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Aktuelle Aspekte zur Epistaxis

Current aspects in epistaxis

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Zusammenfassung

Evidenzbasierte Untersuchungen mit hohem methodologischem Wert zum Thema Epistaxis finden sich in der Literatur nur vereinzelt. Die Analyse dieser Publikationen im Hinblick auf Neuerungen ergab, dass die Notwendigkeit routinemäßiger Gerinnungstests derzeit kontrovers diskutiert wird. Diese sollten nur bei begründetem klinischem Verdacht auf eine Koagulopathie erfolgen. Auch über den blutstillenden Effekt der lokalen Kühlung im Nacken bestehen weiterhin Kontroversen. Die Gabe von Nasensalbe und abschwellenden Nasentropfen wird dagegen als effektiv bewertet, ebenso wie die gezielte Koagulation blutender Gefäße und die Tamponade der Nase. Das Absetzen von Cumarinpräparaten ist umstritten, wenn sich die INR im therapeutischen Bereich befindet. Schweres oder gar unstillbares Nasenbluten erfordert eine breite Palette diagnostischer und therapeutischer Optionen. Chronisch rezidivierende Epistaxis im Rahmen hereditärer Syndrome stellt nach wie vor ein großes Problem dar, obwohl in der Diagnostik und symptomatischen Therapie einige Verbesserungen erzielt werden konnten. Einige neue Medikamente (Viagra®, Cialis®) können als unerwünschte Nebenwirkung Epistaxis auslösen.

Abstract

A survey of current literature on the topic of epistaxis revealed only a circumscript number of publications with a high methodologic value. The analysis of these publications showed that there is a controversy on the necessity of routine coagulation tests in epistaxis patients. These tests should only be performed in cases with clinical evidence of a coagulation disorder. Also, there is an ongoing controversy on the value of local cooling with ice or cold packs. Nasal creams and decongestive nose drops have been found to be effective in uncomplicated epistaxis. Rhinoscopically and endoscopically targeted coagulation of bleeding vessels and nasal packing are recommended treatment options. There is a debate on discontinuation of anticoagulant therapy, if INR is within normal limits in Cumadin patients. Intractable epistaxis requires a broad armamentarium of different diagnostic and therapeutic options. Recurrent epistaxis in hereditary syndromes remains to be a challenge, although some advances have been made in diagnosis and symptomatic treatment. Some new medical drugs, as Viagra® or Cialis® may have nosebleeds as side-effects.

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Authors and Affiliations

  1. Klinik für Hals-, Nasen- und Ohrenheilkunde, Karl Hansen Klinik, Antoniusstraße 19, 33175, Bad Lippspringe, Deutschland

    B.J. Folz

  2. HNO-Klinik, Philipp-Universität Marburg, Marburg, Deutschland

    M. Kanne & J.A. Werner

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  1. B.J. Folz
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  2. M. Kanne
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Correspondence to B.J. Folz.

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Folz, B., Kanne, M. & Werner, J. Aktuelle Aspekte zur Epistaxis. HNO 56, 1157–1166 (2008). https://doi.org/10.1007/s00106-008-1838-3

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