Clinicopathological profile and treatment outcomes of patients presenting with epistaxis: a hospital-based cross-sectional study in Southern railway headquarters hospital, Chennai
Keywords:Epistaxis, Clinicopathological, Conservative methods, Nasal packing, Surgery
Background: Epistaxis (nose-bleed) is one of the commonest emergencies presenting to an otolaryngological emergency that affects up to sixty per cent of the population in their lifetime; in this, six per cent needs medical care.
Methods: Hospital-based cross-sectional study carried between October 2018 to January 2020 in the department of ENT at Southern Railway Headquarters Hospitals, Perambur, Chennai.
Results: The mean age of the subjects was 47.76±23.01. Females were less affected compared to males with 1.68:1 male: female ratio. The results of ENT examination/anterior rhinoscopic examination revealed that all 153 (100%) subjects had anterior epistaxis and 5 (3.27%) had posterior epistaxis. 143 (93.46%) had deviated nasal septum. Diagnostic nasal endoscopy revealed that 90 (58.82%) had deviated nasal septum to the left, and 55 (35.94%) had to the right. The majority of subjects, i.e., 86 (56.21%), were managed conservatively, followed by 52 (33.99%), 5 (3.27%), and 1 (0.65%) patient were given treatment with anterior nasal packing, anterior and posterior nasal packing, and cauterization respectively. Whereas 9 (5.88%) subjects needed a surgical mode of treatment to manage their epistaxis.
Conclusions: Findings revealed that the incidence was high in elderly individuals, with male preponderance over females. Anterior epistaxis more commonly occurred in comparison to posterior epistaxis. Our research supports the conservative management methods’ credibility in the epistaxis treatment. The practice of simple nasal packing is the commonest conservative approach that has a high rate of success. As a result, this method will be the best choice for epistaxis management.
Tabassom A, Cho JJ. Epistaxis (nose bleed). StatPearls. 2020:30.
Beck R, Sorge M, Schneider A, Dietz A. Current approaches to epistaxis treatment in primary and secondary care. Dtsch. Arztebl. 2018;115(1-2):12.
Kuo CL. Updates on the Management of Epistaxis. Clin Med Ther. 2019:12.
Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ et al. Clinical practice guideline: nosebleed (epistaxis). Otolaryngol Head Neck Surg. 2020;162(1):S1-38.
Smith J, Hanson J, Chowdhury R, Bungard TJ. Community-based management of epistaxis: Who bloody knows? Can Pharm J/Revue des Pharmaciens du Canada. 2019;152(3):164-76.
Hill CS, Hughes O. Update on management of epistaxis. WLJM. 2009;1(1):33-41.
Walker TW, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995–2004. Clin. Otolaryngol. 2007;32(5):361-5.
Nayak P, Das A. Clinicoepidemiological Study on Epistaxis and Its Management. Trauma. 2020;15:17-4.
Gilyoma JM, Chalya PL. Etiological profile and treatment outcome of epistaxis at a tertiary care hospital in Northwestern Tanzania: a prospective review of 104 cases. BMC ear, Nose and throat Disord. 2011;11(1):1-6.
Manappattu N, Bashir NK, Raj G. Aetiological profile of non-traumatic epistaxis: a two-year retrospective analysis in a tertiary care hospital. Int J Otorhinolaryngol Head Neck Surg. 2019;5(2):440.
Shah WA, Amin P, Nazir F. Epistaxis-etiological profile and treatment outcome at a tertiary care centre. J Evol Med Dent Sci. 2015;4(30):5204-11.
Meccariello G, Georgalas C, Montevecchi F, Cammaroto G, Gobbi R, Firinu E et al. Management of idiopathic epistaxis in adults: what’s new? Acta Otorhinolaryngol Ital. 2019;39(4):211.
https://emedicine.medscape.com/article/863220-treatment. Accessed on 10 May 2021.
Adoga AA, Kokong DD, Mugu JG, Okwori ET, Yaro JP. Epistaxis: The demographics, etiology, management, and predictors of outcome in Jos, North-Central Nigeria. Ann Afr Med. 2019;18(2):75.
Bertrand B, Eloy P, Rombaux P, Lamarque C, Watelet JB, Collet S. Guidelines to the management of epistaxis. B ENT. 2005:27.
Siddapur GK, Siddapur KR. Clinical Profile of Referred Otalgia in a Tertiary Health Centre-A Retrospective Study. IJCRR. 2014;6(14):17-24.
Razdan U, Raizada RM, Chaturvedi VN. Efficacy of conservative treatment modalities used in epistaxis. Indian J Otolaryngol Head Neck Surg. 2004;56(1):20-2.
Varshney S, Saxena RK. Epistaxis: a retrospective clinical study. Indian J Otolaryngol Head Neck Surg. 2005;57(2):125-9.
Eziyi JA, Akinpelu OV, Amusa YB, Eziyi AK. Epistaxis in Nigerians: A 3-year experience. East Cent. Afri J surg. 2009;14(2):93-8.
Santos PM, Lepore ML. Epistaxis in head and neck surgery. In Bailey BJ. Philadelphia, PA: Lippincott-Raven. 1998:513-29.
Culbertson MC, Manning SC. Epistaxis. In: Bluestone CD, Stool SE(Eds)Paediatric otolaryngology. W.B. Saunders Philadelphia. 1990;672-9.
Tomkinson A, Roblin DG, Flanagan P, Quine SM, Backhouse S. Patterns of hospital attendance with epistaxis. Rhinol. 1997;35(3):129-31.
Walker TW, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995–2004. Clin Otolaryngol. 2007;32(5):361-5.
Arshad M, Ahmed Z, Ali L. Epistaxis: An experience with over 100 cases. Trauma. 2007;17:15-60.
Islam R, Islam MA, Mahbub AR, Chowdhury AK, Islam MN, Khan AM. A Clinical Study on Etiological Factors and Management of Epistaxis at a Tertiary Level Hospital. Bangladesh J otorhinolaryngol. 2020;26(1):45-54.
Watkinson JC. Epistaxis. In: Mackay IS, Bull TR, eds. Scott Brown’s Otolaryngology, London: Butterworths. 1997;18:5-7.
Shaheen OH. Arterial Epistaxis. J Laryngol Otol. 1975;89:17-34.
Iseh KR, Muhammad Z. Pattern of epistaxis in Sokoto, Nigeria: A review of 72 cases. Ann Afr Med. 2008;7(3):107-11.
Chaiyasate S, Roongrotwattanasiri K, Fooanan S, Sumitsawan Y. Epistaxis in Chiang Mai University Hospital. J Med Assoc Thai. 2005;88(9):1282.
Hussain G, Iqbal M, Shah S A, Said M, Sanaulla, Khan SA, et al. Evaluation of aetiology and efficacy of management protocol of epistaxis. J Ayyub Med Col. 2006;18(4):62-5.
Pollice PA, Yoder MG. Epistaxis: a retrospective review of hospitalized patients. Otolaryngol. Head Neck Surg. 1997;117(1):49-53.
Razdan U, Zada R, Chaturvedi VN. Epistaxis: study of aetiology, site and side of bleeding. Indian J Med. 1999;53(12):545-52.