Sinonasal adenocarcinomas: Retrospective analysis from an oncology center.

INTRODUCTION AND OBJECTIVES: Sinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution. MATERIAL AND METHODS: Retrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019). RESULTS: Sixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5±14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p<0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p=0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years. CONCLUSIONS: Despite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors.

Sinonasal adenocarcinomas: Retrospective analysis from an oncology center

Introduction and objectives: Sinonasal adenocarcinomas are rare and heterogeneous tumors and for this reason remain understudied. Our purpose is to analyze clinical presentation, outcomes and factors affecting survival of patients with sinonasal adenocarcinomas, treated at our institution.Material and methodsRetrospective review of clinical records of patients with sinonasal adenocarcinoma, treated at a tertiary oncology institution (January 2010 to December 2019).ResultsSixty patients diagnosed with adenocarcinoma were included, with male preponderance (54.90%) and a mean age of 57.5±14.9 years. Adenocarcinoma was the most frequent type of sinonasal cancer, contrary to previous reports from our institution. In most patients, it was detected at an advanced disease stage, significantly decreasing their survival rate when compared to patients diagnosed at initial stages (p<0.029). Intestinal type adenocarcinoma was established in 47 patients, the most frequent being the colonic subtype (24%). Tumors with good/moderate histologic differentiation presented a survival advantage over those that were poorly differentiated (p=0.043). The most common treatment modality was surgery followed by radiotherapy. Endoscopic resection was performed in 53% of the patients and an external approach was used in 40% of the patients. Estimated overall survival rates at 3 and 5-years were 64% and 53%, respectively, and cancer specific survival 72% and 65%, for the same period. Recurrence rate was 32% and occurred mainly locally. Disease Free Survival rate was 71% at 3 years and 65% at 5 years.ConclusionsDespite being the most common sinonasal malignancy in our sample, in contrast to other series, sinonasal adenocarcinomas are still rare tumors with a substantial local failure rate of around 30%. Advanced stage at diagnosis and histologic differentiation grade negatively affected prognosis of these tumors. (AU)

Introducción y objetivos: Los adenocarcinomas sinonasales son tumores raros y heterogéneos y, por esta razón, son poco estudiados. Nuestro objetivo es analizar la presentación clínica, los resultados y los factores que afectan la supervivencia de los pacientes con adenocarcinoma sinonasal tratados en nuestra institución.Material y métodosRevisión retrospectiva de las historias clínicas de los pacientes con adenocarcinoma sinonasal tratados en una institución oncológica terciaria (enero de 2010 a diciembre de 2019).ResultadosSe incluyeron 60 pacientes diagnosticados de adenocarcinoma, con predominio masculino (54,90%) y una edad media de 57,5±14,9años. El adenocarcinoma fue el tipo de tumor sinonasal más frecuente, a diferencia de los informes previos de nuestra institución. En la mayoría de los pacientes se ha diagnosticado en un estadio avanzado de la enfermedad, lo que disminuyó significativamente su tasa de supervivencia en comparación con los pacientes diagnosticados en estadios iniciales (p<0,029). El adenocarcinoma de tipo intestinal se estableció en 47 pacientes, siendo el subtipo colónico el más frecuente (24%). Los tumores con diferenciación histológica buena/moderada presentaron más probabilidad de supervivencia sobre los mal diferenciados (p=0,043). La modalidad de tratamiento más frecuente fue la cirugía, seguida de la radioterapia. La resección endoscópica se realizó en el 53% de los pacientes y el abordaje externo se llevó a cabo en el 40%. Las tasas de supervivencia global estimadas a los 3 y a los 5 años fueron del 64% y del 53%, respectivamente, y la supervivencia específica del cáncer, del 72% y del 65%, para el mismo periodo. La tasa de recurrencia fue del 32% y ha ocurrido principalmente a nivel local. La tasa de supervivencia libre de enfermedad fue del 71% a los 3años y del 65% a los 5 años. (AU)

Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique.

INTRODUCTION AND OBJECTIVES: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success. MATERIAL AND METHODS: Retrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure. RESULTS: Most patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding. CONCLUSIONS: In our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients.

Predictive factors for repeated tympanostomy tube placement in children.

OBJECTIVES: To determine the rate and risk factors for additional tympanostomy tube (TT) placement after first set of TT extrusion in children. MATERIALS AND METHODS: Single-centre cohort study. Clinical records of children undergoing TT placement from January 2015 to December 2017 were reviewed and factors related to the need for subsequent TT were evaluated. RESULTS: A total of 183 children were included, with a mean age of 5.45±2.672 years old. All surgeries were performed simultaneously with adenoidectomy and 64.3% with tonsillectomy. The mean TT retention time was 12.13±6.033 months and the rate of second TT insertion was 21.9%. The TT retention time was significantly lower in children who needed a second TT (8.97±3.962 vs 13.05±6.229, p<.001). Other factors significantly associated with the need for a second TT in the univariate analysis were the presence of otorrhoea and snoring after TT placement (p=.042 and p=.02), RAOM (p=.016), passive smoking (p=.038) and rhinorrhoea (p=.008). However, on multivariate analysis only TT retention time (OR=.831, 95% CI: .727-.950) and RAOM as an indication for surgery (OR: 5.767; 95% CI: 1.696-19.603) were predictors of a second TT. Gender, age, asthma, prematurity, and low birth weight were not significantly associated with a second TT. CONCLUSIONS: RAOM and a short TT retention time were significantly associated with additional TT placement, enhancing the need for and importance of follow up of these children after TT extrusion.

Predictive factors for repeated tympanostomy tube placement in children

Objectives: To determine the rate and risk factors for additional tympanostomy tube (TT) placement after first set of TT extrusion in children.Materials and methodsSingle-centre cohort study. Clinical records of children undergoing TT placement from January 2015 to December 2017 were reviewed and factors related to the need for subsequent TT were evaluated.ResultsA total of 183 children were included, with a mean age of 5.45±2.672 years old. All surgeries were performed simultaneously with adenoidectomy and 64.3% with tonsillectomy. The mean TT retention time was 12.13±6.033 months and the rate of second TT insertion was 21.9%. The TT retention time was significantly lower in children who needed a second TT (8.97±3.962 vs 13.05±6.229, p<.001). Other factors significantly associated with the need for a second TT in the univariate analysis were the presence of otorrhoea and snoring after TT placement (p=.042 and p=.02), RAOM (p=.016), passive smoking (p=.038) and rhinorrhoea (p=.008). However, on multivariate analysis only TT retention time (OR=.831, 95% CI: .727–.950) and RAOM as an indication for surgery (OR: 5.767; 95% CI: 1.696–19.603) were predictors of a second TT. Gender, age, asthma, prematurity, and low birth weight were not significantly associated with a second TT.ConclusionsRAOM and a short TT retention time were significantly associated with additional TT placement, enhancing the need for and importance of follow up of these children after TT extrusion. (AU)

Objetivos: Determinar la tasa y los factores de riesgo para la colocación de tubos de timpanostomía (TT) adicional después de la extrusión de los primeros TT en niños.Materiales y métodosEstudio retrospectivo de los registros médicos de los niños sometidos a la colocación de TT desde enero del 2015 hasta diciembre del 2017; se evaluaron los factores relacionados con la necesidad de TT posterior.ResultadosSe incluyó a 183 niños, con una edad media de 5,45±2,672 años. Todas las cirugías se realizaron simultáneamente con adenoidectomía y el 64,3% con amigdalectomía. El tiempo medio de retención del TT fue de 12,13±6,033 meses y la tasa de segunda inserción del TT fue del 21,9%. El tiempo de retención del TT fue significativamente menor en los niños que necesitaron un segundo TT (8,97±3,962 vs. 13,05±6,229, p<0,001). Otros factores asociados significativamente a la necesidad de un segundo TT en el análisis univariable fueron la presencia de otorrea y ronquidos tras la colocación del TT (p=0,042 y p=0,02, respectivamente), la otitis media aguda de repetición (OMAr) (p=0,016), el tabaquismo pasivo (p=0,038) y la rinorrea (p=0,008). Sin embargo, en el análisis multivariado solo el tiempo de retención del TT (OR=0,831, IC del 95%: 0,727-0,950) y la OMAr como indicación de cirugía (OR: 5,767; IC del 95%: 1,696-19,603) fueron predictores de un segundo TT. El sexo, la edad, el asma, la prematuridad y el bajo peso al nacer no se asociaron significativamente con un segundo TT.ConclusionesLa OMAr y un corto tiempo de retención del TT se asociaron significativamente con la colocación de un segundo TT, lo que refuerza la necesidad e importancia del seguimiento de estos niños tras la extrusión del TT. (AU)

Pharyngoplasty for obstructive sleep apnea: The influence of surgical technique

Introduction and objectives: Obstructive sleep apnea is the most frequent sleep disorder worldwide, with rising incidence. Pharyngoplasty is an alternative treatment in patients not suitable to continuous positive airway pressure devices (CPAP). The aim of this study is to compare different surgical techniques of pharyngoplasty for treatment of obstructive sleep apnea and evaluate its influence in surgical success.Material and methodsRetrospective study of 92 patients that underwent pharyngoplasty for treatment of obstructive sleep apnea from 2001 to 2020. Included patients performed classic uvulopalatopharyngoplasty (UPPP), radiofrequency assisted uvulopalatopharyngoplasty (RF-UPPP) or barbed reposition pharyngoplasty (BRP). Surgical success was defined and outcomes and complications assessed for each procedure.ResultsMost patients were male, with a mean age of 49.36±9.6 years and a mean apnea hypopnea index (AHI) of 29.14±2.94events/h. Thirty-six patients performed classic UPPP, thirty-one underwent RF-UPPP and the remaining twenty-five performed BRP. BRP achieved the highest success rate (66%) in comparison with UPPP (57%) and RF-UPPP (54%) (p=0.032). Mean relative AHI reduction after surgery was not statistically different between three procedures (p=0.098), although there was a tendency for greater reduction with BRP. Most symptoms improved after surgery and snoring was the most recurrent symptom. BRP had less foreign body sensation after surgery, however, it was the procedure with highest rate of post-operative tonsillar bleeding.ConclusionsIn our department, the introduction of recent techniques of velopharyngeal surgery, focused in functional and lateral muscular collapse, has translated into an increase in success rate after surgery. The relative ease of the procedure and reduction of long term complications make BRP an attractive alternative option for CPAP in OSA, in carefully selected patients. (AU)

Introducción y objetivos: La apnea obstructiva del sueño es el trastorno del sueño más frecuente en todo el mundo, con una incidencia creciente. La faringoplastia es una alternativa de tratamiento en pacientes no aptos para dispositivos de presión positiva continua en la vía aérea (CPAP). El objetivo de este estudio es comparar diferentes técnicas quirúrgicas de faringoplastia para el tratamiento de la apnea obstructiva del sueño y evaluar su influencia en el éxito quirúrgico.Material y métodosEstudio retrospectivo de 92 pacientes que fueron sometidos a faringoplastia para el tratamiento de la apnea obstructiva del sueño desde 2001 hasta 2020. Los pacientes incluidos se sometieron a uvulopalatoplastia clásica (UPPP), uvulopalatoplastia asistida por radiofrecuencia (RF-UPPP) o faringoplastia de reposición con sutura barbada (BRP). Se definió el éxito quirúrgico y se evaluaron los resultados y las complicaciones de cada procedimiento.ResultadosLa mayoría de los pacientes fueron varones, con una edad media de 49,36±9,6 años y un índice de apnea-hipopnea (IAH) medio de 29,14±2,94 eventos/hora. Treinta y seis pacientes realizaron UPPP clásica, 31 se sometieron a RF-UPPP y los 25 restantes realizaron BRP. La BRP obtuvo la mayor tasa de éxito (66%) en comparación con la UPPP (57%) y la RF-UPPP (54%) (p=0,032). La reducción relativa media del IAH tras la cirugía no fue estadísticamente diferente entre los 3 procedimientos (p=0,098), aunque hubo una tendencia a una mayor reducción con la BRP. La mayoría de los síntomas mejoraron tras la cirugía y el ronquido fue el síntoma más recurrente. La BRP tuvo menos sensación de cuerpo extraño después de la cirugía, sin embargo, fue el procedimiento con mayor tasa de hemorragia postoperatoria. (AU)

Actinomycosis of the Nasal Septum: A Rare Entity.

Actinomycosis is a rare bacterial infection that can affect almost any site in the body. Its occurrence at the nasal septum is extremely rare. We present the case of an 84-year-old diabetic woman, with a past medical history of breast cancer that came to medical attention because of progressive nasal obstruction and severe sleep apnea. Nasal endoscopy revealed a submucosal mass at the anterior nasal septum obstructing both nasal cavities and extending to the anterior hard palate. With a cancer metastasis in mind, she was submitted to surgical resection of the lesion through a Rouge-Denker approach, with the final histologic diagnosis of actinomycosis. She was then treated with a three-month cycle of amoxicillin and remains without recurrence. This case describes a rare disease that should be considered in the differential diagnosis of sinonasal lesions, especially in diabetic patients and after dental procedures.

Role of age and anticoagulants in recurrent idiopathic epistaxis / El papel de la edad y los anticoagulantes en la epistaxis idiopática recurrente

OBJECTIVE: Epistaxis is one of the commonest causes of attendance of Otolaryngology emergency rooms. Given its incidence, potential severity and high recurrence rate, a systematic and careful management is mandatory. This work aims to define prognostic factors of epistaxis recurrence. MATERIAL AND METHODS: Retrospective review of medical records of patients with epistaxis admitted to our emergency department from January 2012 to December 2016. Data of 1005 patients with idiopathic epistaxis were analysed and independent risk factors for recurrence were determined by multiple logistic regression analysis. RESULTS: Recurrence of epistaxis was found in 303 (30.1%) patients. Patients with recurrent epistaxis were older (p < .001) and more commonly had a history of hypertension (p = .001) and antiplatelet (p = .048) and anticoagulant (p = .001) use than those with episodic epistaxis. Age (adjusted OR 1.21, 95%CI 1.08-1.32, p = .003) and anticoagulant use (adjusted OR 2.68, 95%CI 1.94-3.70, p = .009) were predictors of increased risk of recurrent epistaxis. Gender, alcohol abuse, medical history, active bleeding at admission, unidentified bleeding point or treatment modalities were not associated with recurrence. CONCLUSION: Age and use of anticoagulation drugs were risk factors for recurrence of epistaxis. None of the previously described risk factors for episodic epistaxis were found to increase the risk of recurrence. Knowledge of factors involved in recurrence might provide important information for assessment and management of increased risk patients

OBJETIVO: La epistaxis es una causa frecuente de asistencia a los servicios de urgencias de otorrinolaringología. Dada su incidencia, posible gravedad y alta tasa de recurrencia, es obligatorio un manejo sistemático y cuidadoso. Este trabajo tiene como objetivo definir los factores pronósticos de recurrencia de la epistaxis. MATERIAL Y MÉTODOS: Revisión retrospectiva de los registros médicos de pacientes con epistaxis admitidos en nuestro servicio de urgencias desde enero de 2012 a diciembre de 2016. Se analizaron los datos de 1.005 pacientes con epistaxis idiopática, y se determinaron los factores de riesgo independientes de recurrencia mediante análisis de regresión logística múltiple. RESULTADOS: La recurrencia de la epistaxis se encontró en 303 (30,1%) pacientes. Los pacientes con epistaxis recurrente eran mayores (p < 0,001), tenían con más frecuencia antecedentes de hipertensión (p = 0,001) y de tratamiento con antiplaquetarios (p = 0,048) y anticoagulantes (p = 0,001) que aquellos con epistaxis episódica. La edad (OR ajustada: 1,21; IC 95%: 1,08-1,32; p = 0,003) y el uso de anticoagulantes (OR ajustada: 2,68; IC 95%: 1,94-3,7; p = 0,009) fueron factores predictivos de mayor riesgo de epistaxis recurrente. El sexo, el abuso del alcohol, el historial médico, el sangrado activo al ingreso, el punto de sangrado no identificado o las modalidades de tratamiento, no se asociaron a la recurrencia. CONCLUSIÓN: La edad y el uso de medicamentos anticoagulantes fueron factores de riesgo para la recurrencia de la epistaxis. Ninguno de los factores de riesgo descritos anteriormente para la epistaxis episódica aumentó el riesgo de recurrencia. El conocimiento de los factores involucrados en la recurrencia podría proporcionar información importante para la evaluación y el manejo de los pacientes de mayor riesgo

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease / Evaluación clínica, diagnóstico y manejo de pacientes con patología nasosinusal unilateral

OBJECTIVES: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p = 0.02) and older patients (56 ± 18 years vs. 38 ± 18, p < .01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k = .883, p < .001). CONCLUSION: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen

OBJETIVOS: La patología nasal unilateral es común en la práctica clínica y causa preocupación ya que las neoplasias pueden mimetizar las condiciones inflamatorias. Este trabajo pretende describir los patrones demográficos, clínicos y radiológicos de las patologías unilaterales y establecer un algoritmo para el diagnóstico y manejo. MATERIAL Y MÉTODOS: Revisión retrospectiva de los registros médicos de pacientes con opacificación sinusal unilateral en la TC sometidos a cirugía nasal endoscópica en nuestro servicio desde enero de 2011 hasta diciembre de 2017. RESULTADOS: De los 150 pacientes incluidos, 97(64,7%) y 53(35,3%) presentaban patología inflamatoria y neoplásica, respectivamente. En el grupo neoplásico, la malignidad estaba presente en el 35% de los pacientes. Las condiciones neoplásicas fueron más comunes en hombres (p = 0,02) y pacientes mayores (56 ± 18 años vs. 38 ± 18, p < 0,01). Se observó masa nasal en el 56,7% de los pacientes. La sinusitis crónica fue la afección inflamatoria más prevalente, mientras que el papiloma invertido y el osteoma fueron las neoplasias más frecuentes. La neuralgia facial, la parestesia, la epistaxis y, en la TC, las puntuaciones superiores de Lund-Mackay, remodelación y erosión ósea fueron significativamente más comunes en los trastornos neoplásicos. Se encontró una excelente concordancia entre la biopsia por punción y los resultados histológicos postoperatorios (k = 0,88, p < 0,01). CONCLUSIÓN: Con base en nuestra experiencia, proponemos que, el examen físico se complemente con endoscopia nasal, TC y biopsia, en caso de una masa visible. A pesar de que la información clínica y radiológica puede generar sospechas de algunas afecciones, el diagnóstico final solo se puede establecer con el examen histológico postoperatorio

Clinical assessment, diagnosis and management of patients with unilateral sinonasal disease.

OBJECTIVES: Unilateral sinonasal disease is commonly encountered in practice and represents an issue of major concern since neoplasms may mimic inflammatory conditions. This paper aims to describe the demographic, clinical and radiological patterns of unilateral pathologies and, accordingly, to establish a guiding algorithm for diagnosis and management. MATERIAL AND METHODS: We conducted a retrospective review of medical records of patients with unilateral sinus opacification on CT scan who underwent endoscopic nasal surgery in our department from January 2011 to December 2017. RESULTS: Of the 150 patients included, 97(64.7%) and 53(35.3%) had inflammatory and neoplastic pathology, respectively. In the neoplastic group, malignancy was present in 35% of patients. Neoplastic conditions were more common in males (p=0.02) and older patients (56±18 years vs. 38±18, p<.01). Nasal mass or polyp was observed in 56.7% patients. Chronic sinusitis was the most prevalent inflammatory condition, whereas inverted papilloma and osteoma were the most frequent neoplasms. Facial neuralgia, paraesthesia, epistaxis and, on CT scan, superior Lund-Mackay scores, bone remodelling and erosion were significantly more common in neoplastic conditions. Excellent agreement between punch biopsy and postoperative histological results was obtained (k=.883, p<.001). CONCLUSION: A sequential and careful management of unilateral lesions is mandatory. Based on our experience, we propose that, as routine, physical examination should be complemented with nasal endoscopy, CT scan and punch biopsy, in case of visible mass. Although clinical and radiological information might raise suspicion of some conditions, final diagnosis can only be established with histological examination of the surgical specimen.

Role of age and anticoagulants in recurrent idiopathic epistaxis.

OBJECTIVE: Epistaxis is one of the commonest causes of attendance of Otolaryngology emergency rooms. Given its incidence, potential severity and high recurrence rate, a systematic and careful management is mandatory. This work aims to define prognostic factors of epistaxis recurrence. MATERIAL AND METHODS: Retrospective review of medical records of patients with epistaxis admitted to our emergency department from January 2012 to December 2016. Data of 1005 patients with idiopathic epistaxis were analysed and independent risk factors for recurrence were determined by multiple logistic regression analysis. RESULTS: Recurrence of epistaxis was found in 303 (30.1%) patients. Patients with recurrent epistaxis were older (p<.001) and more commonly had a history of hypertension (p=.001) and antiplatelet (p=.048) and anticoagulant (p=.001) use than those with episodic epistaxis. Age (adjusted OR 1.21, 95%CI 1.08-1.32, p=.003) and anticoagulant use (adjusted OR 2.68, 95%CI 1.94-3.70, p=.009) were predictors of increased risk of recurrent epistaxis. Gender, alcohol abuse, medical history, active bleeding at admission, unidentified bleeding point or treatment modalities were not associated with recurrence. CONCLUSION: Age and use of anticoagulation drugs were risk factors for recurrence of epistaxis. None of the previously described risk factors for episodic epistaxis were found to increase the risk of recurrence. Knowledge of factors involved in recurrence might provide important information for assessment and management of increased risk patients.