Objective To compare the impact of decongestive effect of xylometazoline and adrenaline in controlling active idiopathic anterior epistaxis on adult patients prior to use silver nitrate for cauterization. Study design Prospective case study. Methods The study used a prospective review of 150 consecutive adult patients diagnosed as anterior epistaxis (from August 2010 to January 2011). The study group was analyzed in three groups based on method of intervention used for management of anterior epistaxis. The conventional method of pinching nose and use of xylometazoline (0.5%) or adrenaline (1:10,000) soaked cotton packs for control of active arterial spurt followed in each case with silver nitrate cauterization. Results A total of 150 patients reviewed who were medically fit and subjected to study design in three groups. Fifty adult patients in each group with similar presentation. In first group, 32 patients out of 50 (64%) had successful control of bleeding with silver nitrate cauterization only after pinching nose (for 10 minutes). In second group, it was seen that 43 patients out of 50 (86%) in one group had successful control of bleeding following use of 0.5% xylometazoline-soaked cotton packs (for 10 minutes). prior to silver nitrate cauterization. In another group, 45 patients out of 50 (90%) had successful control of bleeding following use of 1:10,000 adrenaline-soaked cotton packs (for 10 minutes) prior to silver nitrate cauterization. Conclusions 1. Almost all patients with idiopathic anterior epistaxis can be managed more effectively and successfully by the use of vasoconstrictive agents followed by silver nitrate cauterization and risks of anterior nasal packing can be avoided. 2. The success rate of silver nitrate cauterization can be increased significantly with use of vasoconstrictive agents (xylometazoline and adrenaline) for control of actively bleeding arterial spurts prior to cauterization. 3. With the use of adrenaline not suitable in high-risk group patients, like coronary artery disease, cerebrovascular diseases, myocarditis, drugs like beta blockers, tricyclic antidepressants; xylometazoline can safely replace adrenaline in these cases.

Abstract

Background: Epistaxis is the commonest otorhinolaryngological emergency affecting up to 60% of the population in their lifetime with 6% requiring medical attention. Objective: The aim of this study was to fi nd out the epidemiological profi le of epistaxis in our area and to fi nd out the effectiveness of various available eight treatment options. Materials and methods: This study was conducted to describe the etiological profi le and treatment outcome of epistaxis. This was a prospective study of the cases of epistaxis from July 2012 to May 2013. Till date, the data regarding the management of epistaxis in our setting was not available. The purpose was to evaluate the clinical and management options for epistaxis in our settings. Results: A total of 100 patients with epistaxis were studied. Males were affected twice more than the females (2.6:1). Their mean age was 48.63 years (4-82 years). The commonest cause of epistaxis was idiopathic (33%) followed by trauma (21%) and hypertension (18%). Nonsurgical measures, such as light packing with cotton gauze soaked with local hemostatic (hemocoagulase) and antiseptic/antibiotic (36%), silver nitrate cauterization 20 (16%) and anterior nasal packing (15%) and observation alone (11%) were the main intervention methods in 78% of cases. Surgical measures mainly intranasal tumor resection was carried out in 3% of cases. Conclusion: The most common etiological factor for epistaxis is idiopathic. Most cases were successfully managed with conservative treatment alone and surgical intervention may not be necessary in most cases and should be the last resort.

Objective: Criteria for defi ning 'severe septal deviation' and to describe the clinical profi le of the same.Study: Retrospective study. Materials and methods: Hundred patients who were diagnosed with severe DNS and treated with extracorporeal septoplasty (ECSP) from September 2010 to December 2012, were retrospectively evaluated for this study. A review of their clinical charts formed the basis of this study. Results• In this study, majority of patients (96%) had nasal obstruction as their prime symptom followed by postnasal discharge in 60% cases, headache in 40% cases and anterior nasal discharge in 30% cases. External nasal deformity was reported by 22 patients. Snoring was seen in 24% of patients with same percentage complaining of altered sense of smell and throat discomfort. Epistaxis, sneezing and facial pain were seen in 14% patients. Epiphora was complained by only 8% of patients. • In this study, nasal endoscopy/anterior rhinoscopy was used to type the septal deformity. The commonest septal deviation was C-shaped cephalocaudal (48%), followed by S-shaped cephalocaudal (18%), C-shaped AP (16%), S-shaped AP (12%) and sharp septal deviation/angulation in 6% cases. • All but three patients (6%) had deviated nasal septum involving multiple Cottle's areas. These three patients had sharp septal angulation involving Cottle's area 2 only. • In this study, most common region involving DNS was area 1 + 2 + 3 (48%) followed by area 2 + 4 + 5 (28%) and 1 + 2 + 3 + 4 (18%). • Area 2 was invariably involved in 100% of cases. • NOSE (nasal obstruction symptom evaluation) scores. • Preoperatively, mean NOSE score was 67.60 ± 5.26 (65.34-72.86). • NSS (nasal symptoms score):-Preoperatively, mean NSS was -5.08 ± 0.38 (-5.46--4.70). Conclusion• A septal deviation is regarded as 'severe' if patient satisfi es all of the below-mentioned criteria: -Preoperatively, mean NOSE score should be 65.34 or more. IJHNS RESEARCH ARTICLE

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Background: Epistaxis is the commonest otorhinolaryngological emergency affecting up to 60% of the population in their lifetime, with 6% requiring medical attention.

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Objective: To compare the outcomes of various medical treatment modalities for laryngopharyngeal reflux (LPR).Study design: Prospective study design. Materials and methods:One-hundred and fifty patients were divided into three groups (A, B, C) based on the mode of intervention used for the control of LPR. Each study group enrolled 50 patients using random tables. • Group A: These patients were put on a twice daily dosage of esomeprazole (20 mg bd) and domeperidone (10 mg bd) for 4 months • Group B: These patients were put on bd dosage of esomeprazole (20 mg) and domeperidone (10 mg) and also received counseling for dietary and lifestyle changes. The duration of treatment was for 4 months. • Group C: These patients received, in addition to above, 10 mg of amitriptyline (tricyclic antidepressant) bid, again for 4 months. Results:The success achieved in controlling LPR was defined as greater than 50% improvement in baseline symptoms. The success achieved in group A was 46%, in group B was 54% and in group C was 40%. The relative change in reflux symptom index (RSI) over any given period of time was significantly higher than the relative change in reflux finding score (RFS). The relative change in RSI over first month was 30.99%, which is significantly higher than the relative change of RFS (6.39%) over the same period.The mean RSI scores during 4 months of treatment fell from 20.67 to 8.9 (p < 0.01) in group A, from 23.3 to 8.6 (p < 0.01) and from 21.3 to 10.8 (p < 0.05) in group C.The mean RFS during 4 months fell from 15 to 6.5 (p < 0.05) in group A, from 16 to 6.4 (p < 0.05) and from 15 to 6.4 (p < 0.05) in group C. Conclusion• All the three interventions had a statistically significant impact on the signs and symptoms of LPR. • However, higher success rates were achieved in group Bwhere patients were put on a bid dosage esomeprazole and domeperidone nad counseled for lifestyle and dietary changes. Paradoxically, success rates achieved in group C was lower than other groups, possibly because of the anticholinergic effects of amitriptyline causing dry mouth and dry throat. • The symptomatic improvement was seen much earlier than the improvement in laryngoscopic findings. This was evidenced by the fact that relative change in RSI was much higher than the relative change of RFS over a given period of time. • If diagnosed with enough surety and certainty, patients of LPR do not need any antidepressant medications as these medications may not have any role in the treatment of same and may, however, worsen the condition owing to their anticholinergic side effects.