Role of nasal endoscopy in evaluation and management of epistaxis

Authors

  • Hardeep Singh Department of E.N.T. Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Preeti Sharma Department of E.N.T. Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Sonika Kanotra Department of E.N.T. Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Kshitij Gupta ASCOMS, Jammu, Jammu and Kashmir, India
  • Sunil Kotwal Department of E.N.T. Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India
  • Divya Gupta Department of E.N.T. Head and Neck Surgery, Government Medical College, Jammu, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20240330

Keywords:

Epistaxis, Nasal endoscopy, Leech, Cauterisation

Abstract

Background: Epistaxis is the most common ENT emergency. The localization of bleeding site and its control in profuse epistaxis is of major concern for the ENT surgeon. Nasal endoscope has proved to be a boon for the otolaryngologist and is an important tool in diagnosing these bleeding points and their immediate management which reduces the incidence of nasal packing either anterior or posterior. Aim was to study the importance of nasal endoscopy in diagnosing the cause and site of epistaxis and managing them appropriately.

Methods: It was a prospective study conducted in 187 patients of epistaxis visiting ENT emergency at SMGSH, Jammu after getting IEC clearance.  

Results: 139 (73.8%) had anterior and 48 (26.2%) posterior epistaxis. Dry nasal septum and mass lesions were the common local causes followed by deviated nasal septum. Anterior part of septum (little’s area) was the common site of bleeding followed by woodruff’s area. The overall success rate of diagnosing the local cause and site of epistaxis was 99% with nasal endoscopy and only 47% with combined anterior and posterior rhinoscopy. Thus, eliciting the importance of nasal endoscopy over conventional anterior and posterior rhinoscopy.

Conclusions: Nasal endoscopy helps in detecting the site and cause of epistaxis and also aids in its appropriate management. It helps in endoscopic guided direct pressure packing, bipolar electrocautery, endoscopy assisted mass excision and endoscopic guided foreign body removal. However, nasal endoscopy is not a substitute for nasal packing.

 

References

Small M, Murray J, Maran A. A study of patients with epistaxis requiring admission to hospital. Health Bull (edinb.). 1982;40:20-9.

Ptitkin JB, Caldarelli DD, Panje WR. Endoscopic ligation of the internal maxillary artery for treatment of intractable posterior epistaxis. Ann Oto Rhinol Laryngol. 1998;107:85-91.

Paul J, Kanotra SP, Kanotra S. Endoscopic Management of Posterior Epistaxis. Ind J Otolaryngol Head neck surg. 2011;63:141-4.

Rodrigo PS, Fernando DL, Ricardo GF, Luiz CG.Endoscopic endonasal ligation of the sphenopalatine artery for severe epistaxis. Brazilian J Otorhinolaryngol. 2002;68:511-4.

Schaitkin B, Strauss M, Houck JR. Epistaxis: Medical versus surgical therapy. A comparison of efficacy, complications and economic considerations Laryngoscope. 1987;97:1392.

Duncan IC, Fourie PA, le Grange CE. Endovascular treatment of intractable epistaxis- results of a 4-year local audit. S Afr Med J. 2004;33:211-6.

Padgham N. Epistaxis; Anatomical and Clinical Corelates. J laryngol Otol. 1990;104:308-11.

Safaya A, Venkatachalam VP, Chaudhary N. Nasal Endoscopy-Evaluation in Epistaxis. Ind J Otolaryngol Head Neck Surg. 2002;52:133-6.

Kennedy DW, Brent A. Endoscopic sinus surgery-A Review. Otolaryngol Clinics of NA. 1997;30:313.

Hou N. lv D, Zhao K, Xu X, Yang W, Wang Y. A case of living leech in nasal cavity. Otolaryngol Case Rep. 2021;19;100277.

ChenWC, Chien CY, Yang CH, Li JH, Hwang CF. Nasal leech infestation: report of seven leeches and literature review. Eur Arch Otolaryngol. 2010;267:1225-9.

Wurman LH, Sack JG, Flannery JV Jr, Paulson TO. Selective endoscopic electrocautery for posterior epistaxis. Laryngoscope. 1998;98:1348-9.

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Published

2024-02-19

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Section

Original Research Articles