paediatric epistaxis

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PAEDIATRIC EPISTAXIS

Dr Irfan ZafarP.G.R. /E.N.T.SupervisorProf Dr Israr Ahmed



Abstract

In 100 successive cases of epistaxis in children,71 were idiopathic followed by accidentaltrauma and forigen body(12/100). Infection in

the nose , nasopharynx (adenoids)was seen in7/100. tumor in nose and paranasal sinuses,nasopharynx in 5/100 and bleeding disorderswere also seen in 5/100 respectively. Males

and females were affected in ratio 2:1. Exceptin cases of tumor ,forign body , medicaltreatment was adequate to control bleeding.



introduction

Epistaxis or bleeding from nose is afrequently seen symptom in childrenpresenting to E.N.T. department .Interior of nose is a very vascular area supplied by bothexternal and internal carotid system. There isa rich confluence of vessels in the little’s area,

which is dependent antero-inferior part of nasal septum and is frequent site of bleeding

2.



Introduction…contd

Epistaxis in children can vary from bloodstained nasal discharge to seriousbleeding.Bleeding can be unilateral or

bilateral. Epistaxis can be accompanied by avariety of other symptoms and signs likenasal obstruction , nasal discharge, whichmay be foul smelling. Present study was

conducted to identify causes of epistaxis inchildren and to suggest appropriatetreatment for each group.



Patients and methods

Patient with epistaxis were received either inemergency or in the outdoor, E.N.T. departmentor were refered from other departments like

Paediatrics. Patients presenting with an acuteepisode of epistaxis were given initial medicaltreatment by pinching of nose , anterior nasalpacking and sometimes blood transfusion as

required. .All patients presenting in between theepisodes of epistaxis were acessed by history ,general physical examination , E.N.T. andsystemic examination



Patients and methods

. In addition complete blood and urineexamination , bleeding and clotting profilewere obtained including platelet count.Liverfunction tests were obtained in releventcases. Radiology of nose , paranasal sinusesand nasopharynx and plain chest x ray was

obtained in all cases.. C.T. scan of nose ,paranasal sinuses and nasopharynx was done incases where a tumor was suspected.



Results

Table 1 ----age incidence

Birth Nil

1-2 years Nil

2-3 years 2

3-4 years 3

4-5 years 5

5-6 years 5

6-7 years 7

7-8 years 11

8-9 years 15

9-10 years 17

10-11 years 1711-12 years 18



results

Table 2 -----sex incidence

Male 66 66%

Female 34 34%

Total 100



Results

Table 3 ----causes of bleeding

With normalcoagulation

Causes numberIdiopathic 71/100

Foreign body noseand trauma

12/100

U.R.T. infection 7/100

Tumors 5/100

With abnormalcoagulation

Acute leukemia 1

Von willebrandDisease

1

Haemphilia 3



Modes of treatmentMedical treatment Surgical treatment

Nasalpinch--ingandlocalapplic-ationof Emol--ient

Anteriornasalpacking

Posteriornasalpacking

Cautery of bleedingpoint

Removal of foreignbody

Ligation of vessels

Adenoidectomy

Septalsurgery

Removal of tumorsAngiofibroma’Gi-antcellgranuloma

Radiationof tumor

53 21 0 8 8 0 3 2 3 2



DISCUSSION

Despite the fact that causes of epistaxis inpediatrics population are at cosiderable variancefrom those seen in adults,previous studies have

tended to the group causes of epistaxis inchildren and adult together.This study wasconducted to focus on the causes of epistaxisseen in paediatric population and to discuss

treatment. As in adults,the group in which no cause could be

identified(Idiopathic)comprised of largest(71/100).



DISCUSSION

It has been postulated that frequent picking of

nose leads to ulceration and crusting of thefragile nasal mucosa.

These crusts on separation either by finger or

by forceful sneezing lead to bleeding and this isthe most common cause of spontaneousbleeding from the nose seen in children.

This problem tends to exacerbate in hot and dry

climate because of itching in nose . Pinching of nose and local cold application is enough tostop bleeding in majority of these cases of spontaneous nasal bleed .



Discussion ---contd

Rarely anterior packing or electric /chemical cauteryis required to control bleeding, this is to be followedby local application of emolient like petroleum jellyfor 2-3 weeks. Nasal picking of course is to be

avoided . Trauma and forign body constitute the next

common group (12/100). Any young child havinghistory of foul smelling blood stained nasaldischarge should be suspected of having a nasalforeign body until proved other wise. These casescontinue to be neglected and are given frequentcourses of antibiotic which proove unfruitful unlessthe forign body is removed.



Discussion---contd

Nasal infections and adenoids can give rise tobilateral nasal bleeding specially , on forcefulblowing of nose while cleaning . These casesquickly clear up with medical treatment andrarely hospital admission required.



References

1. Shaheen.O.M.,In Mackay S.T.and bull T.R.(Ed)

Scott Brown’s Otolaryngology, 5th Edition Vol4

.London, Butter Worth,1987: 272-282.

2.Monux A.,Toms M., KaiserCand Gavilane:

Conservative Management of Epistaxis. The

Journal of Laryngology and Otology

1992;104:868-870 3.Narula A.A.,Vallis M. P. Bradley P.J.:Surgical

management of nose bleed.J.Laryngol.Otol1987:101:359-362



Refrences

4.Singh b. : Combines Int. Maxillary and ant.Ethmnoidal arterial occlusion: the treatmentof choice in intractable Epistaxis:J.laryngol.Otol.1992:106;507-710

5.Zaidi.S.H.Jafri I.H. Juvenil nasopharyngealangiofibroma: Pak .J. otolaryngology,

1987;4:77-84.

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