Epistaxis

Arteriovenous hemangioma formation following radiofrequency ablation for inferior turbinate reduction

October 26, 2011     Senol Polat, MD, Hasan Murat Tanyeri, MD, and Selcuk Bilgi, MD
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Abstract

Inferior turbinate reduction by radiofrequency ablation (RFA) has been recommended as an easy and safe option for the treatment of patients with inferior turbinate hypertrophy. Complications of this type of excision are generally acceptable. We describe a case of RFA turbinate reduction that resulted in an unusual complication: the formation of an arteriovenous hemangioma.

Effectiveness of a nasal saline gel in the treatment of recurrent anterior epistaxis in anticoagulated patients

September 20, 2011     Doug Massick, MD and Agnes Hurtuk, MD
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Abstract

We believe that the use of cauterization in patients with anterior epistaxis in the absence of acute bleeding should be discouraged because it does not address the underlying cause and because it may even worsen the condition by extending the degree of mucosal disruption. This is especially true in patients who are receiving anticoagulation therapy. Therefore, we conducted a study to determine if the use of a nasal saline gel as monotherapy would be an effective alternative to invasive measures in treating recurrent epistaxis in anticoagulated patients. Our study group consisted of 74 patients-43 men and 31 women (mean age: 64.4 yr)-who had been seen in our department over an 18-month period and whose bleeding had originated in the anterior portion of the nasal vault. Most patients had been experiencing epistaxis for at least 6 months. Patients were given the saline nasal gel and taught to gently apply it to the mucosa of the anterior nasal vault with a cotton-tipped applicator at the first sign of recurrent bleeding. Patients were then followed up periodically over the next 3 months. Among the 74 patients, 69 (93.2%) had experienced a cessation of their epistaxis at 3 months. The results of our study suggest that this simple, painless technique has considerable value as a treatment option in this cohort of patients.

Primary nasal tuberculosis-a rare clinical entity

July 13, 2011     Sandeep Lerra, MS (ENT), Tanvir Nazir, MS (ENT), Sajjad Mir Qadri, MS (ENT), and Masod Kirmani, MS (ENT)
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Abstract

Primary tuberculosis of the nose is very rare. We report a case of a 35-year-old woman who presented with bilateral nasal obstruction and epistaxis of 3 months' duration but who was otherwise healthy. She was diagnosed with primary nasal septal tuberculosis and was treated with antituberculosis DOTS (directly observed treatment, short course) therapy for 6 months with complete recovery. Given the resurgence of tuberculosis in recent times, it is important that clinicians remain aware of this rare and treatable clinical entity.

A report of CSF leak as a complication of nasal packing for epistaxis

March 1, 2010     Nicole L. Bryan, MD and Melissa A.M. Hertler, MD
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Abstract

While nasal packs are effective in controlling epistaxis, some potential complications are associated with this procedure that physicians should be aware of and take measures to avoid. We report the case of an 80-year-old man who developed cerebrospinal fluid rhinorrhea several hours after he had undergone placement of nasal packing in an emergency department. He was eventually transferred to our facility, where he required a prolonged hospital stay to correct the complication. We also review the literature on various complications of nasal packing, and we emphasize the importance of carefulness when performing intranasal manipulation.

Primary sinonasal tuberculosis in a Nigerian woman presenting with epistaxis and proptosis: A case report

August 31, 2009     B. Sulyman Alabi, FWACS, Enoch A.O. Afolayan, FMCPath, A. Abdulakeem Aluko, FWACS, O. Abdulraman Afolabi, MBBS, and F. Grace Adepoju, FWACS
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Abstract

Tuberculosis is the second leading cause of death worldwide after human immunodeficiency virus/AIDS and is especially prevalent in developing countries. We report a case of primary sinonasal tuberculosis without pulmonary involvement, which is rare, in a 27-year old female Nigerian fish farmer. She had a 3-year history of right-eye proptosis, bilateral nasal masses, and epistaxis. Cranial computed tomography suggested an extensive sinonaso-orbital neoplastic lesion. We performed a right external frontoethmoidectomy. Histologically, the excised nasal polyps revealed tuberculosis. Six months of antituberculosis therapy provided satisfactory improvement. Sinonasal tuberculosis, despite its rarity, should be added to the differential diagnosis of nasal and paranasal sinus disorders, and histologic evaluation remains the hallmark of diagnosis. Therapy with a short-duration, multidrug combination, rather than the longer-duration treatment regimen hitherto used, could be quite valuable, especially in the setting of a developing country with poor patient compliance.

Transport of a patient with massive traumatic epistaxis using a cricket helmet and posterior nasal packing

May 31, 2009     Philip V. Alexander, MS and Alka Walters, MS
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Abstract

In developing countries, when patients with traumatic epistaxis cannot be adequately treated at their local medical facility and require further treatment at a distant tertiary care center, it is important that bleeding be controlled before their transport. We describe a patient with a traumatic anterior ethmoidal artery bleed who needed to be taken to a tertiary care center 8 hours away for endoscopic ablation, which was not available at our hospital. The inflated balloon of an 18-Fr Foley catheter attached to the face guard of a cricket helmet was used as a posterior nasal pack. The patient arrived safely and was successfully treated. This case report illustrates that, in an emergency, readily available materials can be used to effect adequate tamponade of nasal bleeding so that a patient can be transferred safely. We believe this is the only such report in the literature.

Nasal packing after septoplasty: A randomized comparison of packing versus no packing in 88 patients

October 31, 2008     Mohammad Sohail Awan, FCPS and Moghira Iqbal, MBBS
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Abstract

The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.

Epistaxis and its relationship to handedness with use of intranasal steroid spray

July 31, 2008     Michael S. Benninger, MD
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Abstract

Topical intranasal steroid spray is often used to treat allergic and nonallergic rhinitis, and epistaxis is a common side effect. The prospective, observational study described was designed to determine the incidence of epistaxis and the relationship between the side of bleeding and the hand used to administer the spray, as well as the handedness of the patient, in a noninvestigational, real-world setting. Of 559 consecutive patients using an intranasal steroid for more than 3 months, 28 patients (5%) reported epistaxis within the prior 2 months. Of the 32 reported sides of bleeding (unilateral and bilateral combined), 25 episodes (78%) were on the same side as the hand used to apply the spray. A strong correlation was found between the side of bleeding and both the hand used (p < 0.001) and the handedness of the patient (p < 0.002). Patient instruction on technique may reduce the incidence of epistaxis.

Sinonasal neuroendocrine carcinoma: A case report

April 30, 2008     Dulani Mendis, MRCS, DOHNS and Nasser Malik, FRCS(Edin.), DLO
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Abstract

Neuroendocrine carcinoma (NEC) is rare. We report a case of probable sinonasal NEC in a 73-year-old man who had presented with a history of right nasal obstruction, nasal discharge, and recurrent epistaxis. On examination, a red, friable, gelatinous, polypoid mass with a tendency to bleed was seen in the right nasal cavity. Computed tomography revealed that the lesion was confined to the right nasal cavity; coincidental or reactive opacification was seen in the adjacent sinuses. The final histologic evaluation of the excised biopsy specimens yielded a diagnosis of an invasive, poorly differentiated NEC, probably a large-cell variant, with the differential diagnosis lying at a point somewhere between poorly differentiated large-cell NEC and high-grade olfactory neuroblastoma. The patient underwent a right lateral rhinotomy and medial maxillectomy followed by adjuvant radiotherapy. At 20 months of follow-up, he exhibited no sign of recurrence.

Management of recurrent epistaxis in an anticoagulated patient by temporarily closing the nares with sutures

March 31, 2008     Chee-Yean Eng, MBChB, MRCS, Teck-Aun Yew, MBChB, Wai-Siene Ng, MBChB, and Amged S. El-Hawrani, FRCS(ORL-HNS)
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Abstract

We describe an unusual case of recurrent, refractory anterior epistaxis in an 86-year-old man with two mechanical heart valves who was on permanent warfarin therapy. His numerous episodes of epistaxis were incited by chronic nose-picking and strong nose-blowing, practices that he continued to engage in despite repeated medical advice to stop. Stopping his anticoagulation therapy was not considered as a management option because of an unacceptably high risk that this would lead to a thromboembolic event. Eventually, we temporarily sutured his nares closed, and his nosebleeds ceased. The suturing was performed in the ward with local anesthesia. This procedure was simple to perform, fairly well tolerated, easily reversible, and highly effective.

Paranasal sinus melanoma masquerading as chronic sinusitis and nasal polyposis

August 31, 2007     Brian Kung, MD; Geoffrey R. Deschenes, BA; William Keane, MD; Mary Cunnane, MD; Marie-Paule Jacob-Ampuero, MD; Marc Rosen, MD
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Abstract
Malignant melanoma of the nose and paranasal sinuses can be a devastating disease, typically presenting at an advanced stage, with a 5-year survival rate ranging between 20 and 30%. It is an uncommon process, often misdiagnosed both clinically and pathologically. We present the case of an 80-year-old man who had a 2-month history of progressively worsening left-sided epistaxis and nasal obstruction. Radiographic evidence indicated the presence of soft tissue in the left maxillary sinus and nasal cavity resembling massive nasal polyposis and chronic fungal sinusitis. Magnetic resonance imaging was not performed because the patient had a pacemaker. After endoscopic debridement of the soft-tissue mass, frozen-section analysis detected no evidence of tumor. The final pathologic diagnosis was malignant melanoma. Otolaryngologists should be familiar with the difficulties inherent in the diagnosis and management of sinonasal melanomas.

Multifocal tuberculosis of the nose and lymph nodes without pulmonary involvement: A case report

April 30, 2007     M. Panduranga Kamath, MS; Kiran M. Bhojwani, MS; Shivananda Prabhu, MS; Ramdas Naik, MD; Geo P. Ninan, MBBS; Yeshwanth Chakravarthy, MBBS
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