Nasal Bacterial Colonization in Pediatric Epistaxis: The Role of Topical Antibacterial Treatment

Abstract

Background: Epistaxis is a common problem in childhood. It has been shown that children with recurrent epistaxis are more likely to have nasal colonization with Staphylococcus aureus. It has been suggested that low-grade inflammation, crusting and increased vascularity due to bacterial colonization contributes to the development of epistaxis in children.  Aims: This study aimed to investigate the nasal colonization and treatment outcome in pediatric epistaxis patients.  Study Design: Retrospective cross-sectional study. Methods: Charts of the pediatric patients referred to our university hospital otolaryngology outpatient clinics for the evaluation of epistaxis were reviewed. The patients whose nasal cultures had been taken at the first clinical visit comprised the study group.   Results: Staphylococcus aureus was the most common bacteria grown. The presence of crusting and hypervascularity was not dependent on the type of bacterial growth and there was no relation between hypervascularity and crusting of the nasal mucosa. Thirty-six patients were evaluated for the outcome analysis. Resolution of bleeding was not dependent on nasal colonization; in patients with colonization, there was no difference between topical antibacterial and non-antibacterial treatments.  Conclusion: Despite the high colonization rates, topical antibacterial treatment was not found superior to non-antibacterial treatment. Our study does not support the belief that bacterial colonization results in hypervascularity of the septal mucosa causing epistaxis since no relation was found between nasal colonization, hypervascularity and crusting. The role of bacterial colonization in pediatric epistaxis need to be further investigated and treatment protocols must be determined accordingly.

Keywords

• Antibacterial treatment, nasal colonization, nasal vascularization, pediatric epistaxis

Kaynakça

1. 1. Barnes ML, Spielmann PM, White PS. Epistaxis: a contemporary evidence based approach. Otolaryngol Clin North Am 2012;45:1005-17. [CrossRef]
2. 2. Shaheen OH. Epistaxis. In Kerr AG, Groves J, eds. Scott Brown’s Otolaryngology, 5th ed. London Butterworths, 1987;4:272-82.
3. 3. Kara N, Spinou C, Gardiner Q. Topical management of anterior epistaxis: a national survey. J Laryngol Otol 2009;123:91-5. [CrossRef]
4. 4. Gifford TO, Orlandi RR. Epistaxis. Otolaryngol Clin North Am 2008;41:525-36. [CrossRef]
5. 5. Whymark AD, Crampsey DP, Fraser L, Moore P, Williams C, Kubba H. Childhood epistaxis and nasal colonization with Staphylococcus aureus. Otolaryngol Head Neck Surg 2008;138:307-10. [CrossRef]
6. 6. Montague ML, Whymark A, Howatson A, Kubba H. The pathology of visible blood vessels on the nasal septum in children with epistaxis. Int J Pediatr Otorhinolaryngol 2011;75:1032-4. [CrossRef]
7. 7. Kubba H, MacAndie C, Botma M, Robison J, O’Donnell M, Robertson G, et al. A prospective, single-blind, randomized controlled trial of antiseptic cream for recurrent epistaxis in childhood. Clin Otolaryngol Allied Sci 2001;26:465-8. [CrossRef]
8. 8. Loughran S, Spinou E, Clement WA, Cathcart R, Kubba H, Geddes NK. A prospective, single-blind, randomized controlled trial of petroleum jelly/Vaseline for recurrent paediatric epistaxis. Clin Otolaryngol Allied Sci 2004;29:266-9. [CrossRef]

9. 9. Robertson S, Kubba H. Long-term effectiveness of antiseptic cream for recurrent epistaxis in childhood: five-year follow up of a randomised, controlled trial. J Laryngol Otol 2008;122:1084-7. [CrossRef]
10. 10. Walker FD, Baring DE. Nasal bacterial carriage in adult epistaxis: is neomycin the answer? J Laryngol Otol 2009;123:623- 5. [CrossRef]
11. 11. Ciftci IH, Koken R, Bukulmez A, Ozdemir M, Safak B, Cetinkaya Z. Nasal carriage of Staphylococcus aureus in 4-6 age groups in healthy children in Afyonkarahisar, Turkey. Acta Paediatr 2007;96:1043-6. [CrossRef]
12. 12. Pynnonen M, Stephenson RE, Schwartz K, Hernandez M, Boles BR. Hemoglobin promotes Staphylococcus aureus colonization. PLoS Pathog 2011;7:e1002104. [CrossRef]
13. 13. Ruddy J, Proops DW, Pearman K, Ruddy H. Management of epistaxis in children. Int J Pediatr Otorhinolaryngol 1991;21:139-42. [CrossRef]
14. 14. Ozmen S, Ozmen OA. Is local ointment or cauterization more effective in childhood recurrent epistaxis. Int J Pediatr Otorhinolaryngol 2012;76:783-6. [CrossRef]