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Effects of adenoid and nasal pathologies in pediatric epistaxis

Year 2022, , 242 - 249, 31.12.2022
https://doi.org/10.30565/medalanya.1127833

Abstract

Aim: The aim of this study was to investigate the effects of adenoid and nasal pathologies in paediatric patients with recurrent epistaxis.

Methods: A total of 100 (61 boys, 39 girls) individuals aged 2–17 years (mean age: 8.9 ± 3.6 years) were included in this study. Anterior rhinoscopy and flexible nasal endoscopy were used to examine all the patients. The epistaxis duration, treatment in active epistaxis by parents, medical history, medical treatment and interventions were recorded. The location of the epistaxis site, nasal mucosa type, the presence of nasal vestibulitis, nasal septum deviation location and type, adenoid size and the degree of inferior turbinate hypertrophy were recorded.

Results: The deviation was present in 31 (62%) patients with recurrent epistaxis and in 14 (28%) patients without epistaxis. The presence of deviation was significantly higher in the epistaxis group than in the control group (p < 0.05). The nasal mucosa type was friable mucosa in 37 (74%) patients, vascularised mucosa in 11 (22%) patients and friable-vascularised mucosa in 2 (4%) patients in recurrent epistaxis group. A significant relationship was detected between nasal mucosa type and age, the presence of the deviation, deviation location, the Mladina type in epistaxis group (p < 0.05, p < 0.05, p < 0.05, p < 0.05).

Conclusion: Nasal septum deviation, inferior turbinate hypertrophy and nasal mucosa type are associated with paediatric recurrent epistaxis. 

Thanks

The authors would like to thank Assoc. Prof. Güven Özkaya for helping to statistical analysis of the manuscript.

References

  • 1. Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. Int J Pediatr Otorhinolaryngol. 2017;103:121–4. doi: 10.1016/j.ijporl.2017.10.026.
  • 2. Jamil W, Rowlands G. A practical approach to recurrent epistaxis in children. Paediatr Child Heal (United Kingdom). 2019;29(6):279–80. doi: 10.1016/j.paed.2019.03.005.
  • 3. Davies K, Batra K, Mehanna R, Keogh I. Pediatric epistaxis: Epidemiology, management & impact on quality of life. Int J Pediatr Otorhinolaryngol. 2014;78(8):1294–7. doi: 10.1016/j.ijporl.2014.05.013.
  • 4. McIntosh N, Mok JYQ, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120(5):1074–8. doi: 10.1542/peds.2007-2097.
  • 5. Abrich V, Brozek A, Boyle TR, Chyou P-HH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc. 2014;89(12):1636–43. doi:10.1016/j.mayocp.2014.09.009.
  • 6. Melia L, McGarry GW. Epistaxis: Update on management. Curr Opin Otolaryngol Head Neck Surg. 2011;19(1):30–5. doi: 10.1097/MOO.0b013e328341e1e9.
  • 7. Yu G, Fu Y, Dong C, Duan H, Li H. Is the occurrence of pediatric epistaxis related to climatic variables? Int J Pediatr Otorhinolaryngol. 2018;113:182–7. doi: 10.1016/j.ijporl.2018.07.053.
  • 8. Mangussi-Gomes J, Enout MJR, Castro TC de, de Andrade JSC, Penido N de O, Kosugi EM. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study. Acta Otolaryngol. 2016;136(11):1184–9. doi: 10.1080/00016489.2016.1191673.
  • 9. Link TR, Conley SF, Flanary V, Kerschner JE. Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate. Int J Pediatr Otorhinolaryngol. 2006;70(8):1439–42. doi: 10.1016/j.ijporl.2006.03.003.
  • 10. Patel N, Maddalozzo J, Billings KR. An update on management of pediatric epistaxis. Int J Pediatr Otorhinolaryngol. 2014;78(8):1400–4. doi: 10.1016/j.ijporl.2014.06.009.
  • 11. Mladina R. The role of maxillar morphology in the development of pathological septal deformities. Rhinology. 1987;25(3):199–205. PMID: 3672004.
  • 12. Durgut O, Dikici O. The effect of adenoid hypertrophy on hearing thresholds in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2019;124(35):116–9. doi: 10.1016/j.ijporl.2019.05.046.
  • 13. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: A novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol. 2003;67(12):1303–9. doi: 10.1016/j.ijporl.2003.07.018.
  • 14. Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46(1):77–81. doi: 10.1016/j.annemergmed.2004.12.014.
  • 15. Paranjothy S, Fone D, Mann M, Dunstan F, Evans E, Tomkinson A, et al. The incidence and aetiology of epistaxis in infants: a population-based study. Arch Dis Child. 2009;94(6):421-24. doi: 10.1136/adc.2008.144881.
  • 16. Svider P, Arianpour K, Mutchnick S. Management of Epistaxis in Children and Adolescents: Avoiding a Chaotic Approach. Pediatr Clin North Am. 2018;65(3):607–21. doi: 10.1016/j.pcl.2018.02.007.
  • 17. Montague M-LL, Whymark A, Howatson A, Kubba H. The pathology of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol. 2011;75(8):1032–4. doi: 10.1016/j.ijporl.2011.05.011.
  • 18. O’Reilly BJ, Simpson DC, Dharmeratnam R. Recurrent epistaxis and nasal septal deviation in young adults. Clin Otolaryngol Allied Sci. 1996;21(1):12–4. doi: 10.1111/j.1365-2273.1996.tb01017.x.
  • 19. Fuller JC, Levesque PA, Lindsay RW. Functional septorhinoplasty in the pediatric and adolescent patient. Int J Pediatr Otorhinolaryngol. 2018;111:97–102. doi: 10.1016/j.ijporl.2018.06.003.

Adenoid ve Nazal Patolojilerin Pediatrik Epistaksisteki Etkileri

Year 2022, , 242 - 249, 31.12.2022
https://doi.org/10.30565/medalanya.1127833

Abstract

Amaç: Bu çalışmanın amacı, tekrarlayan epistaksisi olan çocuk hastalarda adenoid ve nazal patolojilerin etkilerini araştırmaktır.

Yöntemler: Bu çalışmaya 2-17 yaşları arasında (ortalama yaş: 8.9 ± 3.6 yıl) 100 (61 erkek, 39 kız) birey dahil edildi. Tüm hastaların muayenesinde anterior rinoskopi ve fleksibl nazal endoskopi kullanıldı. Hastanın tıbbi öyküsü, epistaksis süresi, aktif epistaksiste ebeveynler tarafından uygulanan tedavi yöntemi, tıbbi tedavi ve müdahaleler kaydedildi. Epistaksisin yeri, nazal mukoza tipi, nazal vestibülit varlığı, nazal septum deviasyonu yeri ve tipi, adenoid dokunun boyutu ve alt konka hipertrofisi derecesi kaydedildi.

Bulgular: Tekrarlayan epistaksisi olan 31 (%62) hastada ve epistaksisi olmayan 14 (%28) hastada deviasyon mevcuttu. Epistaksis grubunda deviasyon varlığı kontrol grubuna göre anlamlı derecede yüksekti (p < 0.05). Epistaksis grubunda; 37 (%74) hastada nazal mukoza frajil mukoza, 11 (%22) hastada vaskülarize mukoza ve 2 (%4) hastada frajil – vaskülarize mukoza mevcuttu. Epistaksis grubunda burun mukozasının tipi ile yaş, deviasyon varlığı, deviasyon yeri, Mladina tipi arasında anlamlı bir ilişki saptandı (p < 0.05, p < 0.05, p < 0.05, p < 0.05).

Sonuç: Nazal septum deviasyonu, alt konka hipertrofisi ve nazal mukoza tipi pediatrik tekrarlayan epistaksis ile ilişkilidir.

References

  • 1. Shay S, Shapiro NL, Bhattacharyya N. Epidemiological characteristics of pediatric epistaxis presenting to the emergency department. Int J Pediatr Otorhinolaryngol. 2017;103:121–4. doi: 10.1016/j.ijporl.2017.10.026.
  • 2. Jamil W, Rowlands G. A practical approach to recurrent epistaxis in children. Paediatr Child Heal (United Kingdom). 2019;29(6):279–80. doi: 10.1016/j.paed.2019.03.005.
  • 3. Davies K, Batra K, Mehanna R, Keogh I. Pediatric epistaxis: Epidemiology, management & impact on quality of life. Int J Pediatr Otorhinolaryngol. 2014;78(8):1294–7. doi: 10.1016/j.ijporl.2014.05.013.
  • 4. McIntosh N, Mok JYQ, Margerison A. Epidemiology of oronasal hemorrhage in the first 2 years of life: implications for child protection. Pediatrics. 2007;120(5):1074–8. doi: 10.1542/peds.2007-2097.
  • 5. Abrich V, Brozek A, Boyle TR, Chyou P-HH, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc. 2014;89(12):1636–43. doi:10.1016/j.mayocp.2014.09.009.
  • 6. Melia L, McGarry GW. Epistaxis: Update on management. Curr Opin Otolaryngol Head Neck Surg. 2011;19(1):30–5. doi: 10.1097/MOO.0b013e328341e1e9.
  • 7. Yu G, Fu Y, Dong C, Duan H, Li H. Is the occurrence of pediatric epistaxis related to climatic variables? Int J Pediatr Otorhinolaryngol. 2018;113:182–7. doi: 10.1016/j.ijporl.2018.07.053.
  • 8. Mangussi-Gomes J, Enout MJR, Castro TC de, de Andrade JSC, Penido N de O, Kosugi EM. Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study. Acta Otolaryngol. 2016;136(11):1184–9. doi: 10.1080/00016489.2016.1191673.
  • 9. Link TR, Conley SF, Flanary V, Kerschner JE. Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate. Int J Pediatr Otorhinolaryngol. 2006;70(8):1439–42. doi: 10.1016/j.ijporl.2006.03.003.
  • 10. Patel N, Maddalozzo J, Billings KR. An update on management of pediatric epistaxis. Int J Pediatr Otorhinolaryngol. 2014;78(8):1400–4. doi: 10.1016/j.ijporl.2014.06.009.
  • 11. Mladina R. The role of maxillar morphology in the development of pathological septal deformities. Rhinology. 1987;25(3):199–205. PMID: 3672004.
  • 12. Durgut O, Dikici O. The effect of adenoid hypertrophy on hearing thresholds in children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2019;124(35):116–9. doi: 10.1016/j.ijporl.2019.05.046.
  • 13. Cassano P, Gelardi M, Cassano M, Fiorella ML, Fiorella R. Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings: A novel approach to therapeutic management. Int J Pediatr Otorhinolaryngol. 2003;67(12):1303–9. doi: 10.1016/j.ijporl.2003.07.018.
  • 14. Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med. 2005;46(1):77–81. doi: 10.1016/j.annemergmed.2004.12.014.
  • 15. Paranjothy S, Fone D, Mann M, Dunstan F, Evans E, Tomkinson A, et al. The incidence and aetiology of epistaxis in infants: a population-based study. Arch Dis Child. 2009;94(6):421-24. doi: 10.1136/adc.2008.144881.
  • 16. Svider P, Arianpour K, Mutchnick S. Management of Epistaxis in Children and Adolescents: Avoiding a Chaotic Approach. Pediatr Clin North Am. 2018;65(3):607–21. doi: 10.1016/j.pcl.2018.02.007.
  • 17. Montague M-LL, Whymark A, Howatson A, Kubba H. The pathology of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol. 2011;75(8):1032–4. doi: 10.1016/j.ijporl.2011.05.011.
  • 18. O’Reilly BJ, Simpson DC, Dharmeratnam R. Recurrent epistaxis and nasal septal deviation in young adults. Clin Otolaryngol Allied Sci. 1996;21(1):12–4. doi: 10.1111/j.1365-2273.1996.tb01017.x.
  • 19. Fuller JC, Levesque PA, Lindsay RW. Functional septorhinoplasty in the pediatric and adolescent patient. Int J Pediatr Otorhinolaryngol. 2018;111:97–102. doi: 10.1016/j.ijporl.2018.06.003.
There are 19 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research Article
Authors

Oğuzhan Dikici 0000-0002-3413-8994

Osman Durgut 0000-0002-3518-2903

Publication Date December 31, 2022
Submission Date June 8, 2022
Acceptance Date October 28, 2022
Published in Issue Year 2022

Cite

Vancouver Dikici O, Durgut O. Effects of adenoid and nasal pathologies in pediatric epistaxis. Acta Med. Alanya. 2022;6(3):242-9.

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