Servet ERDEMES, Ahmet YÜKKALDIRAN, Osman ERDOĞAN, Müslüm AYRAL

Epistaksisle Başvuran Geriyatrik Hastaların Analizi

Amaç: Epistaksis çeşitli sebeplerle ortaya çıkabilen ve özellikle geriyatrik yaş grubunda ciddi sıkıntılara sebep olabilen bir kulak burun boğaz acilidir. Bu çalışmada amacımız geriatrik yaş grubunda olup burun kanamasıyla hastanemize başvuran hastaları incelemektir. Hastalar ve Yöntemler: Bu retrospektif çalışmaya 2015-2021 yılları arasında Siverek Devlet Hastanesi Kulak Burun Boğaz Anabilim Dalı'na burun kanaması ile başvuran 65 yaş ve üstü 474 hastanın verileri geriye dönük olarak incelendi. Hastalar yaş, cinsiyet, ek hastalık, burun kanamasının yeri ve yapılan müdaheleler açısından değerlendirildi. Travma , operasyon ve yetersiz verileri olan hastalar çalışma dışı bırakıldı. Bulgular: Hastaların yaş ortalaması 73,76 ± 6,35 ve yaş aralığı 65-96 idi. Kadın erkek oranı 213:202 olarak saptandı. Hastaların %53’ünde medikal takip ile kanama kontrolü sağlanırken, %47’sinde girişimsel işlemler gerekmiştir. Bu girişimsel işlemler arasında en sık gümüş nitrat ile kimyasal koterizasyon (%21,7) uygulanırken bunu sırasıyla anteriyor tampon (%13,5), tampon + elektrokoterizasyon (%8,4) ve posteriyor tampon (%3,4) izlemiştir. Hastalarda görülen en sık ek hastalık hipertansiyon (%67) iken bunu koroner arter hastalığı (%14,5) takip etmiştir. Hospitalizasyon oranı %4,1 olurken kan transfüzyon ihtiyacı %1,7 hastada oluşmuştur Sonuç: Epistaksis etiyolojisinin tespiti ve kanamanın kaynağının bulunması özellikle geriyatrik hastalarda titizlikle yapılmalıdır. Her kulak burun boğaz uzmanı, uygun standardizasyon ve tedavi için epistaksiste iyi bir yönetim protokolüne sahip olmalıdır.

Anahtar Kelimeler:

epistaksis, geriyatri, analiz

Analysis Of Geriatric Patients Presenting with Epistaxis

in the geriatric age group. Our aim in this study is to examine patients in the geriatric age group who applied to our hospital with epistaxis. Material and Method: In this retrospective study, the data of 474 patients aged 65 and over who applied to the Siverek State Hospital, Department of Otorhinolaryngology between 2015 and 2021, were retrospectively analyzed. The patients were evaluated in terms of age, gender, comorbidity, location of the epistaxis and interventions. Patients with trauma, operation and insufficient data were excluded from the study. Results: The mean age of the patients was 73.76 ± 6.35 years and the age range was 65-96. The female to male ratio was found to be 213:202. While bleeding control was achieved with medical follow-up in 53% of the patients, interventional procedures were required in 47%. Among these interventional procedures, chemical cauterization with silver nitrate (21.7%) was most frequently applied, followed by anterior buffer (13.5%), buffer + electrocautery (8.4%), and posterior buffer (3.4%). The most common comorbidity observed in the patients was hypertension (67%), followed by coronary artery disease (14.5%). While the hospitalization rate was 4.1%, the need for blood transfusion occurred in 1.7% of the patients. Conclusion: Determining the etiology of epistaxis and finding the source of bleeding should be done meticulously, especially in geriatric patients. Every otolaryngologist should have a good management protocol in epistaxis for appropriate standardization and treatment.

Keywords:

Cholecystectomy laparoscopic cholecystectomy, Gallbladder, General surgery,

PDF

___

1- Gilyoma JM,Chalya PL,Etiological profile and treatment outcome of epistaxis at a tertiary care hospital in Northwestern Tanzania:a prospective review of 104 case,2011 ;11(8):1-6.
2- Teker AM, Korkut AY, Kahya V, Gedikli O, prospective randomized, controlled clinical trial of Ankaferd Blood stopper in patient with acute anterior epistaxis.Eur Arch otorhinolaryngol 2010;267:1377-81 .
3- Varshney S, Saxena RK. Epistaxis: a retrospective clinical study. Indian J Otolaryngol Head Neck Surg 2005; 57: 125–9. 4- Juselius H: epistaxis; clinical study of1724 patients; J laryng Oto 1974; 88:317-27
5-Gifford TO, Orlandi RR. Epistaxis. Otolaryngol Clin N Am 2008; 41: 525–536. 6- Genç S, Kürkçüoğlu ŞS, Karabulut H, Acar B, Tunçel Ü, Değerli S. Giant lobular capillary hemangioma of the nasal septum. Turk J Med Sci 2009; 39: 325–328.
7- Thornton MA, Mahesh BN, Lang J : Posterior epistaxis : ldentfication of common Bleeding sites, Laringoscope , 2005, 115 (4): 588-90.
8- Pope LE, Hobbs CG. Epistaxis: an update on current management. Postgrad Med J 2005; 81: 309–314.
9- Beule AG. Physiology and pathophysiology of respiratory mucosa of the nose and the paranasal sinuses. GMS Curr Top Otorhinolaryngol Head Neck Surg. 2010;9:Doc07.
10- Janzen VD. Rhinological disorders in the elderly. J Otolaryngol. 1986;15:228–230.
11- Hussain G, Iqbal M, Shah SA, Said M, Sanaulla H, et al. (2006) Evaluation of aetiology and eﬃ cacy of management protocol of epistaxis. J Ayub Med Coll Abbottabad 18: 63-66.
12- Pallin DJ, Chang Y, Mc Kay MP, Emond JA, Pelletier AJ, et al. (2005) Epidemiology of epistaxis in USA emergency departments, 1992 to 2001. Ann Emerg Med 46: 77-81. Link: https://bit.ly/3b67A5A
13- Walker TWM, Caefarlane TV, Mc Garry GW (2007) The epidemiology and chronobiology of epistaxis: aninvestigation of Scottish hospital admission 1995-2004. Clin Otolaryngol 32: 361-365.
14- Zahed R, Mousavi Jazayeri MH, Naderi A, Naderpour Z, Saeedi M. Topical tranexamic acid compared with anterior nasal packing for treatment of epistaxis in patients taking antiplatelet drugs: Randomized controlled trial. Acad Emerg Med 2018;25:261-6.
15-Buchberger AMS, Baumann A, Johnson F, Peters N, Piontek G, Storck K, et al. The role of oral anticoagulants in epistaxis. Eur Arch Otorhinolaryngol 2018;275:2035-43.
16- Biggs TC, Baruah P, Mainwaring J, Harries PG, Salib RJ. Treatment algorithm for oral anticoagulant and antiplatelet therapy in epistaxis patients. J Laryngol Otol 2013;127:483-8.
17- Yüksel A, Kurtaran H, Kankiliç ES, Ark N, Uğur KS, Gündüz M. Epistaxis in geriatric patients. Turk J Med Sci 2014;44:133-6.
18- İsmi O, Vayisoğlu Y, Özcan C, Görür K, Ünal M. Endoscopic sphenopalatine artery ligation in posterior epistaxis: Retrospective analysis of 30 patients. Turk Arch Otorhinolaryngol 2016;54:47-52.
19- Herkner H, Laggner AN, Müllner M, Formanek M, Bur A, Gamper G, et al. Hypertension in patients presenting with epistaxis. Ann Emerg Med 2000;35:126-30.
20- Ridker PM, Cook NR, Lee IM, Gordon D, Gaziano JM, Manson JE, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women. N Engl J Med 2005;352:1293-304.
21- Thaha MA, Nilssen EL, Holland S, Love G, White PS. Routine coagulation screening in the management of emergency admission for epistaxis-is it necessary? J Laryngol Otol 2000; 114: 38–40.
22- Hanif J, Tasca RA, Frosh A, Ghufoor K, Stirling R. Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times. Clin Otolaryngol Allied Sci 2003; 28: 368–370.
23- Tan LKS, Calhoun KH (1999) Epistaxis. Med Clin North Am 83: 43-56.
24- Klotz DA, Winkle MR, Richmon JBS, Hengerer AS. Surgical management of posterior epistaxis: a changing paradigm. Laryngoscope 2002; 112: 1577–1582
25- Middleton MP. Epistaxis. Emergency Medicine Australasia 2004; 16: 428–440.