Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment

Abstract

Background: Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that lowgrade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children. Aims: This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients. Study Design: Retrospective cross-sectional study. Methods: Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group. Results: Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments. Conclusion: Despite the high colonization rates, topical antibacterial treatment was not found superior to nonantibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.

Efficacy and Safety of Intranasal Medical Management in Pediatric Patients with Idiopathic Recurrent Epistaxis

“…Use of local ointments for hydrating, moisturizing nasal mucosa and local antimicrobial ointments have been found to be effective in 65.2%-91% of pediatric IRE patients [5][6][7][8][9][10][11][12][13][14] which was compatible with our results (71.6%). On the contrary, Robertson and Kubba 17 found that in 65% of pediatric epistaxis patients treated with cream with/ without cautery for long periods of five years nasal bleeding persisted, and the rate was highest (77%) in patients treated with combined application of cautery and cream.…”

“…Additionally, this colonization leads to new vessel formation 8 . Effectiveness of intranasal application of antimicrobial agents to stop IRE attacks in pediatric patients explains this proposed causative effect of bacterial colonization on the anterior nasal mucosa [11][12][13][14] . Terramycin ® which is originally an ophthalmic ointment is a locally effective antimicrobial agent used mainly by ophthalmologists.…”