Jiro Iimura

Risk factors for recurrent epistaxis: Importance of initial treatment

OBJECTIVE A retrospective study of risk factors for recurrent epistaxis and initial treatment for refractory posterior bleeding was performed. Based on the results, proposals for appropriate initial treatment for epistaxis by otolaryngologists are presented. METHODS The data of 299 patients with idiopathic epistaxis treated during 2008-2009 were analyzed by multivariate logistic regression analysis. Treatment data for 101 cases of posterior bleeding were analyzed using the chi-square test. RESULTS Recurrent epistaxis occurred in 32 cases (10.7%). Unidentified bleeding point (adjusted odds ratio (OR) 5.67, 95% confidence interval (CI) 1.83-17.55, p=0.003) was predictive of an increased risk of recurrent epistaxis, and electrocautery (adjusted odds ratio (OR) 0.07, 95% confidence interval (CI) 0.03-0.17, p=0.000) was predictive of a decreased risk of recurrent epistaxis. In terms of initial treatment for posterior bleeding, the rate of recurrent epistaxis was significantly lower for patients who underwent electrocautery as initial treatment compared with those who did not (6.4% vs. 40.7%, p<0.01), and it was significantly higher for those who underwent endoscopic gauze packing compared with those who did not (39.5% vs. 15.9%, p<0.01). CONCLUSION In the present study, the risk factors for recurrent epistaxis were unidentified bleeding point. Thus, it is important to identify and cauterize a bleeding point to prevent recurrent epistaxis. The present results also suggest the effectiveness of electrocautery and the higher rate of recurrent epistaxis for patients who underwent gauze packing as initial treatment for posterior bleeding. Electrocautery should be the first-choice treatment of otolaryngologists for all bleeding points of epistaxis, and painful gauze packing may be inadvisable for posterior bleeding. More cases of posterior bleeding are needed for future studies involving multivariate analyses and appropriate analyses of factors related to hospitalization, surgery, and embolization.

Study of hemostasis procedures for posterior epistaxis

OBJECTIVE Hemostasis is difficult in patients with bleeding emanating from the deep regions in the nasal cavity; however, there is no standard treatment method. We studied hemostasis procedures in patients who visited our outpatient department and presented with idiopathic epistaxis extending from the posterior nasal cavity to Kiesselbachs area. METHODS The subjects were patients with epistaxis who visited our hospital between June 2008 and May 2010. We asked specific questions at the time of the hospital visit and examined patients using a nasal speculum, a flexible endoscope, and a rigid endoscope (0 or 70 degree) to identify bleeding sites. Hemostasis using electrocoagulation was selected as the first-line therapy for patients in whom a bleeding point had been identified, whereas hemostasis using a gauze tampon was performed in patients in whom the bleeding point was unknown. The subjects were analyzed by multivariate logistic regression analysis. RESULTS The bleeding point was unknown in most cases of recurrent posterior epistaxis. Electrocoagulation was the best hemostasis procedure. Identifying the bleeding points as much as possible and performing electrocoagulation at these sites was the preferred procedures. CONCLUSION We propose the treatment procedure for refractory epistaxis. When it is difficult to identify a bleeding point in a patient with refractory epistaxis due to a deviated nasal septum, a bleeding point should be identified after septoplasty; for bleeding from the sphenopalatine artery region, electrocoagulation or endoscopic cauterization of the sphenopalatine artery should be performed.

Features of sinonasal hemangioma: A retrospective study of 31 cases

OBJECTIVE Although hemangiomas are common lesions of the head and neck, sinonasal hemangiomas are rare. The purpose of this study was to analyze the clinical features (sex, age, symptoms, and size and anatomical location of the lesion) and the histological findings of sinonasal hemangioma cases, to assess preoperative transarterial embolization, and to evaluate the outcome (recurrence or no recurrence) of endoscopic sinus surgery. METHODS Clinical records of 31 patients who underwent endoscopic sinus surgery for resection of sinonasal hemangioma between January 2010 and June 2015 were retrospectively reviewed. RESULTS The study group consisted of 19 men and 12 women. Mean age was 53.3±15.9years. The principal symptom was epistaxis (81%). Mean tumor size was 12.6±8.2mm. The most common origin of hemangioma was the inferior turbinate (45%), followed by the nasal septum (39%), and, in both locations, the origin had a tendency to be located in the anterior portion. Thirty-one specimens were histologically categorized as 9 cavernous hemangiomas and 22 capillary hemangiomas. Preoperative transarterial embolization was performed in 2 cases. Only one recurrence was observed among 31 cases. In the recurrent case, the hemangioma of the nasal septum was resected during pregnancy. CONCLUSION According to our results, the transnasal endoscopic approach can be useful for the resection of sinonasal hemangioma. However, sinonasal hemangioma in connection with pregnancy must be addressed with care to decide the appropriate time for treatment.

Clinical Trend of Churg-Strauss Syndrome in Japan

Objective: There are a lot of reports that LTRA internal use, steroid medicine, and weight loss are associated with the onset of CSS. Because we experienced 2 cases of CSS that occurred during treatment of eosinophilic sinusitis this time, in addition, we consider some discussion from the literature. Method: We examined retrospectively 2 eosinophilic sinusitis patients, one with asthma and the other with allergic rhinitis. After these operations, we added wash-out sinuses and prescribed LTRA and nasal steroids. Depending on the state of intranasal findings, we gave steroid medicine. Results: We performed wash-out sinuses, LTRA internal use, and nasal steroids as postoperative treatment with both cases, and, at the exacerbation of intranasal findings, the intranasal findings improved by administration of steroid medicine. When we took steroid medicine, we did not do it with fixed quantity and the administration method that we did it and reduced. CSS was diagnosed by mononeuritis multipleand polyarthritis and purpuric onset subsequently. We suggested the possibility that LTRA internal use was associated with the onset of the CSS. Conclusion: LTRA internal use, steroid medicine, and weight loss may be associated with the onset of the CSS, and it is important to discontinue a causing agent when the otolaryngologist who frequently prescribes these drugs grasps overall status, and suspects CSS.