Epistaxis. “It is estimated that more than 60% of the population suffers from this pathology at some point” – Health – SAPO.pt

How prevalent is epistaxis?

It is estimated that more than 60% of the population suffers from this pathology at some point, with 6% of these seeking/needing medical intervention. It is the main reason for resorting to the Otorhinolaryngology Emergency Service.

Who is most affected? Is there a patient profile?

In epidemiological terms, it has a bimodal distribution, and is therefore more common in young ages – from 2 to 10 years old – and older ages – between 50 and 80 years old. Men are more affected, which appears to be related to a protective hormonal effect of estrogen in women and is more common in the winter months and in dry environments. The presence of cardiovascular disease, as well as peripheral vascular disease and a history of epistaxis, appear to be relevant risk factors. The role of arterial hypertension, as well as anticoagulant and antiplatelet agents, continues to be much discussed, as risk factors associated with epistaxis.

“Undoubtedly, recurrent unilateral epistaxis should warrant rapid referral to the ENT to screen for neoplastic disease, especially if associated with progressive nasal obstruction, changes in smell, pain and/or changes in hearing”

What are the associated causes?

While in primary epistaxis, the most frequent are episodes of idiopathic causes (around 85%), in secondary epistaxis there are multiple causes such as trauma or history of previous nasal surgery, chronic rhinosinusitis and allergic rhinosinusitis, coagulopathies, such as von Willebrand’s disease, teleangiectasia hereditary hemorrhagic diseases, inflammatory and connective tissue diseases such as granulomatosis with polyangiitis, or multiple neoplasms, such as rhabdomyosarcoma or juvenile angiofibroma in childhood.

How should the family doctor deal with this health problem? Does it require referral to the ENT in some more complex situations?

Without a doubt, recurrent unilateral epistaxis should warrant rapid referral to the ENT to screen for neoplastic disease, especially if associated with progressive nasal obstruction, changes in smell, pain and/or changes in hearing. Furthermore, a history of recurrent epistaxis with analytical repercussions must obviously also be mentioned. Furthermore, educating patients and acting in a preventive manner are measures that will certainly have a positive impact on the treatment of this pathology – explain that in case of bleeding, it should be closed and put pressure on the wings of the nose for at least 10 minutes, tilting the nose. head forward and trying not to swallow blood; apply ice to the neck to promote some vasoconstriction of the neck vessels; assess blood pressure and, if necessary, take SOS medication; apply a vasoconstrictor spray, with neo-synephrine or oxymetazoline; After the episode or in very dry environments, apply an ointment that stimulates hydration of the nasal mucosa. Avoiding blowing your nose and sneezing with your mouth open to avoid an increase in pressure in the nasal cavity for 1 to 2 weeks can also contribute to healing and thus closing the bleeding point more quickly.

When referring, is it important for the patient to undergo an examination that can be immediately prescribed by the family doctor?

Yes, if there is a strong suspicion of neoplasia, a CT scan of the paranasal sinuses will certainly help us to be faster in the differential diagnosis and therapeutic decision. Or if changes in coagulation are suspected, a first analytical assessment and perhaps also a referral to a Hematology consultation.

MJG

More information about Epistaxis:

• EPOS: https://epos.myesr.org/poster/esr/ecr2020/C-05136/Background#poster
• Amboss: https://next.amboss.com/de/article/Hj0KbT?q=epistaxis#Z9c17724d497ff9c4b9cf7d32d 9e18775
• Risk factors for the occurrence of epistaxis: Prospective study, Côrte, Filipa et ali, Auris Nasus Larynx, 2018-06-01, Volume 45, Issue 3, Pages 471-475
• Cummings Otolaryngology: Head and Neck surgery, 6th edition, chapter 42, 658 – 690