Epistaxis: aspectos nuevos a considerar / Epistaxis: new aspects to consider

La epistaxis es una de las urgencias otorrinolaringológicas más frecuentes, y se estima que un 6% requerirá algún tipo de intervención. Según la localización del sitio de sangrado puede clasificarse en anterior, posterior o superior. A lo largo de la historia su manejo ha seguido ciertos ejes que se mantienen vigentes, como son la compresión nasal, posicionamiento de la cabeza, taponamiento nasal, entre otros. Tras la implementación de la evaluación endoscópica sistemática del sitio de sangrado, estudios han descrito un nuevo punto de sangrado denominado S-point, que debiese ser especialmente considerado en epistaxis severa. Además, durante los últimos años la evidencia ha revelado ciertos aspectos especiales y relevantes en torno a la evaluación y/o manejo de pacientes con epistaxis y condiciones asociadas, como el uso de terapia antitrombótica, telangiectasia hemorrágica hereditaria o con hipertensión arterial. El objetivo de esta revisión es resumir aspectos novedosos en la evaluación, estudio y manejo de la epistaxis, donde se incluirán el uso de ácido tranexámico y de nuevos dispositivos intranasales.

Epistaxis is one of the most frequent otorhinolaryngological emergencies, and it is estimated that 6% require some type of intervention. Depending on the location of the bleeding site, it may be classified as anterior, posterior or superior. Throughout history, its treatment has remained the same, including nasal compression, head positioning, nasal packing, among others. After the implementation of the systematic endoscopic assessment of the bleeding site, studies have described a new point of bleeding called S-point, which should be especially considered in severe epistaxis. In addition, during the last years the evidence has revealed certain special and relevant aspects regarding the evaluation and/or management of patients with epistaxis and associated conditions, such as the use of antithrombotic therapy, hereditary hemorrhagic telangiectasia or arterial hypertension. The objective of this review is to summarize novel aspects in the evaluation, study and management of epistaxis, which include the use of tranexamic acid and new intranasal devices.

Cauterización transoral de la arteria maxilar interna en la fosa infratemporal: informe de un caso / Transoral cauterization of the internal maxillary artery in the infratemporal fossa: case report

Se describe el caso clínico de una paciente de 84 años que tuvo epistaxis recidivante por padecer enfermedad de Rendu-Osler-Weber. Tuvo antecedentes de diversos tratamientos quirúrgicos que incluyeron el cierre de la fosa nasal izquierda (operación de Young). Por la persistencia de epistaxis izquierda se indicó una angiografía y embolización. Esta última no se hizo porque se diagnosticaron anastomosis entre el sistema carotídeo externo y el interno. Se realizó un abordaje intraoral paramaxilar asistido con endoscopios para cauterizar la arteria maxilar interna en la fosa infratemporal y un abordaje externo para cauterizar la arteria etmoidal anterior solucionando la epistaxis. (AU)

The clinical case of an 84-year-old patient who had recurrent epistaxis due to Rendu-Osler- Weber disease is described. She had a history of various surgical treatments including closure of the left nostril (Young's operation).Due to the persistence of left epistaxis, angiography and embolization were indicated. The latter was not done because anastomosis between the external and internal carotid system was diagnosed. An intraoral paramaxillary approach assisted with endoscopes was performed to cauterize the internal maxillary artery in the infratemporal fossa and an external approach to cauterize the anterior ethmoidal artery solving the epistaxis. (AU)

Consenso de epistaxis en pediatría: causas, clínica y tratamiento / Consensus on pediatrics epistaxis: Causes, clinic and treatment

Se define la epistaxis como el sangrado proveniente del vestíbulo, la cavidad nasal o la nasofaringe. Representa el 3 % de las consultas de guardia. El 30 % de los niños menores de 5 años presentan, al menos, un episodio de epistaxis. La edad media de presentación es entre los 7,5 y los 8,5 años. Predomina en el sexo masculino (el 56-67 %). La rinorrea es el síntoma más frecuentemente asociado (el 46 %). El origen puede ser anterior o posterior, y las anteriores son las más frecuentes. Es necesario un enfoque integral para determinar la etiología (primaria o secundaria). Los principales objetivos del tratamiento son el control de la hemorragia, de la causa subyacente y la prevención de la recurrencia.La mayoría de las hemorragias son autolimitadas; sin embargo, el taponamiento nasal y la cauterización son requeridos ante casos recurrentes o graves. Cuando estas técnicas fracasan, puede utilizarse un manejo endoscópico, angiografía-embolización y ligadura quirúrgica abierta

Epistaxis is defined as bleeding from the vestibule, nasal cavity or nasopharynx. It represents 3 % of Emergency Room consultations. Thirty per cent of children under 5 years of age have an episode of epistaxis. The average age of presentation is between 7.5 and 8.5 years. It predominates in males (56-67 %). Nasal obstruction (nasal discharge) is the most associated symptom (46 %). The origin can be anterior or posterior, with the previous ones being the most frequent. An integral approach is necessary to determine the etiology (primary or secondary). The main purposes of the treatment are bleeding control and the underlying cause and the prevention of recurrence. Most hemorrhages are self-limiting; however, nasal tamponade and cauterization are required in cases of recurrence and/or severity. When these techniques fail, endoscopic management, angiography-embolization, and open surgical ligation may be used.

[Consensus on pediatrics epistaxis: Causes, clinic and treatment]. / Consenso de epistaxis en pediatría: causas, clínica y tratamiento.

Epistaxis is defined as bleeding from the vestibule, nasal cavity or nasopharynx. It represents 3 % of Emergency Room consultations. Thirty per cent of children under 5 years of age have an episode of epistaxis. The average age of presentation is between 7.5 and 8.5 years. It predominates in males (56-67 %). Nasal obstruction (nasal discharge) is the most associated symptom (46 %). The origin can be anterior or posterior, with the previous ones being the most frequent. An integral approach is necessary to determine the etiology (primary or secondary). The main purposes of the treatment are bleeding control and the underlying cause and the prevention of recurrence. Most hemorrhages are self-limiting; however, nasal tamponade and cauterization are required in cases of recurrence and/or severity. When these techniques fail, endoscopic management, angiography-embolization, and open surgical ligation may be used.

Se define la epistaxis como el sangrado proveniente del vestíbulo, la cavidad nasal o la nasofaringe. Representa el 3 % de las consultas de guardia. El 30 % de los niños menores de 5 años presentan, al menos, un episodio de epistaxis. La edad media de presentación es entre los 7,5 y los 8,5 años. Predomina en el sexo masculino (el 56-67 %). La rinorrea es el síntoma más frecuentemente asociado (el 46 %). El origen puede ser anterior o posterior, y las anteriores son las más frecuentes. Es necesario un enfoque integral para determinar la etiología (primaria o secundaria). Los principales objetivos del tratamiento son el control de la hemorragia, de la causa subyacente y la prevención de la recurrencia. La mayoría de las hemorragias son autolimitadas; sin embargo, el taponamiento nasal y la cauterización son requeridos ante casos recurrentes o graves. Cuando estas técnicas fracasan, puede utilizarse un manejo endoscópico, angiografía-embolización y ligadura quirúrgica abierta.

Systematic endoscopic assessment of bleeding sites in severe epistaxis: the role of the S-point and the superior epistaxis.

BACKGROUND: Systematic endoscopic assessment (SEA) of bleeding sites is critical for topodiagnosis and treatment of severe epistaxis, which is not limited to the posterior region. A bleeding site originating from the ethmoidal vasculature, the S-point, has recently been described. The aim of this study is to ascertain the prevalence of each bleeding site in severe epistaxis using a SEA protocol that includes the S-point. METHODOLOGY: Prospective longitudinal study of 51 severe epistaxis patients who underwent 53 SEA under general anesthesia from April 2018 through March 2019. SEA consisted of use of a rigid nasal endoscope; no reduction in blood pressure; no use of topical vasoconstrictor; systematic search of all regions of the nose. Bleeding sites were assigned to either superior or posterior epistaxis. RESULTS: At least one bleeding site was identified in 37 evaluations (69.8%). The S-point was the most common bleeding site (28.3%), followed by the lateral middle turbinate (9.4%), non-S-point upper septum (7.5%), nasal roof (7.5%), and upper lateral wall (7.5%). Superior epistaxis was identified in the most of cases (27 SEA, 50.9%), whereas only 14 SEA (26.4%) identified posterior epistaxis â€" fewer than the 16 SEA that did not identify any bleeding sites (30.2%). There were two recurrences (3.8%). CONCLUSIONS: Systematic endoscopic assessment effectively identified bleeding sites in 69.8% of severe epistaxis. The S-point was the most common bleeding site identified (28.3%). Finally, superior epistaxis corresponded to more than half of the identified bleeding sites, demonstrating the importance of examining this region judiciously in patients with severe epistaxis.

Arterial Embolization in the Treatment of Severe Epistaxis: A Case Report / Embolización Arterial en el Tratamiento de la Epistaxis Severa: Reporte de un Caso

ABSTRACT: Nasal hemorrhage or epistaxis is a common finding in the emergency department. The causes of epistaxis are varied and can be classified as local, systemic or a combination of both. The aim of this study was to report a case of embolization of branches of the maxillary artery for treatment of epistaxis secondary to facial trauma. A 43-year-old man suffered blunt trauma in the frontonasal area as a result of a bicycle accident. It presented with amnesia, severe epistaxis, panfacial edema and nasal deformity. The patient was hypotensive and hypothermic, with evidence of hemorrhagic intracranial. Orotracheal intubation was performed immediately to protect the airways and prevent aspiration of blood to the lower respiratory tract. The occlusion of the artery was successful and was immediately followed by cessation of oronasal bleeding. The patient was discharged after ten days. Arterial embolization should be the gold-standard treatment, which provides a safe and effective alternative for the control of epistaxis.

RESUMEN: La hemorragia nasal o epistaxis es un hallazgo común en el servicio de urgencias. Las causas de la epistaxis son variadas y pueden clasificarse como locales, sistémicas o una combinación. El objetivo de este estudio fuerelatar un caso de embolización de ramas de la arteria maxilar para el tratamiento de epistaxis secundaria a trauma facial. Um hombre de 43 años de edad sufrió traumatismo contuso en la zona frontonasal como consecuencia de un accidente de bicicleta. Se presentaba con amnesia, epistaxis grave, edema panfacial y deformidad nasal. El paciente fue hipotenso y hipotermático, con evidencia de hemorragia intracraneal. La intubación orotraqueal fue realizada inmediatamente para proteger las vías aéreas y evitar la aspiración de sangre para el tracto respiratorio inferior. La oclusión de la arteria fue exitosa y fue seguida inmediatamente por cesación de sangramiento oronasal. El paciente fue dado de alta después de diez días. La embolización arterial debe ser el tratamiento de elección, que proporciona una alternativa segura y eficaz para el control de la epistaxis.

Breaking paradigms in severe epistaxis: the importance of looking for the S-point / Quebrando paradigmas na epistaxe grave: a importância de procurar o S-point

Abstract Introduction: Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. Objective: The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. Methods: A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. Results: Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10 g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. Conclusion: The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis.

Resumo Introdução: Desde a introdução da endoscopia nasal no campo de otorrinolaringologia, o paradigma de tratamento para casos graves de epistaxe voltou-se para a identificação precoce e correta do local de sangramento. Embora a epistaxe grave seja geralmente considerada uma hemorragia posterior, um pedículo vascular arterial tem sido frequentemente observado na porção superior do septo nasal, ao redor da projeção da axila da concha média, posterior ao tubérculo septal. Esse pedículo vascular foi chamado de Stamm's S-point. Objetivo: Descrever o S-point e relatar casos graves de epistaxe que se originam nesse local. Método: Um estudo retrospectivo de série de casos foi conduzido. Nove pacientes com epistaxe grave espontânea, na qual o S-point foi identificado como a fonte do sangramento, foram tratados de março de 2016 a março de 2017. Resultados: Houve predominância do sexo masculino (77,8%) com média de 59,3 anos. A maioria dos casos apresentava comorbidades (88,9%), mas sem uso de ácido acetilsalicílico (66,7%). Observou-se predominância do lado esquerdo (55,6%) com sangramento anteroposterior como a principal apresentação inicial (77,8%). Seis pacientes (66,7%) apresentaram níveis de hemoglobina inferiores a 10 g/dL e quatro (44,4%) necessitaram de transfusão sanguínea. Cauterização do S-point foi feita em todos os pacientes, com resolução completa do sangramento. Nenhum paciente apresentou recorrência de epistaxe grave. Conclusão: O Stamm's S-point é relatado como uma nova região de origem de epistaxe grave espontânea e o tratamento feito com cauterização foi eficaz e seguro. Os otorrinolaringologistas devem buscar ativamente esse local de sangramento em casos de epistaxe grave.

Breaking paradigms in severe epistaxis: the importance of looking for the S-point.

INTRODUCTION: Since the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the axilla projection of the middle turbinate, posterior to the septal body, frequently has been observed. That vascular pedicle was named the Stamm's S-point. OBJECTIVE: The aim of this study was to describe the S-point and report cases of severe epistaxis originating from it. METHODS: A retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017. RESULTS: Male predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) and anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis. CONCLUSION: The Stamm's S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis.

Tratamiento endovascular para epistaxis posterior / Endovascular treatment for posterior epistaxis / Tratamento endovascular para epistaxe posterior

INTRODUCCIÓN: Las complicaciones del tratamiento endovascular son infrecuentes. Las lesiones isquémicas a los tejidos de la cabeza y el cuello se han reportado de forma esporádica, siendo complicaciones raras gracias al aporte redundante de la amplia red anastomótica en esta región. OBJETIVOS: Realizar una análisis estadístico de los pacientes que se sometieron a tratamiento endovascular por epistaxis, identificando las complicaciones, y realizar una revisión comparada con la literatura disponible evaluando la efectividad del tratamiento...

INTRODUCTION: Complications of endovascular treatment are infrequent. Ischemic injuries to the tissues of the head and neck have been reported sporadically, being rare complications thanks to the redundant contribution of the extensive anastomotic network in this region. OBJECTIVES: Perform a statistical analysis of patients who underwent endovascular treatment for epistaxis, identifying complications and conducting a review compared to the available literature evaluating the effectiveness of the treatment...

INTRODUÇÃO: Complicações do tratamento endovascular são infrequentes. Lesões isquêmicas nos tecidos da cabeça e pescoço têm sido relatadas esporadicamente, sendo complicações raras graças à contribuição redundante da extensa rede anastomótica nessa região. OBJETIVOS: Realizar uma análise estatística dos pacientes que foram submetidos a tratamento endovascular para epistaxe, identificando complicações e realizando uma revisão em comparação com a literatura disponível que avalia a eficácia do tratamento...

Manejo de epistaxis posterior en el Hospital Clínico de la Universidad de Chile entre los años 2013 y 2016 / Treatment of posterior epistaxis in the Clinical Hospital of the University of Chile between the years 2013 and 2016

Introducción: La epistaxis corresponde a una de las causas más frecuentes de consulta otorrinolaringológica en los servicios de urgencia. La epistaxis posterior es menos frecuente pero su presentación más severa. Existen varias alternativas terapéuticas, en las últimas décadas el manejo quirúrgico endoscópico de la arteria esfenopalatina (AEP) ha ido en aumento dado las ventajas en comodidad para el paciente y reducción de costos asociados. Objetivo: Revisar el manejo realizado en los cuadros de epistaxis posterior en el Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio descriptivo en el Servicio de Otorrinolaringología del HCUCh de pacientes que presentaron epistaxis posterior entre el año 2013 y 2016. Resultados: Se revisó un total de 33 casos. La edad promedio de los pacientes fue 61,6 años siendo las comorbilidades más frecuentes la hipertensión arterial (36,3%) y fibrilación auricular (18,1%). Se realizó tratamiento quirúrgico en 57,6% de los pacientes siendo el clipaje de AEP la intervención quirúrgica más frecuente. Discusión y conclusiones: Tanto el manejo tradicional como las técnicas quirúrgicas presentaron eficacia similar en la serie revisada.

Introduction: Epistaxis corresponds to one of the most frequent causes of otorhinolaryngological consultation in the emergency services. Posterior epistaxis is less frequent but more severe. There are several therapeutic alternatives, in recent decades the surgical endoscopic management of the sphenopalatine artery (AEP) has been increasing given the advantages in comfort for the patient and reduction of associated costs. Aim: To review the management of posterior epistaxis in the Clinical Hospital of the University of Chile (HCUCh). Material and method: Descriptive study in the Otorhinolaryngology Service of the HCUCh of patients who presented posterior epistaxis between the years 2013 and 2016. Results: A total of 33 cases were reviewed. The mean age of the patients was 61.6 years, with the most frequent comorbidities being hypertension (36.3%) and atrial fibrillation (18.1%). Surgical treatment was performed in 57.6% of the patients, with AEP clipping being the most frequent surgical intervention. Conclusion: Both traditional management and surgical techniques presented similar efficacy in the revised series.

Pseudotumor inflamatorio nasosinusal: reporte de un caso / Inflammatory pseudotumor sinonasal: a case report / Pseu-dotumor inflamatório nasossinusal: relatório de um caso

El pseudotumor inflamatorio (PTI) es una entidad no neoplásica, de etiología desconocida, caracterizada por la proliferación de un infiltrado inflamatorio policlonal sobre un estroma de tejido conjuntivo. Pueden ser definidos como lesiones que clínica y radiológicamente simulan neoplasias. El pseudotumor inflamatorio puede causar dolor facial, obstrucción nasal, exoftalmos y discapacidad visual y con frecuencia causa la erosión y destrucción ósea. Los corticoesteroides, la radioterapia y la cirugía se han utilizado como modalidades de tratamiento, solos o en combinación.

The inflammatory pseudotumour (IPT) is a nonneoplastic entity of unknown origin, and is characterised by a proliferation of connective tissue and a polyclonal inflammatory infiltrate. May be defined as lesions that clinically and radiologically simulate neoplasms. Inflammatory pseudotumour sometimes causes facial pain, nasal obstruction, exophthalmos and visual impairment, and often causes bone erosion and destruction. Corticosteroids, radiotherapy and surgery have been used as treatment modalities either on their own or in combination.

O pseudo-tumor inflamatório (PTI) é uma entidade não neoplásica de etiologia desconhecida, caracterizada pela proliferação de um infiltrado inflamatório policlonal em um estroma do tecido conjuntivo. Podem ser definidos como lesões que simulam neoplasias clínica e radiologicamente. O pseudo-tumor Inflamatório pode causar dor facial, obstrução nasal, exoftalmia (olhos saltados), deficiência visual e freqüentemente provoca o desgaste e a destruição óssea. Os cortiçoesteroides, a radioterapia e a cirurgia têm sido usadas como modalidades de tratamento, por si só ou em combinação.

Tratamiento quirúrgico de la epistaxis en la enfermedad de Rendu Osler Weber / Epistaxis surgical treatment in Rendu Osler Weber disease / Tratamento cirúrgico da epistaxe na doença de Rendu Osler Weber

Introducción: la telangiectasia hemorrágica hereditaria (THH) o Rendu Osler Weber es una enfermedad genética que produce falta de soporte elástico en el endotelio vascular, lo cual genera sangrado ante el mínimo trauma producido. Aunque la morbilidad y mortalidad en esta patología resultan de las malformaciones vasculares presentes en pulmón, hígado y cerebro, la calidad de vida se altera significativamente debido a los episodios recurrentes de epistaxis. Objetivos: El objetivo del presente trabajo es determinar el porcentaje de pacientes con diagnóstico de THH que requirieron uno o más tratamientos quirúrgicos para el sangrado nasal y realizar una revisión bibliográfica de las técnicas quirúrgicas utilizadas...

Introduction: HHT is a genetic disease that causes lack of elastic support in the vascular endothelium, which causes bleeding at the slightest trauma occurred. The quality of life is significantly altered due to recurrent episodes of epistaxis. The aim of this study is to determine the percentage of patients diagnosed with HHT, requiring one or more surgical procedures for treatment of epistaxis, and perform a literature review of surgical techniques used. Methods: The medical records of patients with Osler Rendu disease requiring surgical treatment for epistaxis, who consulted the service of Otolaryngology of the Hospital Italiano de Buenos Aires were analyzed...

Introdução: o THH é uma doença genética que provoca falta de suporte elástico no endotélio vascular, que provoca o sangramento ao menor trauma ocorreu. A qualidade de vida é significativamente alterada devido a episódios recorrentes de epistaxe. O objetivo deste estudo é determinar a porcentagem de pacientes diagnosticados com HHT, exigindo um ou mais procedimentos cirúrgicos para o tratamento de epistaxe, e realizar uma revisão da literatura sobre técnicas cirúrgicas utilizadas...

Evolución en la técnica quirúrgica endoscópica para la cirugía del fibroangioma. Nuestra experiencia / Evolution in endoscopic surgical technique for fibroangioma surgery. Our experience / Evolução em cirurgia endoscópica cirurgia técnica fibroangioma. A nossa experiência

El fibroangioma nasofaríngeo juvenil es una neoplasia vascular benigna poco frecuente, que afecta exclusivamente al sexo masculino. Para su tratamiento la cirugía es la alternativa más aceptada. Existen diversas técnicas quirúrgicas para su resolución. En la actualidad la cirugía endoscópica permite resolver prácticamente todos los estadios del fibroangioma. En 5 años nuestro servicio realizó 53 cirugías de fibroangioma, siendo progresiva la incorporación del endoscopio, que primeramente se utilizó para las recidivas, y paulatinamente se logró realizar abordajes completos con esta técnica. Es importante tener en cuenta que la curva de aprendizaje es fundamental para lograr dichos avances quirúrgicos.

The juvenile nasopharyngeal fibroangioma is arare benign vascular tumor that affects only males.Treatment for surgery is the most accepted alternative.There are several surgical techniques for resolution.Currently endoscopic surgery can solve allstages of the nasopharyngeal fibroangioma. In 5 years our service performed 53 surgeries ofnasopharyngeal fibroangioma, being progressivethe incorporation of the endoscope, which wasfirst used for recurrence, and gradually managed tomake complete approaches to this technique.It is important to note that the learning curve is criticalto obtaining these surgical advances.

O fibroangioma nasofaríngeo juvenil é um tumor vascular benigno raro que afeta apenas os machos.O tratamento para a cirurgia é a alternativa mais amplamente aceito. Existem várias técnicas cirúrgicas para resolução. Atualmente a cirurgia endoscópica pode resolver praticamente todos os estágios de fibroangioma.Em5anosonosso fibroangiomaserviçorealizado53 cirurgias, sendo incorporação progressiva do endoscópio, que é usado pela primeira vez para a recaídas e, gradualmente, conseguiu fazer abordagens abrangentes para esta técnica. É importante notar que a curva de aprendizagem é fundamental para alcançar esses avanços cirúrgicos.

¿Lo sabes todo sobre epistaxis? / Do you know all about epistaxis?

La epistaxis es un síntoma muy común es muestra práctica diaria, aproximadamente el 60% de la población ha tenido al menos un episodio en algún momento de su vida pero solo 6% precisó atención médica. La mayoría de episodios son limitados y benignos pero, en ocasiones, nos encontramos con casos que pueden resultar fatales.

Nosebleed is a really common symptom, about 60% of the population has had at least one episode at some point in their lives but only 6% required medical attention. Most episodes are limited and benign but in some rare cases, it could be deathly.

Is the occurrence of spontaneous epistaxis related to climatic variables? A retrospective clinical, epidemiological and meteorological study.

CONCLUSION: Epistaxis has a bimodal age distribution. Anterior epistaxis of mild severity is more common in children; severe epistaxis occurs more often in adults and elderly patients. The occurrence of spontaneous epistaxis was shown to be weakly-to-moderately and inversely correlated to the mean monthly temperature, relative humidity and total rainfall. OBJECTIVES: To describe the clinical and epidemiological profiles of patients diagnosed with spontaneous epistaxis; to correlate its monthly occurrence with meteorological variables. METHODS: A retrospective cross-sectional study was performed in a referral ENT service in São Paulo, Brazil. The study assessed the clinical and epidemiological features of 508 patients with spontaneous epistaxis treated between February 2010 and January 2011. The occurrence of epistaxis was associated with weather variables for the same study period. RESULTS: Spontaneous epistaxis presented two age peaks of higher incidence (11-20 and 51-70 years). Children more frequently had localized bleeding (p = 0.003), in the anterior region of the nasal cavity (p = 0.0001), of absent-mild severity (p = 0.0082). Diffuse bleeding (p = 0.005), of moderate-severe intensity (p = 0.003), was more common in adults and elderly patients. The total number of visits because of epistaxis was inversely correlated to mean temperature (R = -0.489; p = 0.011), mean relative humidity (R = -0.364; p = 0.038), and total rainfall (R = -0.512; p = 0.009) during each month of the analyzed period.