Epistaxis management

Epistaxis is common and has been reported to occur in up to 60 percent of the general population. The affected person usually does not seek medical attention, particularly if the bleeding is minor or self-limited. In rare cases, however, massive nasal bleeding can lead to death. The nose has an abundant blood supply. The arterial supply to the nose comes from carotid arteries. Nasal bleeding usually responds to first-aid measures. When epistaxis does not respond to simple measures, the source of the bleeding should be located and treated appropriately. There is no unanimity amongst Otorhinolaryngologists in terms of the sequence of different treatment methods in Epistaxis patients. We aimed in this study to examine our existing practice in terms of management of epistaxis, and to try to come up with suggestions of sequential treatment steps. This is a retrospective study conducted from November 2004 to January 2005 in the Otolaryngology Department in Midway Maritime Hospital. The study group consisted of 100 case notes requested. The demographic data of the patients were collected and the history of epistaxis in each patient. The study showed the peak of incidence of epistaxis [66%] was in adults [51 - 91 years old]. No sex predilection. It was mostly spontaneous. 60% of the patients presented for the first time. 63% of the patients have co-morbid conditions. 60% of the patients needed hospital admission. The patients were treated with different measures. We concluded that the cases of epistaxis caused by trauma in our series is far less than expected. Co-morbidity plays a major role in the causation of epistaxis according to this study. We recommend the use of chemical cautery, merocele or both as the first line of local treatment of epistaxis. If it does not work, Rapid Rhino with or without anterior packing should be considered. If this does not work, then sphenopalatine artery ligation is the next step

Evaluation of fine needle aspiration cytology [FNAC] in diagnosis of head and neck swellings in Bab Elsheria Hospital

FNAC is believed to be of great benefit as an alternative diagnostic approach to lesions in Head and Neck region. This study aims at evaluating the results of FNAC undertaken in Otorhinolaryngology, Head and Neck Surgery Department, Bab Elsheria Hospital in relation to the International big series. This is a retrospective study of 42 cases with FNACs performed between September 2004 and April 2006. All patients had both FNAC and Histology done. Patients were classified into 3 groups according to the site of their swellings: [parotid, thyroid and others]. The origin of the swellings in this series was 48% from the parotid gland, 19% from the thyroid gland and 33% from other sites. The first FNAC was only diagnostic in 21 patients [50%]. While the 2nd FNAC was diagnostic in 8 patients out of 15 [53.3%]. The majority of swellings with positive findings on FNAC in 29 patients had matched the histology results [68.9%]. So, the chances of getting diagnosis were about 50% in either first or second FNAC. The FNAC sensitivity was 69% and its specificity was 80%, which lags behind the International big series. We need to improve our FNAC results to be compared with the results of International big series