Epistaxis; causes and management at King Fahd hospital of the University

ABSTRACT

Objective:To study the causes of epistaxis and its management and to compare it to the current literature. Setting: A retrospective study of all cases of epistaxis seen between January 1997 - December 1999 in the ENT department of King Fahd Hospital of the University [KFHU], Al-Khobar. All patients underwent a general evaluation. Vital signs were monitored and resuscitation was carried out when needed. An intravenous line was secured, and a full blood count and coagulation profile were ordered on presentation. All patients were initially treated conservatively, by anterior and/or posterior nasal packing, or by chemical or galvanocautery. There were 204 epistaxis patients during the period under study. Their ages ranged between 2-60 years, and 64.4% were aged 20 or under. Male to female ratio was 2.71. The main causes of epistaxis were nose picking in 33%, external trauma 31%, rhinosinusitis in 20%, bleeding disorder in 7.3% idiopathic 6.7%, post septoplasty in 1% and in 1% due to angiofibroma. Eight per cent were hospitalized. The remaining 92% were treated as outpatients cases. Conservative treatment controlled epistaxis in all but three patients who required surgery. Five patients required blood transfusion [1.96%]. At follow-up, 8% reported mild attacks of epistaxis which stopped spontaneously and did not require treatment. Conservative treatment for epistaxis is still successful in controlling epistaxis in the majority of patients. Arterial ligation is rarely required in patients who do not respond to conservative measures. The value of coagulation screening should not be underestimated