The Importance of Nasal Cytological Examination in Determining The Etiology and Treatment of Idiopathic Recurrent Epistaxis İn Children

Abstract

Background and aim : It was aimed to clarify the etiology of recurrent idiopathic epistaxis (RIE) by evaluating the results of the nasal cytological examination (NCE) and to evaluate their responses to treatment prepared according to nasal cytological findings. Materials and methods:Pre and post-treatment the results of NCE, 78 children who applied to the ENT clinic for RIE and 40 healthy children were evaluated. In the majority of cases with RIE, the main cell type was determined to be neutrophils (70%) followed by eosinophils (20%). The treatments of the children were tailored by their nasal cytology findings. According to the results of NCE, 25 / 3.6 mg/kg of amoxicillin /clavulanate was administered orally twice a day for 7 days to children with high neutrophil counts. Children with high eosinophil count were given 5 ml of desloratadine orally once a day for 15 days. These treatments were administered together and at the same doses to children with high neutrophil and eosinophil counts.Results : Clinical evaluation and NCE was performed at the end of the first month. Families reported that epistaxis did not occur in children after treatment. As a result of the re-performed NCE, 74 (94.8%) of the patients responded to the treatment. In children with recurrent epistaxis due to inflammation caused by neutrophils and eosinophils, the dominance of cells decreased after treatment and no epistaxis was observed. The relationship between the dominance of inflammatory cells in the nasal mucosa and epistaxis was found to be statistically significant (p<0.05). Conclusion :NCE, which is used in the differential diagnosis and follow-up of rhinological diseases, can help us to clarify the etiology of RIE in children. According to the results of the nasal cytological examination, anti-inflammatory treatment with a high response to treatment can be planned in these children.