Management of Epistaxis in ENT Emergencies – Therapeutic Approach, Intervention Tactics, and Particularities in Epistaxis Associated with Chronic Alcoholism.
DOI:
https://doi.org/10.52692/1857-0011.2025.3-83.47Abstract
Epistaxis represents one of the most common ENT emergencies, with a variable clinical spectrum and a significant impact on medical practice. The main risk factors include hypertension, nasal trauma, the use of anticoagulants, and systemic conditions, which influence both the severity and recurrence of bleeding episodes. In the context of chronic alcoholism, liver damage, coagulopathy, thrombocytopenia, and vascular fragility contribute to more severe, recurrent hemorrhagic episodes that are difficult to control through conventional methods. Therapeutic management requires a stepwise, multidisciplinary approach, integrating both standard ENT measures and the correction of associated systemic disorders. This review summarizes current data on epidemiology, risk factors, and treatment strategies, with an emphasis on the specific features of patients with chronic alcoholism.
References
Ababii I., Maniuc M., Sandul A., Popa V., Danilov L.,Cabac V., Ababii P., Diacova S., Vetricean S., Gagauz A., Sencu E., Chiaburu A., Antohi A. Otorinolaringologie. Chișinău, 2019.
Ataman T. Examinarea Otorinolaringologică. Chișinău: Editura Tehnica; 2003.
Ministerul Sănătății al Republicii Moldova. Protocol clinic național „Epistaxis” PCN-397. Ordinul MS Nr. 1135 din 06.12.2021. Chișinău: Ministerul Sănătății; 2021.
Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, et al. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020;162(1_suppl):S1–S38.
Hai-Yan Li, Ting Luo , Liang Li , Ying Liu, Xiang Zhai, Xu-Dong Wang. Etiology and clinical characteristics of primary epistaxis. Annals of Translational Medicine. 2023;11(2):96.
Hughes JM, Teh BM, Hart CJ, Gibbs HH, Aung AK. Risk factors and management outcomes in epistaxis: a tertiary centre experience. ANZ J Surg. 2023, 93(3):555–560.
Tunkel DE, Anne S, Payne SC, Ishman SL, Rosenfeld RM, Abramson PJ, Alikhaani JD, Benoit MM, Bercovitz RS, Brown MD, Chernobilsky B, Feldstein DA, Hackell JM, Holbrook EH, Holdsworth SM, et all. Clinical Practice Guideline: Nosebleed (Epistaxis). Otolaryngol Head Neck Surg. 2020, 162(1_suppl): S1-38.
Abrich V, Brozek A, Boyle TR, Chyou P-H, Yale SH. Risk factors for recurrent spontaneous epistaxis. Mayo Clin Proc. 2014, 89(12):1606-1612..
Salcan I, Olgun A. Is There a Relationship Between Epitaxis and Anatomical Variations?. Eurasian J Med. 2020, 52(2):136-138.
Zainea Viorel. Ghid de diagnostic și tratament în epistaxis. București,2000.
Beck R, Sorge M, Schneider A, Dietz A. Current Approaches to Epistaxis Treatment in Primary and Secondary Care. Dtsch Arztebl Int. 2018, 115(1- 02):12-22.
Shobhit Gupta, Himanshu Kumar Singh, Prashant Jain, Mohd Amir. Etiopathological evaluation of epistaxis and management. International Journal of Life Sciences, Biotechnology and Pharma Research. 2025, Vol. 14, No. 2, pp.894-900. DOI: 10.69605/ijlbpr_14.2.2025.162.
Chin-Lung Kuo. Updates on the Management of Epistaxis. Clinical Medicine and Therapeutics. 2019;1(1):5.
Kravchik L, Jamal Z, Pester JM. Anterior Epistaxis Nasal Pack. [Updated 2021 Jan 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan https://www.ncbi.nlm.nih.gov/books/NBK538304/.
Meccariello G, Georgalas C, Montevecchi F, et al. Management of idiopathic epistaxis in adults: what’s new?. Acta Otorhinolaryngol Ital. 2019;39(4):211-219.
Smith J., Hanson J., Chowdhury R., Bungard T.Community-based management of epistaxis: Who bloody knows?. CanPharm J (Ott). 2019 May-Jun; 152(3): 164–176.
McDermott AM, Dutt SN, Ganesan S, Timms MS. Management of posterior epistaxis: a review. J Laryngol Otol. 2016;130(2):122–128.
McDermott AL, Jones NS, Robertson G. Management of epistaxis: surgical options and outcomes. J Laryngol Otol. 2016;130(2):123–129.
Bequignon E. , Vérillaud B., Robard L., Michel J., et.al. Guidelines of the French Society of Otorhinolaryngology (SFORL). First-line treatment of epistaxis in adults. Eur Ann Otorhinolaryngol Head Neck Dis. 2017 May;134(3):185-189.
Michael B Soyka 1, Thomas Schrepfer, David Holzmann. Blood markers of alcohol use in epistaxis patients. Eur Arch Otorhinolaryngol. 2012, 269(8):1917-22.
Althaus AE, Arendt U, Hoffmann F, et al. Epistaxis and anticoagulation therapy: an analysis based on health insurance data from Lower Saxony. HNO 2021;69:206-12. Erratum in: HNO 2021;69:98.
Ministerul Sănătăţii al Republicii Moldova. Tulburări mentale şi de comportament legate de consumul de alcool: Protocol clinic naţional. Chişinău; 2014.
Stergaard SD, Schmidt M, Horváth-Puhó E, Nielsen RB, Pedersen L, Sørensen HT. Alcohol and risk of non-traumatic bleeding events requiring hospital care in the general population: a prospective cohort study. Addiction. 2020;115(6):1063-1072.
Djoussé L, Ellison RC, Beiser A, Scaramucci A, D’Agostino RB, Wolf PA. Alcohol consumption and hemostatic factors: analysis of the Framingham Offspring Study. Circulation. 1999;100(7):703-708.
Cabac V., Tihonova L., Castraveţ P., Grumeza O., Ianacoglo L., Grecova A. Aspecte statistice ale epistaxisului în SCM Sfânta Treime. Analele Ştiinţifice ale USMF „N. Testemiţanu”, 2010, Nr. 4(11), p.367- 369. ISSN 1857-1719.
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