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Advicor : dr. H. Oscar Djauhari, Sp.THT

STASE THTRSUD R. SYAMSUDIN, S.H

UNIVERSITAS MUHAMMADIYAH JAKARTA2011

Epistaxis :Prevailing Factor and Treatment

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Epistaxis is defined a bleeding of nasal mucosa, and represent the most commont emergency in otorhinolaryngology, with prevalence of about 10 to 12%

The etiology of epistaxis is devide into local and systemic causes. The severe epistaxis, associated to prevailing factor such as systemic arterial hypertension and coagulapathy.

Epistaxis is defined a bleeding of nasal mucosa, and represent the most commont emergency in otorhinolaryngology, with prevalence of about 10 to 12%

The etiology of epistaxis is devide into local and systemic causes. The severe epistaxis, associated to prevailing factor such as systemic arterial hypertension and coagulapathy.

IntroductionIntroduction

The admission criteria are severe epistaxis with clinical repercussion in patients with hypertension crisis, difficulty to the service control or associated to pathologies that require medical care.

It may clinically be divided into anterior and posterior with significant differences in its manifestation and prognosis

EtiologyEtiology

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Local1.Inflammatory infectious2.Traumatic3.Anatomic4.Foreign body5.Chemical or climatic agent6.Nasal tumor

Systemic1.The arterial hypertension2.Drugs 3.Neoplasma

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1. The advance of endoscopic techniques

2. Chemical or electrical cauterization ( silver nitrate or trichloracetic acid).

3. The anterior splinting with Vaseline-soaked gauze, glove finger or merocel

4. The antero-posterior splinting ( Foley probe atau gauze ).

5. Embolisation

1. The advance of endoscopic techniques

2. Chemical or electrical cauterization ( silver nitrate or trichloracetic acid).

3. The anterior splinting with Vaseline-soaked gauze, glove finger or merocel

4. The antero-posterior splinting ( Foley probe atau gauze ).

5. Embolisation

The Treatment of Epistaxis

1. The endoscopic techniques

for the treatment of severe posterior epistaxis has been preventing prolonged admissions and morbidities caused by the nasal splint, with ligation of the sphenopalatine artery.

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2. The anterior splinting with vaseline – soaked gauze, glove finger or merocel

If the bleeding is defined to be anterior

3. The antero-posterior splinting with Foley probe or gauze

The posterior bleeding is normally highly intense and it is many times difficult to find the bleeding point, to stabilize the patient and identify factors that may contribute for such bleeding.

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4. Electrocauterization

After the bleeding point is found, the electrocauterization is carried out on profuse bleedings and the endoscopic ligation of the sphenopalatine artery is indicated in case of difficult identitification

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5. Embolisation

Its Advantages :

a. Finding of the bleeding region, diagnosis of associated diseases such as tumor and vascular lesion

b. Its does not require general anesthesia

Its disadvantages like:

Membutuhkan peralatan yang khusus dan orang yang telah mahir.

objective

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To evaluate the main associated prevailing factors in patient with epistaxis and its

treatment

Method

- Retrospective study of patients admitted with epistaxis between 2005 and 2006

- Inclusion criteria patients with epistaxis who need

admission due to clinical reprecussion of bleeding or other associated pathology with one of the prevailing factor

- Exclusion criteria patients with epistaxis who did not need admission were excluded

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• In our study, the age range varied from 1 to 88 years and was prevalent from 11 to 30 years (35%) and 51 to 60 years old (28%), most patiens being male.

• In children, it generally comes from the anterior region of the nasal cavity and is caused by local alterations.

• In most adults it’s associated wu=ith systemic alterations and comes from the posterior part of the nasal cavity

• In our study, the age range varied from 1 to 88 years and was prevalent from 11 to 30 years (35%) and 51 to 60 years old (28%), most patiens being male.

• In children, it generally comes from the anterior region of the nasal cavity and is caused by local alterations.

• In most adults it’s associated wu=ith systemic alterations and comes from the posterior part of the nasal cavity

DISCUSSION

The severe epistaxis is normally associated to prevailing factors

• systemic arterial hypertension was the most frequent 36% (n = 22)

• trauma 16% (n= 10)•Coagulopathy 5% (n = 3)

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Some studies show that in patients with severe bleeding coagulopathy is

researched, but the alterations are more frequent in patients with the use

of asetylsalicylic acid and non-hormonal anti inflamatory, medications

that alter the arachidonic acid metabolism and the function of the

platelets and lead to bleeding

Some studies show that in patients with severe bleeding coagulopathy is

researched, but the alterations are more frequent in patients with the use

of asetylsalicylic acid and non-hormonal anti inflamatory, medications

that alter the arachidonic acid metabolism and the function of the

platelets and lead to bleeding

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The treatment may be by anterior, antero-posterior

splint, electrocuaterization,

endoscopic arterial ligation (with clip or cauterization)

and embolisation

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The main prevailing factors associated to epistaxis were systemic arterial hypertension, trauma and coagulopathy. The early endoscopic arterial ligation is indicated for patients with severe epistaxis and prevailing factors, because it prevents prolonged interments and morbidities associated to the nasal splint.

CONCLUSION

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Thank You

For your attention