Etiology and clinical characteristics of primary epistaxis

Hai-Yan Li; Ting Luo; Liang Li; Ying Liu; Xiang Zhai; Xu-Dong Wang

doi:10.21037/atm-22-6590

Etiology and clinical characteristics of primary epistaxis

Ann Transl Med. 2023 Jan 31;11(2):96. doi: 10.21037/atm-22-6590.

Authors

Hai-Yan Li^#^{1

2}, Ting Luo^#³, Liang Li^#⁴, Ying Liu⁵, Xiang Zhai², Xu-Dong Wang¹

Affiliations

¹ Department of Maxillofacial & Ear, Nose, and Throat, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China.
² Department of Otolaryngology, Tianjin Huanhu Hospital, Tianjin, China.
³ Department of Otolaryngology, Tianjin Jinnan Hospital, Tianjin, China.
⁴ Department of Otolaryngology, Tianjin Children's Hospital, Tianjin University Children's Hospital, Tianjin, China.
⁵ Laboratory Department, Tianjin Huanhu Hospital, Tianjin, China.

^# Contributed equally.

Abstract

Background: Primary epistaxis (rupture of nasal artery vessels) is a common emergency, but the related factors are still controversial. This study collected the data on primary epistaxis patients and healthy people undergoing a physical examination at the same center to explore and classify primary epistaxis by its characteristics.

Methods: Primary epistaxis was divided into septal epistaxis and non-septal epistaxis, and logistic regression was performed to determine the risk factors.

Results: In total, 196 cases of septal epistaxis and 127 cases of non-septal epistaxis, and the control group was 182 healthy subjects. There were significant differences in sex, drinking history, hypertension history and hyperlipidemia between the bleeding group and the control group, but no correlation with smoking, diabetes, cardiovascular and cerebrovascular events, or anticoagulant drug use. In the age group of 26-40 years it was related to alcohol consumption and hypertension, for those aged 41-55 years it was related to hypertension, in the age group of 56-70 years it was related to hypertension, high triglyceride and high apolipoprotein B levels, and no related factors were found in the age group >70 years. The risk factors for non-septal cases were increased low-density lipoprotein (LDL) [P=0.035; odds ratio (OR), 2.450; 95% confidence interval (CI): 1.067-5.624], male sex (P=0.002; OR, 3.136; 95% CI: 1.501-6.554), and younger age (P=0.000; OR, 0.941; 95%CI: 0.920-0.962). All patients with nosebleed underwent nasal endoscopy and the bleeding site was successfully located and treated with electrocoagulation. No further bleeding or serious complications occurred after 6 months of follow-up.

Conclusions: Primary epistaxis is more common in males and is related to alcohol consumption, hypertension, and hyperlipidemia. In the young age groups, male sex, and increased LDL were high risk factors for non-septal hemorrhage in winter and spring. Nasal endoscopy and electrocoagulation are safe and effective.

Keywords: Electrocoagulation; hemostasis; nasal endoscopy; primary epistaxis.