The Experts below are selected from a list of 324 Experts worldwide ranked by ideXlab platform
Rakesh K. Chandra - One of the best experts on this subject based on the ideXlab platform.
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Seasonal variation and predictors of Epistaxis.
The Laryngoscope, 2014Co-Authors: Matthew R. Purkey, Zachary H. Seeskin, Rakesh K. ChandraAbstract:Objectives/Hypothesis To examine the incidence of Epistaxis as a function of season and age and to determine predictors of episodes within the Epistaxis patient population presenting to a tertiary hospital system. Study Design Retrospective cohort study. Methods Electronic medical record charts of patients presenting to the Northwestern Emergency Department, admitted to an inpatient ward, or seen in an outpatient setting between 2008 and 2012 were reviewed and selected for an International Classifications of Disease-Ninth Revision Epistaxis code of 784.7. Season of presentation, demographic factors (age, race, gender, insurance status), medication use (including anticoagulants and topical nasal steroid administration), and several comorbidities were analyzed as potential predictors of episodes. Results A total of 2,405 patients were identified with a total of 3,666 individual Epistaxis episodes over 5 years. Multivariate analysis identified allergic rhinitis (AR), chronic sinusitis (CRS), coagulopathy, hereditary hemorrhagic telangiectasia (HHT), hematologic malignancy, and hypertension (HTN) as predictors of a higher number of cases. Epistaxis occurred more frequently during colder months and in older patients. Conclusions Epistaxis occurs more commonly during the winter and in older patients. AR, CRS, coagulopathy, HHT, hematologic malignancy, and HTN are associated with increased Epistaxis incidence. Level of Evidence 2b. Laryngoscope, 124:2028–2033, 2014
Steven H. Yale - One of the best experts on this subject based on the ideXlab platform.
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Risk Factors for Recurrent Spontaneous Epistaxis
Mayo Clinic proceedings, 2014Co-Authors: Victor Abrich, Annabelle Brozek, Timothy R. Boyle, Po-huang Chyou, Steven H. YaleAbstract:Abstract Objective To identify risk factors associated with spontaneous recurrent Epistaxis. Patients and Methods This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having Epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous Epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of Epistaxis recurrence. Results Traditional risk factors for Epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent Epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first Epistaxis event. Conclusion Congestive heart failure is an underappreciated risk factor for recurrent Epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent Epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent Epistaxis to prevent major adverse cardiovascular events.
Christian A Merlo - One of the best experts on this subject based on the ideXlab platform.
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Effect of topical intranasal therapy on Epistaxis frequency in patients with hereditary hemorrhagic telangiectasia: A randomized clinical trial
JAMA - Journal of the American Medical Association, 2016Co-Authors: Kevin J. Whitehead, Marianne S. Clancy, Eric M. Everett, Maribeth H. Johnson, Melissa James, Justin P Mcwilliams, Christian A Merlo, Nathan B Sautter, Murali M. Chakinala, Marie E. FaughnanAbstract:IMPORTANCE: Epistaxis is a major factor negatively affecting quality of life in patients with hereditary hemorrhagic telangiectasia (HHT; also known as Osler-Weber-Rendu disease). Optimal treatment for HHT-related Epistaxis is uncertain. OBJECTIVE: To determine whether topical therapy with any of 3 drugs with differing mechanisms of action is effective in reducing HHT-related Epistaxis. DESIGN, SETTING, AND PARTICIPANTS: The North American Study of Epistaxis in HHT was a double-blind, placebo-controlled randomized clinical trial performed at 6 HHT centers of excellence. From August 2011 through March 2014, there were 121 adult patients who met the clinical criteria for HHT and had experienced HHT-related Epistaxis with an Epistaxis Severity Score of at least 3.0. Follow-up was completed in September 2014. INTERVENTIONS: Patients received twice-daily nose sprays for 12 weeks with either bevacizumab 1% (4 mg/d), estriol 0.1% (0.4 mg/d), tranexamic acid 10% (40 mg/d), or placebo (0.9% saline). MAIN OUTCOMES AND MEASURES: The primary outcome was median weekly Epistaxis frequency during weeks 5 through 12. Secondary outcomes included median duration of Epistaxis during weeks 5 through 12, Epistaxis Severity Score, level of hemoglobin, level of ferritin, need for transfusion, emergency department visits, and treatment failure. RESULTS: Among the 121 patients who were randomized (mean age, 52.8 years [SD, 12.9 years]; 44% women with a median of 7.0 weekly episodes of Epistaxis [interquartile range {IQR}, 3.0-14.0]), 106 patients completed the study duration for the primary outcome measure (43 were women [41%]). Drug therapy did not significantly reduce Epistaxis frequency (P = .97). After 12 weeks of treatment, the median weekly number of bleeding episodes was 7.0 (IQR, 4.5-10.5) for patients in the bevacizumab group, 8.0 (IQR, 4.0-12.0) for the estriol group, 7.5 (IQR, 3.0-11.0) for the tranexamic acid group, and 8.0 (IQR, 3.0-14.0) for the placebo group. No drug treatment was significantly different from placebo for Epistaxis duration. All groups had a significant improvement in Epistaxis Severity Score at weeks 12 and 24. There were no significant differences between groups for hemoglobin level, ferritin level, treatment failure, need for transfusion, or emergency department visits. CONCLUSIONS AND RELEVANCE: Among patients with HHT, there were no significant between-group differences in the use of topical intranasal treatment with bevacizumab vs estriol vs tranexamic acid vs placebo and Epistaxis frequency. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01408030.
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the effects of Epistaxis on health related quality of life in patients with hereditary hemorrhagic telangiectasia
International Forum of Allergy & Rhinology, 2014Co-Authors: Christian A Merlo, Jeffrey B Hoag, Sally E Mitchell, Linda X Yin, Douglas D RehAbstract:Background Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant disease mainly characterized by Epistaxis in more than 96% of patients. Recently, a validated questionnaire known as the HHT Epistaxis Severity Score (ESS) was developed. However, little is known about the relationship between Epistaxis and quality of life. We hypothesize that Epistaxis severity is a major factor predicting health-related quality of life (HR-QoL) in HHT patients. Methods This is a cross-sectional study. The ESS questionnaire and Medical Outcomes Study 36-item short form (SF-36) were administered to subjects through an Internet survey. All participants had a definitive diagnosis of HHT through Curacao criteria or genetic testing. Demographic information, genetics, and extensive histories were also collected. Descriptive analyses were performed with calculations of means and standard deviations (SDs) for continuous variables and proportions for categorical variables. Linear regressions were then performed to assess the association between HR-QoL and ESS. Results A total of 604 subjects participated between April and August 2008. All patients reported Epistaxis, 285 (47.2%) had telangiectasias, and 545 (90.2%) had a family history of HHT; 167 (27.6%) patients had mild Epistaxis (ESS <4), 285 (47.2%) reported moderate Epistaxis (≥4 ESS <7), and 152 (25.2%) reported severe Epistaxis (ESS ≥7). Patients with severe Epistaxis had lower scores for both the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of HR-QoL when compared to those with mild Epistaxis (p < 0.001, p < 0.001). Conclusion The ESS is a major determinant of HR-QoL and should be considered as a measurement of treatment efficacy in HHT-related Epistaxis.
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an Epistaxis severity score for hereditary hemorrhagic telangiectasia
Laryngoscope, 2010Co-Authors: Jeffrey B Hoag, Peter Terry, Sally E Mitchell, Douglas D Reh, Christian A MerloAbstract:Objectives/Hypothesis: Hereditary hemorrhagic telangiectasia (HHT)-related Epistaxis leads to alterations in social functioning and quality of life. Although more than 95% experience Epistaxis, there is considerable variability of severity. Because no standardized method exists to measure Epistaxis severity, the purpose of this study was to determine factors associated with patient-reported severity to develop a severity score. Study Design: Prospective, survey-based study. Methods: HHT care providers and a focus group of patients were interviewed to determine Epistaxis-associated factors. From this, an electronic survey was developed and administered to patients with HHT. Descriptive analyses were performed with calculations of means and medians for continuous and proportions for categorical variables. Multiple ordinal logistic and linear regression models were developed to determine risk factors for Epistaxis severity. Results: Nine hundred respondents from 21 countries were included. Eight hundred fifty-five (95%) subjects reported Epistaxis. The mean (standard deviation) age was 52.1 (13.9) years, and 61.4% were female. Independently associated risk factors for self-reported Epistaxis severity included Epistaxis frequency (odds ratio [OR] 1.57), duration (OR 2.17), intensity (OR 2.45), need for transfusion (OR 2.74), anemia (OR 1.44), and aggressiveness of treatment required (OR 1.53, P < .001 for all). Conclusions: Risk factors for increasing Epistaxis severity in patients with HHT include frequency, duration, and intensity of episodes; invasiveness of prior therapy required to stop Epistaxis; anemia; and the need for blood transfusion. From these factors, an Epistaxis severity score will be presented. Laryngoscope, 2010
Matthew R. Purkey - One of the best experts on this subject based on the ideXlab platform.
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Seasonal variation and predictors of Epistaxis.
The Laryngoscope, 2014Co-Authors: Matthew R. Purkey, Zachary H. Seeskin, Rakesh K. ChandraAbstract:Objectives/Hypothesis To examine the incidence of Epistaxis as a function of season and age and to determine predictors of episodes within the Epistaxis patient population presenting to a tertiary hospital system. Study Design Retrospective cohort study. Methods Electronic medical record charts of patients presenting to the Northwestern Emergency Department, admitted to an inpatient ward, or seen in an outpatient setting between 2008 and 2012 were reviewed and selected for an International Classifications of Disease-Ninth Revision Epistaxis code of 784.7. Season of presentation, demographic factors (age, race, gender, insurance status), medication use (including anticoagulants and topical nasal steroid administration), and several comorbidities were analyzed as potential predictors of episodes. Results A total of 2,405 patients were identified with a total of 3,666 individual Epistaxis episodes over 5 years. Multivariate analysis identified allergic rhinitis (AR), chronic sinusitis (CRS), coagulopathy, hereditary hemorrhagic telangiectasia (HHT), hematologic malignancy, and hypertension (HTN) as predictors of a higher number of cases. Epistaxis occurred more frequently during colder months and in older patients. Conclusions Epistaxis occurs more commonly during the winter and in older patients. AR, CRS, coagulopathy, HHT, hematologic malignancy, and HTN are associated with increased Epistaxis incidence. Level of Evidence 2b. Laryngoscope, 124:2028–2033, 2014
Victor Abrich - One of the best experts on this subject based on the ideXlab platform.
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Risk Factors for Recurrent Spontaneous Epistaxis
Mayo Clinic proceedings, 2014Co-Authors: Victor Abrich, Annabelle Brozek, Timothy R. Boyle, Po-huang Chyou, Steven H. YaleAbstract:Abstract Objective To identify risk factors associated with spontaneous recurrent Epistaxis. Patients and Methods This was a retrospective cohort study assessing patients in the Marshfield Clinic system diagnosed as having Epistaxis between January 1, 1991, and January 1, 2011. There were 461 cases with at least 2 episodes of spontaneous Epistaxis within 3 years and 912 controls with only 1 episode in the same time frame. More than 50 potential risk factors were investigated, including demographic features, substance use, nasal anatomical abnormalities, nasal infectious and inflammatory processes, medical comorbidities, medications, and laboratory values. A Cox proportional hazards regression modeling approach was used to calculate hazard ratios of Epistaxis recurrence. Results Traditional risk factors for Epistaxis, including nasal perforation, nasal septum deviation, rhinitis, sinusitis, and upper respiratory tract infection, did not increase the risk of recurrence. Significant risk factors for recurrent Epistaxis included congestive heart failure, diabetes mellitus, hypertension, and a history of anemia. Warfarin use increased the risk of recurrence, independent of international normalized ratio. Aspirin and clopidogrel were not found to increase the risk of recurrence. Few major adverse cardiovascular events were observed within 30 days of the first Epistaxis event. Conclusion Congestive heart failure is an underappreciated risk factor for recurrent Epistaxis. Hypertension and diabetes mellitus may induce atherosclerotic changes in the nasal vessels, making them friable and more at risk for bleeding. Patients with recurrent Epistaxis may also be more susceptible to developing anemia. Physicians should promote antiplatelet and antithrombotic medication adherence despite an increased propensity for recurrent Epistaxis to prevent major adverse cardiovascular events.