Circadian variation in onset of epistaxis: analysis of hospital admissions

Dear Editor,

It was very interesting to see a circadian variation in the onset of
epistaxis.

Epistaxis is the second most common cause of spontaneous bleeding. Of the
two categories of epistaxis, mundane and severe, the mundane, usually
anterior epistaxis, is the more common. It is a shame they did not report
about the subgroups of epistaxis. It has been reported that 60% of
individuals report at least one episode of epistaxis during their
lifetime. Eighty percent of epistaxis occurs in Kiesselbach's plexus, a
vascular network in the anterior portion of the nasal septum [1]. Beran et
al. reported that common cold and stress or tiredness were frequently
experienced before the occurrence of the nose-bleeds.

The blood pressure
distribution of the habitual nose-bleeders did not differ from that of the
population samples used for comparison [2]. This is in concordance with
the data of Lubianca Neto et al who also could not establish a definite
association between blood pressure and history of adult epistaxis in
hypertensive patients, although they found a link to left ventricular
hypertrophy. The evidence for an association of duration of hypertension
and left ventricular hypertrophy with epistaxis suggests that epistaxis
might be a consequence of long-lasting hypertension. They could also
observe the presence of enlarged vessels at rhinoscopy in hypertensive
patients with history of epistaxis [3]. Data by Herkner et al. document
significantly higher blood pressure values in epistaxis patients compared
with the controls [4].

The discussion on blood pressure and epistaxis will
continue. However as ENT surgeons we see the central task in dealing with
epistaxis to differentiate between anterior and posterior origins of
bleeding and we think further studies have to include the localisation of
the bleeding as Padgham et al did. They found a positive correlation
between hypertension and bleeding from the middle meatus, but not with the
severity of bleeding [5].

1. Doyle, D.E., Anterior epistaxis: a new nasal tampon for fast,
effective control. Laryngoscope, 1986. 96(3): p. 279-81.

2. Beran, M. and B. Petruson, Occurrence of epistaxis in habitual nose-
bleeders and analysis of some etiological factors. ORL J Otorhinolaryngol
Relat Spec, 1986. 48(5): p. 297-303.

3. Lubianca Neto, J.F., et al., Is epistaxis evidence of end-organ damage
in patients with hypertension? Laryngoscope, 1999. 109(7 Pt 1): p. 1111-5.

4. Herkner, H., et al., Hypertension in patients presenting with
epistaxis. Ann Emerg Med, 2000. 35(2): p. 126-30.

5. Padgham, N., Epistaxis: anatomical and clinical correlates. J Laryngol
Otol, 1990. 104(4): p. 308-11.