinus. All patients underwent endoscopic sphenopalatine artery cauterization (7 procedures for 7 patients, 5 were in the right side and 2 were in the left side). RESULTS postoperative evaluation showed no recurrence for epistaxis during the post operative follow up period. Also, no complications were found. The average follow up period was 17.8 months. CONCLUSIONS Endoscopic cauterization of sphenopalatine artery in pediatric age group was effective and safe technique providing that the surgeon has a good experience regarding pediatric endoscopic sinonasal anatomy. Minimal endoscopic technique in this age group is important to avoid unnecessary operative and postoperative complications. Avoid excessive cauterization to lateral nasal wall in this technique is crucial to avoid unexpected nerve injury or tissue necrosis.
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Felek SA, Celik H, Islam A, Demirci M. Bilateral simultaneous nasal septal cauterization in children with recurrent epistaxis. Int J Pediatr Otorhinolaryngol 2009; 73:1390-3. [PMID: 19631995 DOI: 10.1016/j.ijporl.2009.06.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Revised: 06/26/2009] [Accepted: 06/30/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the feasibility, effectiveness and complications of bilateral simultaneous silver nitrate cauterization for anterior nasal septal epistaxis in otherwise healthy children. METHODS Prospective study in a tertiary referral otorhinolaryngology department. Thirty-seven children with anterior epistaxis between the ages of 5-16 years were included in the study. The patients who had varicose vessels or network of small vessels in the Little's area had simultaneous bilateral silver nitrate cauterization. RESULTS Complete or near-complete epistaxis control was obtained in 76% of the patients after the first cauterization, and in 86% of the patients after the second cauterization in a mean follow-up period of 8 months. Partial success was obtained in five patients. The crusting in the cauterization area was healed late in six patients. Septal perforation, tattooing, or mucocutaneous/allergic reactions were not observed in any of the patients. CONCLUSIONS Bilateral silver nitrate cauterization is an effective, feasible, low-cost and preferable treatment method in childhood epistaxis when it is applied in an appropriate concentration and at an appropriate duration in a healthy mucosal environment.
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Affiliation(s)
- Sevim Aslan Felek
- Ministry of Health Ankara Training and Research Hospital, 2nd E.N.T. Department, Talatpasa Bulvarı, Cebeci, Dortyol Postcode 06591 Ankara, Turkey.
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Joice P, Ross P, Robertson G, White P. The effect of hand dominance on recurrent idiopathic paediatric epistaxis. Clin Otolaryngol 2009; 33:570-4. [PMID: 19126131 DOI: 10.1111/j.1749-4486.2008.01831.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES No published data exists to support the belief that nose picking contributes to recurrent idiopathic paediatric epistaxis. If nose picking is implicated then there may be a higher incidence of epistaxis on the side of the dominant hand. The objective of the study was to determine whether nose picking has a significant role in paediatric epistaxis by comparing hand dominance and side of epistaxis. DESIGN AND SETTING A prospective, consecutive cohort of new epistaxis referrals to a tertiary paediatric centre over a 14-month period were assessed for hand dominance and reported side of the epistaxis. The presence of septal excoriation, crusting and prominent blood vessels was also recorded. PARTICIPANTS One hundred and forty-eight new epistaxis referrals. MAIN OUTCOME MEASURES Dominant hand, side of epistaxis history and side of positive examination findings. RESULTS No statistically significant association between hand dominance and either epistaxis history or examination findings was identified. A statistically significant association between epistaxis history and examination findings was identified P < 0.001, K = 0.614, SE 0.571. CONCLUSIONS The study does not provide evidence to support the belief that paediatric epistaxis is influenced by nose picking. The study provides evidence that patients' epistaxis history and positive examination findings are a consistent marker of previous epistaxis.
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Affiliation(s)
- P Joice
- Department of ENT, NHS Tayside, Ninewells Hospital, Dundee, UK.
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Abstract
A survey of current literature on the topic of epistaxis revealed only a circumscript number of publications with a high methodologic value. The analysis of these publications showed that there is a controversy on the necessity of routine coagulation tests in epistaxis patients. These tests should only be performed in cases with clinical evidence of a coagulation disorder. Also, there is an ongoing controversy on the value of local cooling with ice or cold packs. Nasal creams and decongestive nose drops have been found to be effective in uncomplicated epistaxis. Rhinoscopically and endoscopically targeted coagulation of bleeding vessels and nasal packing are recommended treatment options. There is a debate on discontinuation of anticoagulant therapy, if INR is within normal limits in Cumadin patients. Intractable epistaxis requires a broad armamentarium of different diagnostic and therapeutic options. Recurrent epistaxis in hereditary syndromes remains to be a challenge, although some advances have been made in diagnosis and symptomatic treatment. Some new medical drugs, as Viagra or Cialis may have nosebleeds as side-effects.
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Affiliation(s)
- B J Folz
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Karl Hansen Klinik, Antoniusstrasse 19, 33175 Bad Lippspringe, Deutschland.
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