Article Text

OUTCOME OF CHILDHOOD EPISTAXIS WITH TREATMENT OF ALLERGIC RHINITIS: A RANDOMISED CONTROLLED TRIAL
  1. W Y Teo1,
  2. K K Tan2
  1. 1Department of Paediatric Medicine, KK Women’s and Children’s Hospital, Singapore, Singapore
  2. 2Department of Otolaryngology, KK Women’s and Children’s Hospital, Singapore, Singapore

Abstract

Objective There has been no previous studies on the effect of treatment of underlying allergic rhinitis (AR) on outcome of epistaxis.

Aim To study outcome of childhood epistaxis in a local paediatric population with treatment of underlying AR and determine if combined treatment with anti-histamine (clarityne) and nasal steroid spray (nasonex) was better than monotherapy (clarityne or nasonex).

Hypothesis Treatment of underlying AR would improve outcome of epistaxis in children. Primary outcome was frequency of epistaxis after treatment.

Methods From August 2005 to September 2006, 60 children (⩽18 years), with underlying AR, presenting to our Otolaryngology clinic with first presentation of epistaxis were enrolled into this single-blinded trial. Patients were randomized to 3 different treatments. Treatment 1: antihistamine (clarityne); treatment 2: nasal steroid spray (nasonex); treatment 3: clarityne and nasonex. Follow up reviews were conducted at 1 and 3 months using a standard questionnaire. Frequency of epistaxis was standardized to number of episodes of epistaxis in a 6-month-period (adjusted frequency). Data were analysed using SPSS v13.0 software.

Results Prior to treatment, the median adjusted frequency of epistaxis in treatment groups 1, 2 and 3 were 12 (SD 22), 21 (SD 66) and 9 (SD 85) episodes in 6 months, respectively. Post-treatment, the mean number of episodes of epistaxis on follow-up at 1 month were 3.7 (range 0–30), 1.3 (range 0–8) and 0.5 (range 0–3) respectively for treatment groups 1, 2 and 3.

Conclusions There was significant improvement in frequency of epistaxis after treatment of AR. It appeared that treatments 2 and 3 were superior to treatment 1. Steroid spray may be important.

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