Muhammad Sohail Awan, Muhammad Mubarik Ali, Tanvir Hussain, Muhammad Yousaf Mian.
Management of pediatrics Epistaxis; A prospective study of 100 cases.
Professional Med J Jan ;8(2):226-65.

OBJECTIVES: a) To evaluate the etiological factors of epistaxis. b) To evaluate the importance of nasal examination in the diagnosis. c) To compare the efficacy of various treatment methods. DESIGN: Prospective study. SETTING: Department of Otolaryngology and Head Neck Surgery Nishtar Hospital Multan and Aga Khan University Hospital Karachi. MATERIALS & METHODS The study consists of a prospective evaluation of 100 patients presenting with nasal bleeding and requiring admission. All the patients were thoroughly evaluated with a detailed history, physical examination, systemic examination and ENT examination and a same set of investigations were done in all the patients. RESULTS: In our series inflammatory affections of nose and sinuses and trauma to nose are commonest etiologies of pediatric epistaxis. Among the treatment modalities cauterization was only effective when a bleeding point can be identified and was accessible. Comparison of various packing materials showed Vaseline gauze to be most useful and cost effective. Submucous resection was effective in controlling bleeding after failure of nasal packing but arterial ligation was last resort if bleeding could not be controlled with anterior and posterior nasal packing. CONCLUSIONS: Inflammation of the nose and sinuses and trauma to nose is commonest etiological factors in pediatric epistaxis. Chemical cautery is as effective as electric cautery in control of simple epistaxis where bleeding point can be identified. Vaseline gauze should be used for anterior nasal packing being efficacious as well as cost effective. Submucous resection may be considered as effective step if packing fails to control bleeding before proceeding for arterial ligation.

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