Interventions for recurrent idiopathic epistaxis (nosebleeds) in children

Abstract

BackgroundRecurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition. ObjectivesTo assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children. Search methodsWe searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 5 March 2012. Selection criteriaWe identified all randomised controlled trials (RCTs) (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The two authors reviewed the full-text articles of all retrieved trials of possible relevance and applied the inclusion criteria independently. Data collection and analysisWe graded trials for risk of bias using the Cochrane approach. One author performed data extraction in a standardised manner and this was rechecked by the other author. Where necessary we contacted investigators to obtain missing information. We did not undertake a meta-analysis because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented. 1 Interventions for recurrent idiopathic epistaxis (nosebleeds) in children (Review)

Management of pediatric epistaxis in different age group in a tertiary care centre

“…In children with epistaxis secondary to underlying haematological coagulopathies, the primary focus is on correcting underlying clotting problems where possible, and/or the use of topical haemostatic agents. 19 Patients with nasal mass lesion or with adenoid hyperplasia were managed with surgical removal of the lesion. Observation and electro cauterisation patients needed least no of hospital stay.…”

Fifteen-minute consultation: investigation and management of childhood epistaxis

“…Epistaxis often results when this region of the septum is exposed to dry air, giving rise to crusting, nasal vestibulitis and/or nose picking. Other causes of childhood epistaxis include, allergic rhinitis, septal perforation and rarely tumours, acquired or congenital bleeding disorders and vasculitic processes, although in 90% of cases no cause can be identified2 (box 1).

Aetiology of childhood epistaxis

▸  Idiopathic

Inflammation

Upper respiratory tract infection

Allergic rhinitis

Foreign body

Vasculitis

Trauma

Nose picking

External trauma

Anatomic

Septal deviation

Medications

Topical steroid spray

Nasal decongestants

Anticoagulants

Haematologic

Idiopathic thrombocytopenic purpura

Von Willebrand disease

Haemophilia

Neoplasms

Benign

Nasopharyngeal angiofibroma

Pyogenic granuloma

Inverted papilloma

Malignant

Rhabdomyosarcoma

Lymphoma

Vascular abnormalities

Hereditary haemorrhagic telangiectasia

Haemangioma

…”

“…Topical antiseptic cream does appear to assist in reducing the frequency of nosebleeds in clinical practice,16 and a randomised control trial of 103 children demonstrated that 4 weeks treatment with 0.5% neomycin + 0.1% chlorhexidine cream (Naseptin) is effective (relative risk reduction 47%, absolute risk reduction 26%, number needed to treat 3.8),17 although not statistically significant, according to recent a Cochrane review 2…”

“…Although evidence supporting the efficacy of nasal cautery is conflicting,2 children who continue to have recurrent nosebleeds following topical treatment may require silver nitrate nasal cautery if vessels are evident on the nasal septum and referral to ENT surgery should be considered. Rarely, examination under general anaesthesia with cautery may be required if ongoing severe epistaxis continues despite no obvious underlying systemic cause.…”

Practice Guideline: Epistaxis in Children

“…Nasal insufflation of recreational drugs such as cocaine and heroin may damage nasal mucosa with subsequent bleeding. Although the diagnostic causes for childhood epistaxis are extensive, more than 90% of cases have no underlying systemic cause (Qureishi & Burton, 2012 ASSESSMENT Initial evaluation of the child presenting with epistaxis should include assessment of airway, breathing, circulation, associated trauma, and neurologic status. Although epistaxis is usually self-limited, it can be potentially lifethreatening (Nichols & Jassar, 2013).…”