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MANAGEMENT OF PEDIATRIC EPISTAXIS

Keywords: pediatric , etiological factor , epistaxis

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Abstract:

OBJECTIVES: a). To evaluate the etiological factors of epistaxis. b). To evaluate theimportance of nasal examination in the diagnosis. c). To compare the efficacy of varioustreatment methods. DESIGN: Prospective study. SETTING: Department of Otolaryngologyand Head Neck Surgery Nishtar Hospital Multan and Aga Khan University Hospital Karachi.MATERIALS & METHODS The study consists of a prospective evaluation of 100 patients presentingwith nasal bleeding and requiring admission. All the patients were thoroughly evaluated with a detailedhistory, physical examination, systemic examination and ENT examination and a same set of investigationswere done in all the patients. RESULTS: In our series inflammatory affections of nose and sinuses andtrauma to nose are commonest etiologies of pediatric epistaxis. Among the treatment modalitiescauterization was only effective when a bleeding point can be identified and was accessible. Comparisonof various packing materials showed Vaseline gauze to be most useful and cost effective. Submucousresection was effective in controlling bleeding after failure of nasal packing but arterial ligation was lastresort if bleeding could not be controlled with anterior and posterior nasal packing. CONCLUSIONS:Inflammation of the nose and sinuses and trauma to nose is commonest etiological factors in pediatricepistaxis. Chemical cautery is as effective as electric cautery in control of simple epistaxis where bleedingpoint can be identified. Vaseline gauze should be used for anterior nasal packing being efficacious as wellas cost effective. Submucous resection may be considered as effective step if packing fails to controlbleeding before proceeding for arterial ligation.

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