Serious spontaneous epistaxis and hypertension in hospitalized patients

Abstract

The aim of the study was to evaluate the role of hypertension in patients hospitalized for serious spontaneous epistaxis. This 6-year retrospective study was based on 219 patients hospitalized in a University Hospital ENT and Head and Neck surgery department for serious spontaneous epistaxis. The following parameters were recorded: length of hospital stay, history of hypertension, blood pressure (BP) recordings (on admission, during hospitalization and on discharge), epistaxis severity criteria, including medical and/or surgical management of epistaxis (blood transfusion depending on blood count, embolization, surgery), medications affecting clotting. Epistaxis was classified into two groups: serious and severe. No significant differences were observed between the two groups in terms of age, sex ratio, history of epistaxis and BP characteristics including history of hypertension, mean BP on admission, mean arterial pressure on discharge and number of patients in whom BP was difficult to control. Patients with more severe epistaxis had a similar exposure to anticoagulant and platelet antiaggregant medications as patients with less severe epistaxis. Overall, on univariate logistic regression analysis, no factors were independently associated with severity of epistaxis. The pathophysiology of serious spontaneous epistaxis remains to be unclear. It concerns elderly patients (>60-70 years old) with a history of hypertension in about 50% of cases. Serious spontaneous epistaxis may also be the presenting sign of underlying true hypertension in about 43% of patients with no history of hypertension. However, hypertension per se does not appear to be a statistically significant causal factor and/or a factor of severity of serious spontaneous epistaxis.

Evaluation of Etiology of Epistaxis and its Management in Dhulikhel Hospital

“…The assumption that older individuals, who have lost the elastic and contractile properties of their arteries, are prone to more severe nosebleeds than younger individuals and requires hospitalization and aggressive management 8,9 ; is confirmed in our sample of patients.…”

Univariate and multivariate analyses for postoperative bleeding after nasal endoscopic surgery

“…Epistaxis can be caused by many factors, but we mainly considered iatrogenic factors in the present study. Hypertension has been considered to be a major cause for epistaxis for a long time [7]. However, association between the two conditions is controversial [8,9].…”

A Study of Role of Nasal Endoscopy in the Diagnosis and Management of Epistaxis

“…Although, predominantly a benign condition regardless of its aetiology, epistaxis can be severe, particularly in elderly and frail patients requiring hospitalisation and "aggressive" management. (2) We realised in our study that the best way to manage an epistaxis is to go for meticulous nasal endoscopy at the outset. The availability of the nasal endoscope has been a boon to the otolaryngologist, since it not only helps in proper visualisation but also offers a direct mode of treatment to the area that is now accessible.…”