Rigid Nasal Endoscopy in the Diagnosis and Treatment of Epistaxis

Abstract

Background and Objectives: Epistaxis is one of the common symptoms encountered in the Otorhinolaryngology department. Many times the cause for epistaxis is not found on anterior and posterior rhinoscopy. The present study was undertaken to assess the role of rigid nasal endoscope in the diagnosis and treatment of epistaxis, where normal anterior and posterior rhinoscopy did not reveal any specific finding.Methods: Fifty patients with epistaxis were studied using rigid nasal endoscope under local anaesthesia. Patients who were above 15 years with nasal bleeding and who were willing for rigid nasal endoscopy were included in the study. Patients less than 15 years were not included in the study because nasal endoscopy was difficult in them under local anaesthesia. Only those patients in whom, the cause for epistaxis could not be made out on anterior and posterior rhinoscopy were chosen for the study, this was done in order to remove the bias for nasal endoscopy. Results:The use of the nasal endoscope allowed diagnosis of bleeding points and treating them directly. Epistaxis was more in male patients especially in the 3 rd and after the 5 th decade. On endoscopic examination,the bleeding points were identified as coming from the crevices of the lateral nasal wall, posterior spur on the septum, posterior deviation of the septum with ulcer, congested polyps, enlarged and congested adenoids, scabs or crusts in the crevices of the lateral nasal wall and angiofibroma. Endoscope also helps in the treatment of epistaxis, which includes endoscopic selective nasal packing using gelfoam, endoscopic cautery or diathermy and endoscopic polypectomy. Other patients with adenoids, scabs and crusts and angiofibroma were managed on their merits. Interpretation and Conclusion:Nasal endoscopy helps not only in the localisation of the bleeding point but also in the treatment of those bleeding areas that are situated in the posterior and lateral part of the nose.

Endoscopic evaluation and treatment of epistaxis – A prospective study

“…In their study, the most common cause was posterior septal deviation with ulcer (23.3%). This is contradictory to the data available in some other literature [4,6].…”

“…They had history of upper respiratory infection prior to epistaxis. Similar results were seen in other studies also [4,6]. Endoscopic cauterization of bleeding points was done in 12% cases.…”

“…Infected polyp accounted for 10% cases. In other studies also infected polyp was found to be a cause of epistaxis [4][5][6]. Hypertrophied turbinates and oedematous nasal mucosa obscured the view of the polyp during anterior rhinoscopy, which we could clearly visualize by nasal endoscopy after nasal decongestion.…”

“…Bleeding from the crevices of the lateral nasal wall was the commonest etiology for epistaxis in the study conducted by Mahesh Babu et al [4] on 50 patients (24%) and by Kumar et al [6] on 60 patients (28%). For them posterior septal deviation was the second common cause for epistaxis.…”

“…With the advent of nasal endoscope, the diagnosis and treatment of epistaxis became easy. Nasal endoscope has superior lighting quality and magnification which give a detailed view of the nasal cavity and the covert areas of the nose situated in the deep crevices of the lateral nasal wall [5][6][7].…”