Severe spontaneous epistaxis: retrospective study in a tertiary ENT centre.

PURPOSE: To investigate the clinical profile and outcomes of different treatment strategies in patients hospitalized for spontaneous severe epistaxis. METHODS: This is a retrospective descriptive study of a case series of patients hospitalized for epistaxis in the University Hospital of Ghent between 2005 and 2012. RESULTS: 124 patients with, respectively, 132 episodes were included. 64% were male. The mean age was 65 years. 73% had comorbidities of which arterial hypertension was the most common. 61% were taking one or more antithrombotics and in 25.7% a recent change in the medication schedule took place. 47% of the episodes necessitated a vascular intervention. The most performed surgery was endoscopic sphenopalatine artery ligation. The 1-year success rate of conservative treatment was 47% and of vascular intervention 81%. No significant difference between the recurrence rates and need for vascular intervention of the different comorbidities and medications was detected using Pearson chi-squared and Fisher's exact testing. The overall 5-year survival rate was 83.6%. CONCLUSIONS: The typical pattern of a patient presenting with severe epistaxis was a patient in the sixth decade, male, suffering from comorbidities and taking one or more antithrombotic agents. Based on the above-mentioned success rates of the different treatment options, we think all centres treating epistaxis should apply a well-defined protocol to guide the decision when to proceed with surgery. Furthermore, prospective research needs to precisely investigate the role played by comorbidities and their treatment in the occurrence of epistaxis and to test the effectiveness of proposed algorithms.

Idiopathic spontaneous sublingual hematoma: a case report and literature review.

PURPOSE: Sublingual hematoma is a rare complication seen in bleeding disorders, trauma, dental procedures, and the use of anticoagulants. Only a few publications have described idiopathic spontaneous sublingual hematoma, and all of them suspected severe hypertension as etiology. Our objective is to present a case of idiopathic spontaneous sublingual hematoma in a 48-year-old patient without any medical history of hypertension and to perform a literature review on this subject. METHODS: Case report presentation based on information extracted from the electronic patient database of Ghent University Hospital including a literature review of sublingual hematoma. RESULTS: This case report describes a 48-year-old male patient presenting with a spontaneous sublingual hematoma, which needed to be treated with an urgent tracheotomy. Drainage of the old hematoma followed 11 days later. He was not known with hypertension or any bleeding disorder. Clinical examination using fiberoptic nasolaryngoscopy, a CT scan, MRI scan, and biopsy of the sublingual salivary gland showed no focus for etiology. CONCLUSIONS: Clinical work-up is necessary to look for a cause of a spontaneous sublingual hematoma. Idiopathic spontaneous hematoma is only a rare entity. Aggressive airway management should be the first step in treatment. To date, there is no consensus about the management regarding the hematoma itself. Mostly, clinicians start with observation for spontaneous resolution of the hematoma and when possible to treat causative factors. Surgical drainage is performed when conservative treatment is not sufficient.