Nasal Endoscopy and Computed Tomography for Epistaxis of Clinically Inapparent Aetiology.

ABSTRACT

Epistaxis is one of the common otorhinolaryngological emergencies that are encountered in daily practice. Aetiology of epistaxis may range from benign conditions like septal spur, infected nasal polyps etc to serious causes like malignancies. Many a times, the cause for epistaxis is not found on anterior and posterior rhinoscopy. We wanted to assess the role of nasal endoscopy and computed tomography of paranasal sinuses (CT scan of PNS) among patients with epistaxis in whom the cause is not evident after history taking and clinical examination. MethodsThis was a longitudinal study conducted in the Department of ENT in a tertiary care centre in south India. For patients included in the study, diagnostic nasal endoscopy under local anaesthesia was done and findings were noted. If any bleeding point was visualised on endoscopy, it was cauterised. In selected cases, endoscopic biopsy from nasal mass was done, and sent for histopathological examination. CT scan of PNS was done and findings were noted. ResultsIn the evaluation of patients with epistaxis of inapparent aetiology, nasal endoscopy could aid the diagnosis in 61.8% of patients, and CT scan of PNS in 81.8 % of patients. Statistical comparison of measure of agreement between nasal endoscopy and CT scan of PNS for diagnosis of epistaxis of clinically inapparent aetiology yielded a kappa value of 0.187 which can be interpreted as slight agreement. Sensitivity of nasal endoscopy and CT scan for diagnosing sinonasal neoplasms as compared to histopathological examination (gold standard) was 83.3% and 100% respectively. Both had an accuracy of 66.7% as compared to histopathological examination. Statistical comparison of measure of agreement between nasal endoscopy and CT PNS for diagnosing sinonasal inflammation yielded a kappa value of 0.391 which can be interpreted as fair agreement. ConclusionsFor evaluation of sinonasal neoplasm causing epistaxis, CT scan of PNS has higher sensitivity than nasal endoscopy. Subclinical sinonasal infection could be a triggering factor for epistaxis in older patients. Nasal endoscopy and CT scan of paranasal sinuses are important and complementary tools in the evaluation of epistaxis.