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I read with great interest the article by Kristensen et al. (2011) and would like to comment on certain aspects of their study. The authors have constructed their study on the problem of epistaxis. I wish to draw attention specifically to the issue of ‘modern’ epistaxis, which is changing. The episodes that occur in the older population tend to be more severe, whereas those in children are more often minor and self-limiting (Manes 2010). According to this statement, an epistaxis in older frail persons remains a challenge to otolaryngologists and often requires surgical intervention, especially in patients who are receiving antiplatelet and/or anticoagulant treatment (Asanau et al. 2009). Thanks to surgery, we have almost forgotten those long hospitalisations in the past of older frail patients with an epistaxis. Today, more sophisticated technologies such as endoscopic surgery provide the possibility to resolve nasal haemorrhage definitively on or soon after patient admission to hospital. The next day after the surgery, the postoperative patients can be mobilised without risk and are generally discharged 24–48 hours after intervention. It also avoids complications related to bed rest and further readmission for the same problem.

Kristensen et al. (2011) mention that analgesics such as morphine are used in their department to reduce the pain caused by nose packing. This assertion demands more precision because it may be necessary only in cases of antero-posterior nasal packing used to control severe post-traumatic epistaxis (Ardekian et al. 1993). Usually, in otolaryngological practice, a simple ‘spontaneous’ epistaxis is managed by anterior packing, and an administration of less powerful medication is always effective.

According to the optimistic results of this study, I hope that in the near future, the diagnosis of epistaxis even in older patients will not necessitate a hospitalisation stay. However, more work is needed to achieve this goal.

References

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  2. References
  • Ardekian L, Samet N, Shoshani Y & Taicher S (1993) Life-threatening bleeding following maxillofacial trauma. Journal of Craniomaxillofacial Surgery 21, 336338.
  • Asanau A, Timoshenko AP, Vercherin P, Martin C & Prades JM (2009) Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Annals of Otology, Rhinology and Laryngology 118, 639644.
  • Kristensen VG, Nielsen AL, Gaihede M, Boll B & Delmar C (2011) Mobilisation of epistaxis patients – a prospective, randomised study documenting a safe patient care regime. Journal of Clinical Nursing 20, 15981605.
  • Manes RP (2010) Evaluating and managing the patient with nosebleeds. Medical Clinics of North America 94, 903912.