Skip to main content
SpringerLink
Log in

Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis

  • Rhinology
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Epistaxis that is refractory to conservative management can be treated with endoscopic sphenopalatine artery ligation (ESPAL). Although rare, ethmoidal artery (EA) bleeding can be a cause of rebleeding after successful ESPAL. EA bleeding is diagnosed by angiography and can also be identified during surgical exploration. However, since the angiographic embolization of the EA is contraindicated, surgical hemostasis is mandatory. This study investigated whether paranasal sinus (PNS) CT could provide information for predicting EA bleeding without angiography in patients with refractory epistaxis requiring ESPAL.

Methods

Forty-seven patients, who were surgically treated [with ESPAL or EA ligation (EAL)] for refractory epistaxis from March 2010 to June 2019, were retrospectively analyzed. A positive PNS CT finding for EA bleeding was defined as the presence of soft tissue densities having continuity with the EA pathway, accompanied by a partially deficient surrounding bony canal. These findings as well as soft tissue densities in each paranasal sinus were compared between the ESPAL and EAL groups.

Results

All patients in the EAL group had positive CT findings of EA bleeding, compared to only 12.2% in the ESPAL group (P < 0.001). The rate of soft tissue densities within the frontal and sphenoid sinuses were noted in 26.8% and 17.1% of patients in the ESPAL group, compared to 83.3% and 83.3% of patients in the EAL group (P = 0.013 and P = 0.003, respectively).

Conclusion

PNS CT might be useful for predicting EA bleeding in patients with refractory epistaxis requiring surgical hemostasis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Sethi RKV, Kozin ED, Abt NB, Bergmark R, Gray ST (2018) Treatment disparities in the management of epistaxis in United States emergency departments. Laryngoscope 128(2):356–362. https://doi.org/10.1002/lary.26683

    Article  PubMed  Google Scholar 

  2. Goljo E, Dang R, Iloreta AM, Govindaraj S (2015) Cost of management in epistaxis admission: impact of patient and hospital characteristics. Laryngoscope 125(12):2642–2647. https://doi.org/10.1002/lary.25374

    Article  PubMed  Google Scholar 

  3. Small M, Murray JA, Maran AG (1982) A study of patients with epistaxis requiring admission to hospital. Health Bull (Edinb) 40(1):20–29

    CAS  Google Scholar 

  4. Schaitkin B, Strauss M, Houck JR (1987) Epistaxis: medical versus surgical therapy: a comparison of efficacy, complications, and economic considerations. Laryngoscope 97(12):1392–1396. https://doi.org/10.1288/00005537-198712000-00003

    Article  CAS  PubMed  Google Scholar 

  5. Ram B, White PS, Saleh HA, Odutoye T, Cain A (2000) Endoscopic endonasal ligation of the sphenopalatine artery. Rhinology 38(3):147–149

    CAS  PubMed  Google Scholar 

  6. Rudmik L, Leung R (2014) Cost-effectiveness analysis of endoscopic sphenopalatine artery ligation vs arterial embolization for intractable epistaxis. JAMA Otolaryngol Head Neck Surg 140(9):802–808. https://doi.org/10.1001/jamaoto.2014.1450

    Article  PubMed  Google Scholar 

  7. Dedhia RC, Desai SS, Smith KJ, Lee S, Schaitkin BM, Snyderman CH, Wang EW (2013) Cost-effectiveness of endoscopic sphenopalatine artery ligation versus nasal packing as first-line treatment for posterior epistaxis. Int Forum Allergy Rhinol 3(7):563–566. https://doi.org/10.1002/alr.21137

    Article  PubMed  Google Scholar 

  8. Daudia A, Jaiswal V, Jones NS (2008) Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol 33(6):618–620. https://doi.org/10.1111/j.1749-4486.2008.01795.x

    Article  CAS  PubMed  Google Scholar 

  9. Kumar S, Shetty A, Rockey J, Nilssen E (2003) Contemporary surgical treatment of epistaxis. What is the evidence for sphenopalatine artery ligation? Clin Otolaryngol Allied Sci 28(4):360–363

    Article  CAS  Google Scholar 

  10. Soyka MB, Nikolaou G, Rufibach K, Holzmann D (2011) On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 49(4):474–478. https://doi.org/10.4193/Rhino10.313

    Article  CAS  PubMed  Google Scholar 

  11. Padua FG, Voegels RL (2008) Severe posterior epistaxis-endoscopic surgical anatomy. Laryngoscope 118(1):156–161. https://doi.org/10.1097/MLG.0b013e31815708d0

    Article  PubMed  Google Scholar 

  12. McDermott AM, O'Cathain E, Carey BW, O'Sullivan P, Sheahan P (2016) Sphenopalatine artery ligation for epistaxis: factors influencing outcome and impact of timing of surgery. Otolaryngol Head Neck Surg 154(3):547–552. https://doi.org/10.1177/0194599815620134

    Article  PubMed  Google Scholar 

  13. Traboulsi H, Alam E, Hadi U (2015) Changing trends in the management of epistaxis. Int J Otolaryngol 2015:263987. https://doi.org/10.1155/2015/263987

    Article  PubMed  PubMed Central  Google Scholar 

  14. Midilli R, Orhan M, Saylam CY, Akyildiz S, Gode S, Karci B (2009) Anatomic variations of sphenopalatine artery and minimally invasive surgical cauterization procedure. Am J Rhinol Allergy 23(6):e38–41. https://doi.org/10.2500/ajra.2009.23.3403

    Article  PubMed  Google Scholar 

  15. Metson R, Lane R (1988) Internal maxillary artery ligation for epistaxis: an analysis of failures. Laryngoscope 98(7):760–764. https://doi.org/10.1288/00005537-198807000-00015

    Article  CAS  PubMed  Google Scholar 

  16. Asanau A, Timoshenko AP, Vercherin P, Martin C, Prades JM (2009) Sphenopalatine and anterior ethmoidal artery ligation for severe epistaxis. Ann Otol Rhinol Laryngol 118(9):639–644. https://doi.org/10.1177/000348940911800907

    Article  PubMed  Google Scholar 

  17. Christensen NP, Smith DS, Barnwell SL, Wax MK (2005) Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 133(5):748–753. https://doi.org/10.1016/j.otohns.2005.07.041

    Article  PubMed  Google Scholar 

  18. Krajina A, Chrobok V (2014) Radiological diagnosis and management of epistaxis. Cardiovasc Intervent Radiol 37(1):26–36. https://doi.org/10.1007/s00270-013-0776-y

    Article  PubMed  Google Scholar 

  19. Scaramuzzi N, Walsh RM, Brennan P, Walsh M (2001) Treatment of intractable epistaxis using arterial embolization. Clin Otolaryngol Allied Sci 26(4):307–309

    Article  CAS  Google Scholar 

  20. Reyre A, Michel J, Santini L, Dessi P, Vidal V, Bartoli JM, Moulin G, Varoquaux A (2015) Epistaxis: the role of arterial embolization. Diagn Interv Imaging 96(7–8):757–773. https://doi.org/10.1016/j.diii.2015.06.006

    Article  CAS  PubMed  Google Scholar 

  21. Rudmik L, Smith TL (2012) Management of intractable spontaneous epistaxis. Am J Rhinol Allergy 26(1):55–60. https://doi.org/10.2500/ajra.2012.26.3696

    Article  PubMed  PubMed Central  Google Scholar 

  22. Floreani SR, Nair SB, Switajewski MC, Wormald PJ (2006) Endoscopic anterior ethmoidal artery ligation: a cadaver study. Laryngoscope 116(7):1263–1267. https://doi.org/10.1097/01.mlg.0000221967.67003.1d

    Article  PubMed  Google Scholar 

  23. Saraceni Neto P, Nunes LM, Gregorio LC, Santos Rde P, Kosugi EM (2013) Surgical treatment of severe epistaxis: an eleven-year experience. Braz J Otorhinolaryngol 79(1):59–64

    Article  Google Scholar 

  24. Singh B (1992) Combined internal maxillary and anterior ethmoidal arterial occlusion: the treatment of choice in intractable epistaxis. J Laryngol Otol 106(6):507–510

    Article  CAS  Google Scholar 

  25. Souza SA, Souza MM, Gregorio LC, Ajzen S (2009) Anterior ethmoidal artery evaluation on coronal CT scans. Braz J Otorhinolaryngol 75(1):101–106

    Article  Google Scholar 

  26. McClurg SW, Carrau R (2014) Endoscopic management of posterior epistaxis: a review. Acta Otorhinolaryngol Ital 34(1):1–8

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Solares CA, Luong A, Batra PS (2009) Technical feasibility of transnasal endoscopic anterior ethmoid artery ligation: assessment with intraoperative CT imaging. Am J Rhinol Allergy 23(6):619–621. https://doi.org/10.2500/ajra.2009.23.3364

    Article  PubMed  Google Scholar 

  28. Henriquez OA, Schlosser RJ, Mace JC, Smith TL, Soler ZM (2013) Impact of synechiae after endoscopic sinus surgery on long-term outcomes in chronic rhinosinusitis. Laryngoscope 123(11):2615–2619. https://doi.org/10.1002/lary.24150

    Article  PubMed  Google Scholar 

  29. Kim YH, Lee SH, Park CW, Cho JH (2013) Nasalance change after sinonasal surgery: analysis of voice after septoturbinoplasty and endoscopic sinus surgery. Am J Rhinol Allergy 27(1):67–70. https://doi.org/10.2500/ajra.2013.27.3832

    Article  PubMed  Google Scholar 

Download references

Funding

This work was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI17C0984 to SWK). It was also supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF), funded by the Ministry of Education (grant number: 2019R1C1C1002064 to YJJ).

Author information

Author notes

  1. Sang-Wook Kim and Hyun-Jin Cho equally contributed to this work.

Authors and Affiliations

  1. Department of Otorhinolaryngology, Gyeongsang National University College of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea

    Yung Jin Jeon, Dae Hwan Kim, Young Chul Kim, Byeong Min Lee, Hyun-Jin Cho & Sang-Wook Kim

  2. Institute of Health Sciences, Gyeongsang National University, Jinju, Republic of Korea

    Yung Jin Jeon, Hyun-Jin Cho & Sang-Wook Kim

  3. Department of Otorhinolaryngology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea

    Yeon-Hee Joo

Authors
  1. Yung Jin Jeon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dae Hwan Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Young Chul Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byeong Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yeon-Hee Joo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hyun-Jin Cho
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sang-Wook Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization: YJJ, HJC, SWK. Data curation: YJJ, DHK, YCK, BML, YHJ. Formal analysis: HJC, SWK. Funding acquisition: SWK. Methodology: YJJ, SWK. Project administration: YJJ, HJC, SWK. Visualization: HJC, SWK. Writing—original draft: YJJ, SWK. Writing—review and editing: YJJ, HJC, SWK.

Corresponding authors

Correspondence to Hyun-Jin Cho or Sang-Wook Kim.

Ethics declarations

Conflict of interest

The authors have no funding, financial relationships or conflicts of interest to disclose.

Ethical approval

All procedures performed in studies were in accordance with the ethical standards of the Institutional Review Board (IRB) of Gyeongsang National University Hospital (IRB No. 2018-05-009).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 1806 kb)

Supplementary file2 (TIF 30554 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jeon, Y.J., Kim, D.H., Kim, Y.C. et al. Usefulness of computed tomography in predicting ethmoidal arterial bleeding in refractory epistaxis. Eur Arch Otorhinolaryngol 277, 1969–1975 (2020). https://doi.org/10.1007/s00405-020-05914-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-020-05914-y

Keywords

Search

Navigation