Epistaxis: are temperature and seasonal variations true factors in incidence?

OBJECTIVE: To investigate the previously documented inverse association between ambient temperature and presentation rates for patients with epistaxis and seasonal variation of emergency presentation rates for patients with epistaxis. STUDY DESIGN: A retrospective analysis of all consecutive emergency patients with epistaxis presenting to hospital from the community over a five-year period, 1997-2002 (1830 days), including those who required admission to hospital with epistaxis over the same period. Patients in whom there was a clear aetiology for the epistaxis (traumatic, recurrent, iatrogenic, coagulopathic and hypertensive) were excluded. SETTING: A tertiary referral centre in south-west London serving a population in excess of 2.8 million. METHOD: A retrospective analysis of all patients presenting or admitted to St George's Hospital with epistaxis over a five-year period. Daily ambient temperature readings from London Heathrow airport were recorded for the same period. Presentations were correlated with monthly temperature variations and the month itself. Statistical analysis with Pearson's correlation coefficient was performed. RESULTS: 1373 patients with epistaxis presented to our department, of whom 386 (28.1 per cent) were admitted to hospital. No correlation is seen between ambient temperature and presentation rate for patients with epistaxis. No seasonal preponderance is noted for presentation rate (Pearson r = 0.160, p = 0.221) in this series. CONCLUSION: To our knowledge, this is the largest study to date examining ambient temperature association and epistaxis, and the first to investigate presentation rate in place of admission rate. We feel that the exclusion of all patients with epistaxis not admitted to hospital introduces a bias. In this series, there is no correlation between ambient temperature, seasonal preponderance, presentation rate or admission rate for patients with epistaxis. This is contrary to previously reported findings. We do not support the view that there is a relationship between epistaxis and temperature or seasonal variation. This contradicts the current belief that incidence of epistaxis displays seasonality, and has implications for the allocation of resources for healthcare provision within ENT departments.

Airborne environmental pollutant concentration and hospital epistaxis presentation: a 5-year review.

To investigate the hypothesized relationship between various daily atmospheric pollutant concentrations and hospital epistaxis presentation. A retrospective analysis of all presentations of non-traumatic epistaxis to our institution was performed, and the results were cross-referenced with London air quality data supplied by the National Air Quality Data Archive at the National Environmental Technology Centre (NETCEN) at the multi-centre tertiary referral ENT Department. An analysis of epistaxis presentation to St George's Hospital during the 5-year period January 1997-2002 was made from the patient administration system and accident and emergency records. The study includes 1373 emergency patients after traumatic and iatrogenic epistaxis were excluded. Factors measured were atmospheric ozone (O(3)), carbon monoxide (CO), sulphur dioxide (SO(2)), nitrogen dioxide (NO(2)) and particulate matter less than 10 mum in diameter (PM(10)). Hospital epistaxis presentation and atmospheric pollutant concentration were documented for each day of the 5-year period, weekly change in both parameters was recorded and statistical analysis was performed. The statistical methods used are linear correlation using Pearson's coefficient. Increased hospital epistaxis presentation was strongly associated with increased concentration of airborne particulate matter (r = 0.289, P < 0.001; significant if P < 0.05) and less strongly associated with increased concentrations of atmospheric O(3) (r = 0.150, P = 0.019; significant if P < 0.05). There was no association between epistaxis attendance and atmospheric concentrations of CO, NO(2) and SO(2) in this study. The concentrations of local airborne particulate matter and atmospheric O(3) in the days preceding hospital attendance for epistaxis are relevant when considering the associations of the episode. This further increases understanding of the pathophysiology of spontaneous epistaxis.

Is cochlear outer hair cell function affected by mobile telephone radiation?

Mobile telephones emit high-frequency pulsed electromagnetic fields (PEMF). These are known to have measurable biological effects, and possible effects on the auditory system. Otoacoustic emissions give an indication of the functional state of the auditory system. Otoacoustics are known to be highly specific for the individual when the test pulse is identical. In this way, subtle changes in the ear can be detected. We investigated whether there is a measurable effect on Otoacoustic emissions from PEMF radiation. A total of 12 volunteers were recruited who had normal hearing; confirmed by pure tone audiometry. An Otoacoustic emission trace was obtained. The test subjects were exposed to a mobile telephone that was placed over the test ears mastoid process. The subjects had Otoacoustic emissions measured without the telephone and again on receive and transmit. There was no change in the trace signature during the test. There was no statistically significant change in the trace figures. This would indicate that PEMF from commonly available hand held mobile telephones have no measurable effect on the outer hair cell function during the time of use.

Laryngoscopy findings in outpatient notes: the accuracy of the recording of the side of the lesion.

An analysis of 100 patient notes was performed in the South-west Thames Region to determine the accuracy of recording the side of the abnormality in outpatient clinic notes when compared to the findings at direct laryngoscopy. Direct laryngoscopy was felt to be the most accurate method of viewing the larynx. The results were analysed to determine if the specific method of outpatient laryngoscopy or grade of examiner influenced the error rates. Inconsistencies occurred in 29% of the clinic notes when a diagram of the larynx was present. Specialist Registrars made 59% of the errors. Flexible nasendoscopy accounts for more errors than indirect laryngoscopy.