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[Epistaxis in children]
1Service ORL, hôpital Robert-Debré, Paris, France.
Insights
Most childhood nosebleeds originate from the nasal septum and are manageable with simple first aid. Severe or persistent cases may indicate underlying conditions like bleeding disorders or tumors, requiring further investigation and advanced treatments.
Area of Science:
- Otorhinolaryngology
- Pediatric Medicine
- Emergency Medicine
Context:
- Epistaxis, commonly known as nosebleeds, is a frequent pediatric emergency.
- Anterior nasal septum is the primary source of most epistaxis in children.
- Initial management often involves conservative measures like manual compression or nasal packing.
Purpose:
- To outline the diagnostic approach and management strategies for pediatric epistaxis.
- To highlight red flags for severe or recurrent cases requiring further investigation.
- To discuss advanced treatment options for refractory epistaxis.
Summary:
- Most pediatric epistaxis cases stem from the anterior nasal septum and are controlled with basic interventions.
- Severe or recurrent epistaxis necessitates evaluation for bleeding disorders or tumors, particularly juvenile nasopharyngeal angiofibroma in adolescent males.
- Treatment escalates from cautery for recurrent idiopathic cases to anterior/posterior packing and embolization for severe or tumor-related bleeding.
Impact:
- Provides a clinical pathway for managing pediatric nosebleeds, from initial assessment to advanced interventions.
- Emphasizes the importance of identifying underlying causes for persistent or severe epistaxis.
- Informs clinicians on appropriate therapeutic interventions, including surgical and interventional radiology options.
Abstract:
Most epistaxis in children come from the anterior part of the nasal septum. The bleeding is usually under control by manual compression or vestibular packing with a piece of cotton or calcium alginate. In case of severe or recurrent epistaxis, one must look for a bleeding disorder or a nasal/nasopharyngeal tumour, especially juvenile nasopharyngeal angiofibroma in adolescent males. Chemical or electrical cautery of the septum should be suggested in case of recurrent idiopathic epistaxis. When bleeding continues despite such treatments, anterior nasal packing is recommended; life-threatening epistaxis usually requires posterior packing. Embolisation can be used to reduce blood supply before surgery in case of haemorragic tumours or vascular malformations.