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8/3/2019 Paediatric Epistaxis
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PAEDIATRIC EPISTAXIS
Dr Irfan ZafarP.G.R. /E.N.T.SupervisorProf Dr Israr Ahmed
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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.
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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.
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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.
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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
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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.
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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
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results
Table 2 -----sex incidence
Male 66 66%
Female 34 34%
Total 100
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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
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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
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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).
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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 .
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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.
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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.
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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
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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.