Epistaxis

Tx

1st - compress nares, upright, head forward; cold compress

2nd - local oxymetazolone or phenylephrine

3rd - anterior or posterior nasal packing

if bleeding site identified, cautery

Use humidifier, saline drops, petrolatum for prevention

Most common cause of nasal polyp is cystic fibrosis

suspect in any child <12 y with polyp; EVEN in absence of other typical symptoms

may be associated with the Samter triad (polyps, aspirin sensitivity, asthma)

Nasopharyngeal carcinoma (NPC)

an undifferentiated carcinoma of squamous cell origin

common in mediterranean or Far Eastern descent

may be asymptomatic until advanced

often presents with recurrent otitis media (resulting from eustachian tube obstruction by tumor), recurrent epistaxis and/or nasal obstruction

• strongly associated with positive serologies for EBV;
• viral titre can even by used to track the progress of therapy
• also associated with smoking and with chronic nitrosamine consumption (e.g salted fish)

Study shows:

Analysis of EBV DNA in plasma samples was useful in screening for early asymptomatic nasopharyngeal carcinoma. Nasopharyngeal carcinoma was detected significantly earlier and outcomes were better in participants who were identified by screening than in those in a historical cohort. (http://www.nejm.org/doi/full/10.1056/NEJMoa1701717)