Epistaxis NTHC 4.2014 JBW - uclmontgodinne.be NTHC 4.2014 JBW.pdf · Department of ORL and HNS Ghent University Hospital Ghent University EPITHELIUM LAMINA PROPRIA Glandular layer

Department of ORL and HNSGhent University HospitalGhent University

EPISTAXISIntroduction

Watelet JB, MD, PhDVan Zele T, MD, PhD

Department of OtorhinolaryngologyGhent University Hospital

Ghent UniversityBelgium


Objectifs de cette introduction

1. Les fosses nasales: – un organe en première ligne…– …et hautement vascularisé

2. Caractérisation de l’épistaxis: 1. Épidémiologie2. Classification

3. Facteurs associés à l’épistaxis

4. Prise en charge de l’épistaxis5. Risques liés à l’épistaxis et son traitement



EPITHELIUM

LAMINA PROPRIA

Glandular layer(superficial)

Glandular layer(deep)

Vascular layer

1. Les fosses nasalesun organe en première ligne …

J.B. Watelet, MD, PhD


Resistance vessels

Nutrient vessels

Capacitance vessels

Arteriovenous

anastomosis

Capillary bedVenous sinusoid

VeinArteriole

Precapillary sphincter


1. Les fosses nasales…et hautement vascularis é



A



FACE EXTERNE FACE SEPTALEJ.B. Watelet, MD, PhD


1°°°°/ Système carotidien interne

2°°°°/ Système carotidien externe



Schlosser RJ. Epistaxis. N Engl J Med 2009;360:784-789

Viehweg TL, 1. Roberson JB, Hudson JW. Epistaxis: diagnosis and treatment. J Oral Maxillofac Surg 2006;64:511-8

Petruson B, Rudin R. The frequency of epistaxis in a male population sample. Rhinology 1975;13:129-133

“Epistaxis is estimated to occur in 60% of persons worldwide during their lifetime, and approximately 6% of those with nosebleeds seek medical treatment”

2. Caractérisation de l’épistaxisépid émiologie


– 30% des enfants < 5 ans et

– 56 % des enfants 6-10 ans ont eu au moinsune fois une epistaxis

– 1/10.000 chez enfants < 2 ansPetruson B. Epistaxis in childhood. Rhinology 1979; 17:83

– La moitié des adultes avec épistaxis ont présenté des epistaxis dans l’enfance.

Beran M, Petruson B. Occurrence of epistaxis in habitual nose-bleeders and analysis of some etiologicalfactors. ORL J Otorhinolaryngol Relat Spec 1986; 48:297



Services d’urgence1. Retrospective sur 10 years (National Hospital Ambulatory Medical Care Survey)

– +/-1 visite aux SU sur 200 ED (United States)

– Most cases (83%; 95% CI 80% to 86%) wereatraumatic.

2. 33% of all ENT emergency admissions.

Pallin DJ, Chung YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergencydepartments, 1992 to 2001. Ann Emerg Med. 2005 Jul;46(1):77-81



• Overall frequency of visits for epistaxis :

– epistaxis was present in 12.0 (95% CI 9.1 to 14.9) of 1,000 ED visits in patients aged from 70 to 79 years versus

– 2.3 of 1,000 ED visits (95% CI 1.2 to 3.3) for visits by those aged 20 to 39 years

– for children younger than 10 years was 4.0 per 1,000 ED visits (95% CI 3.0 to 5.1)



Michael Reiß, Gilfe Reiß. Epistaxis: some aspects of laterality in 326 patients. Eur Arch Otorhinolaryngol (2012) 269:905–909

2. Caractérisation de l’épistaxisclassification: localisation


2. Caractérisation de l’épistaxisclassification: s évérité


2. Caractérisation de l’épistaxisclassification: s évérité


Chung Y, Emond CA, McKay P, Pelletier AJ, Camargo DJ, Pallin DJ.

Epidemiology of epistaxis in us emergency

department patients, 1992-2001. Ann EmergMed 2004;44, 4, Suppl:

S105-S106

Nash CM, Field S MB. Epidemiology of Epistaxis in a Canadian Emergency Department. Israeli J Emerg Med. 2008; 8,3: 23-28

Atraumatic: in 83%

2. Caractérisation de l’épistaxisclassification: contexte



3. Facteurs associés à l’epistaxisidiopathique

“The cause of epistaxis is unknown in 70% to 80% of cases

and is termed idiopathic epistaxis.”

Stell PM. Epistaxis. Clinical Otolaryngology 1977;2:263–73


Childhood recurrent idiopathic epistaxis is usually attributed to

crusting, nasal …and/or digital trauma (’nose picking’),

although in manycases no direct cause can be established.

• Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD004461. DOI: 10.1002/14651858.CD004461.pub3

• Guarisco JL, Graham 3rd HD. Epistaxis in children: causes, diagnosis and treatment. Ear, Nose, and ThroatJournal 1989;68:522–38

• McGarry G. Nosebleeds in children. BMJ Clinical Evidence 2006;4(311):496–9.

• Petruson B. Epistaxis. Acta Oto-Laryngologica. Supplement 1974;317:1–73


Kucik C, Clenney T. Management of Epistaxis.

Am Fam Physician 2005;71:305-11

3. Facteurs associés à l’epistaxis1. locaux


In adults

3. Facteurs associés à l’epistaxis2. systémiques

US(n=9778)

Spain(n=178)

Tanzania(n=94)

1st comorbidity Hypertension45%

Hypertension56%

Hypertension17,3%

2nd comorbidity Anemia 28% Anti-platelettreatment 23%

CRS 6%

3rd comorbidity Coronaryatherosclerosis

15%

Anti-coagulanttherapy 18,5%

Tumors 5%

Goddard JC et al. 2005 Monjas-Canovas I et al 2010

Gilyoma JM et al. 2011



PATIENTS BEING TREATED WITH

ANTICOAGULANT THERAPY:

Atraumatic epistaxis rates of 25% and 42.9%

Lavy J. Epistaxis in anticoagulated patients: educating an at-risk population. Br J Haematol, 1996; 95:195-197

Choudhury N, Sharp HR, Mir N, Salama NY. Epistaxis and oral anticoagulant therapy. Rhinology, 2004; 42:92-97

Nash CM, Field S MB. Epidemiology of Epistaxis in a Canadian Emergency Department. Israeli J Emerg Med. 2008; 8,3: 23-28


Manfredini R, et al. Circadian variation in onset of epistaxis: analysis of

hospital admissions. BMJ 2000;321:1112



Nash CM,Field S. Epidemiology of Epistaxis in a Canadian Emergency Department. Israeli J Emerg Med. 2008; 8: 23-28

Pallin DJ, Chng YM, McKay MP, Emond JA, Pelletier AJ, Camargo CA Jr. Epidemiology of epistaxis in US emergencydepartments, 1992 to 2001. Ann Emerg Med. 2005 Jul;46(1):77-81

Chung Y, Emond JA, McKay MP, Pelletier AJ, Camargo CA, Pallin DJ. Epidemiology of epistaxis in us emergency departmentpatients, 1992-2001. Ann Emerg Med 2004; 44, 4,, Suppl.: S105-S106

3. Facteurs associés à l’epistaxis3. environnementaux



Le traitement pour but :

-de tarir l'hémorragie

- = traitement primaire

-d'éviter les récidives

- = traitement secondaire

4. Prise en charge de l’épistaxisprincipes


1°°°°/

2°°°°/ 3°°°°/

HEMODYN

AMI

QUE








Feusi B et al. Posterior epistaxis: systematic review on the effectiveness of surgical therapies. Rhinology2005;44:300-304

0-30%

récidiveà 1 an





• “Although death from epistaxis is rare, itcan occur, and significant morbidity is relatively common”.Lucente FE: Thanthology: A study of 100 deaths. Trans Acad Ophthalmol Otol 1972;76:334-339

• Mortality:– Tanzania: 4.8% of admited patients.

Gilyoma JM, Chalva 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 Disorders 2011, 11:8 doi:10.1186/1472-6815-11-8

– China: 7.8% Huang CL, Shu CH. Epistaxis: a review of hospitalized patients. Zhonghua Yi Xue Za Zhi (Taipei). 2002 Feb;65(2):74-8

5. Risques liés à l’épistaxis et àses traitements


Pope IER, Hobbs CGI. Epistaxis: an update on current management. Postgrad Med2005;81:3009-314




Rudmik L, Smith TL. Mangaement of intractablespontaneous epistaxis. Am J Rhinol Allergy2012;26:55-60


EpistaxisConclusions

1. Malgré sa haute prévalence, l’épistaxis reste la plupart du temps bénigne. Ses causes réelles ne sont pas toujours faciles à identifier2. Toutefois, les epistaxis sévères peuvent être fatales ou àhaute comorbidité compte-tenu de leur impact hémodynamique et de la déstabilisation des pathologies qui leur sont associées3. Dans ces conditions, la prise en charge est invasive et non dénuée de risques4. Afin d’éviter au maximum leur récurrence, les épistaxis devraient idéalement bénéficier d’une approche multidisciplinaire

Documents

Epistaxis NTHC 4.2014 JBW - uclmontgodinne.be NTHC 4.2014 JBW.pdf · Department of ORL and HNS Ghent University Hospital Ghent University EPITHELIUM LAMINA PROPRIA Glandular layer