Intractable epistaxis due to isolated primary telangiectasias. JAMA Otolaryngol Head Neck Surg 2014 Feb;140(2):160-3
Date
12/18/2013Pubmed ID
24337437DOI
10.1001/jamaoto.2013.5991Scopus ID
2-s2.0-84894502861 (requires institutional sign-in at Scopus site) 5 CitationsAbstract
IMPORTANCE: Epistaxis is the most common otolaryngologic emergency in the United States. Most cases are controlled with first-line measures, but intractable epistaxis can be a challenging clinical problem requiring posterior nasal packing and surgical or endovascular intervention. Bleeding from nasal telangiectasias is well known in hereditary hemorrhagic telangiectasia, but there are no reports in the literature of recurrent epistaxis due to isolated telangiectasias not associated with systemic disease. This report describes a series of cases in which intractable epistaxis due to isolated primary telangiectasias was effectively controlled with bipolar electrosurgery.
OBSERVATIONS: We describe a patient with intractable epistaxis that had failed management with posterior packing and embolization. We also report a series of 16 cases of epistaxis, 6 of which were intractable, in adults without hereditary hemorrhagic telangiectasia who received treatment between 2009 and 2012. These cases reveal a common pattern of bleeding from telangiectasias on the anterior septum (8 cases [42%]), nasal sidewall (3 [16%]), inferior meatus (2 [10%]), posterior septum (2 [10%]), nasal floor (2 [10%]), middle turbinate (1 [5%]), and inferior turbinate (1 [5%]).
CONCLUSIONS AND RELEVANCE: Telangiectasias not associated with systemic disease are a previously unreported source of significant nasal bleeding that, when identified endoscopically, can be treated successfully with bipolar electrosurgery rather than with more invasive and costly surgical and endovascular measures.
Author List
Stoddard T, Loehrl TA, Hunt BC, Poetker DMAuthors
Bryan C. Hunt MD Associate Professor in the Pathology department at Medical College of WisconsinDavid M. Poetker MD Chief, Professor in the Otolaryngology department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AdultAged
Cohort Studies
Electrocoagulation
Emergency Service, Hospital
Epistaxis
Female
Follow-Up Studies
Humans
Immunohistochemistry
Male
Middle Aged
Nasal Mucosa
Nasal Septum
Retrospective Studies
Risk Assessment
Severity of Illness Index
Telangiectasis
Treatment Outcome
