From, Date: 15.11.2010
The professor and head Place:Bellary.
Department of ENT,
Vijayanagar Institute of Medical Sciences,
Bellary.
To
The Registrar,
Rajiv Gandhi University of Health Sciences,
Bangalore.
THROUGH PROPER CHANNEL
Sir,
Sub:- Submission of Synopsis for registration of dissertation topic and forwarding.
As per the regulation of the Rajiv Gandhi University of Health Sciences for Registration of Dissertation topic, the following Post graduate student in M.S (OTO- RHINO- LARYNGOLOGY) has been allotted the dissertation topic as follows by the official registration committee of all qualified and eligible guide of the Department of ENT.
NAME / TOPIC / GUIDEDr.Mallikarjuna.C.T
PG.Student
Department of ENT
VIMS, Bellary / CLINICAL STUDY AND MANAGEMENT OF EPISTAXIS / Dr.G.Shankar,
Professor
Department of ENT
VIMS, Bellary.
Therefore, I kindly request you to communicate the acceptance of the dissertation topic allotted to the PG student at an early date.
Thanking You
Yours Faithfully,
Guide Name
Dr.G.Shankar, DR.SATHYANANDA RAO
Professor Professor & Head,
Department of ENT Dept of ENT, VIMS, Bellary
VIMS, Bellary.
From,Date:15.11.2010
Dr. MALLIKARJUNA .C.TPlace:Bellary.
Post Graduate in ENT,
Department of ENT,
Vijayanagar Institute of Medical Sciences,
Bellary.
To
The Principal,
Vijayanagar Institute of Medical Sciences,
Bellary
THROUGH PROPER CHANNEL
Sir,
Sub:- Submission of registration and forwarding of
dissertation topic.
In accordance with the above cited topic, I the Undersigned studying in Post Graduate Course in M.S OTO-RHINO-LARYNGOLOGY has been allotted the dissertation topic “CLINICAL STUDY AND MANAGEMENT OF EPISTAXIS” under the guidance of Dr.G.SHANKAR, Professor, Department of ENT, VIMS, Bellary.
I request you kindly to forward dissertation topic in the prescribed form for the Rajiv Gandhi University of health sciences, Bangalore for approval.
Thanking You, Yours Faithfully
(Dr.Mallikarjuna. C. T)
Signature of Guide Signature of HOD
Dr. G.SHANKAR DR.SATHYANANDA RAO
Professor Professor & Head,
Dept of ENT, Dept of ENT, VIMS, Bellary
VIMS, Bellary.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE KARNATAKA
ANNEXURE- II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE
AND ADDRESS [ IN BLOCK LETTERS] / DR.MALLIKARJUNA.C.T
P.G IN OTO-RHINO-LARYNGOLOGY
DEPARTMENT OF ENT, VIMS, BELLARY
2 / NAME OF THE INSTITUTION / VIJAYANAGAR INSTITUTE OF MEDICAL SCIENCES, BELLARY
3 / COURSE OF THE STUDY AND SUBJECT / MS in ENT
4 / DATE OF ADMISSION TO THE COURSE / 02.06.2010
5 / TITLE OF THE TOPIC / CLINICAL STUDY AND MANAGEMENT OF EPISTAXIS
6 / Brief resume of intended work
6.1. Need for the study
Epistaxis is a greek word means, EPI- From aboveSTAXIS- Drop by drop flow of fluid.Epistaxis is defined as acute hemorrhage from nostril, nasal cavity, or nasopharynx. It is a very common condition that can present as a simple self limiting to a life threatening condition. The incidence of epistaxis in general population is difficult to ascertain, at one time or the other, most people experience it. It occurs more commonly in males than females. Rare in infants, children suffer much more frequently than adults. It can be unilateral or bilateral with a number of factors playing a role like age, sex, occupation, anatomical, pathological and climatic conditions etc.,
Patients who seek medical treatment for epistaxis typically fall into two categories, those who have multiple minor episodes, and those who have single severe prolonged episode that does not stop.
Epistaxis is one of the most common emergency that OTO-RHINO-LARYNGOLOGISTS are asked to treat. In primary care centres epistaxis treatment is less thoroughly investigated. Causes of epistaxis can be simple with self limiting to more sinister malignancy which needs a radical approach with many other conditions falling in between.
Hence this study.
6 / 6.2. Review of Literature.
Hippocrates in the fifth century was probably the first to appreciate that pressure on the alae nasi was an effective method to control nasal bleeding.(1)
Pilz was the first to surgically treat epistaxis with ligation of the common carotid artery (1869).(12)
Carl Micheal (1871) Jame Little (1879) and Wilhelm Kiesselbach were the first to identify the nasal septum’s anterior plexus as a source of nasal bleeding.(1)
Seifferent ligated the internal maxillary artery via the maxillary sinus in 1928.(12)
Henry Goodyear performed the first anterior ethmoid artery ligation in the treatment of epistaxis.(12)
In 1949, Woodruff described a plexus of prominent blood vessels lying inferior to the posterior end of the inferior turbinate. He commented on how this plexus was a frequent site of adult epistaxis. Woodruff’s plexus as a frequent source of so-called posterior epistaxis.(1)
In 1967, Shaheen attempted to study and define Woodruff’s plexus but was unable to identify the plexus in nasal ethmoidal blocks.
Recent study with endoscopic photography and anatomical microdissection confirms the existence of the plexus and confirms that it is a venous plexus.(1)
According to recent studies, treatment may be divided into
First line- Direct therapy(Bipolar/cautery, endoscopic if required)
Second line- Indirect therapy (anterior packing)
Third line- Surgical therapy (ESPL) (Endonasal Sphenopalatine artery ligation)
Fourth line- Angiography and embolization.
6 / 6.3. Objectives of the study
1) To find out different causes of Epistaxis
2) Management of Epistaxis regards to its etiology.
7 / MATERIAL & METHODS.
7.1 Source of data
The patients attending the department of ENT & also patients referred from other departments of combined Hospitals of MCH
VIMS, Bellary form the subjects for our study.
INCLUSION CRITERIA
All the cases of Epistaxis who are visiting VIMS group of hospitals.
EXCLUSION CRITERIA
- NIL -
7.2
a) Method of collection of Data.
A written informed consent will be taken from all patients included in the study. A detailed history taking, thorough clinical examination will be done for these patients. The data collected will be entered into a specially designed case record form.
b) Duration of study.
The study will be conducted for a period of one and half years from January 2011 to June 2012.
7.3DOES THE STUDY REQUIRE ANY INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?
Blood investigations like Hb, Tc, Dc, ESR, PCV, BT, CT, Profile Blood grouping, cross matching,Blood Urea Creatinine, Blood Sugar, LFT, PT, aPTT, PPT, INR, Platelet Count. Routine urine examination. Radiological Examinations like X-ray PNS, X-ray nasal bones, CT- PNS & MRI. Investigation to rule out Systemic diseases and immuno compromised state.
No animal interventions required.
7.4HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
YES.
Ethical clearance has been obtained from institutional ethical committee(
IEC) of VIMS, Bellary.
8 / List of references
- SCOTT BROWN’S – Otorhinolaryngologyhead and neck surgery- 7th edition , Volume -2 (Page 1596 to 1598, 1601 to 1606)
- cUMMINGS CHARLES W. ,FLINT Paul w ,HARKER lee aet- al Otolaryngology, Head and neck surgery- Volume II third edition-1998. (page 852 )
- BALLENGER JOHN JACOB,SNOW JAMES B., Jr - Otolaryngology, Head and neck surgery- 15th edition-1996
- PAPARELLA M.M, SHUMRICK DONALD A ,GLUCKMAN JACK L, et-al - Otolaryngology, Volume III, 3rd edition , 1991
- GATES GEORge a., AARSAD rOBERT F ,ADAMS GEORGE L et-al current therapy in - Otolaryngology,Head and neck surgery- 5th edition-1994 (page 354)
- EISELE DAVID W. ,SMITH RICHARD V. - Complications in head and neck surgery 2nd edition-2009 (page 140)
- MYERS EUGENE.N., MD, CARRU Ricardo L ,CASS STEPHEN P et-al - Operative oto laryngology head and neck surgery Volume –I (Page 2)
- hall AND COLOMAN”S, MARTIN BURTON, SUSAPPA LEIGHPON et-al - Disease of the ear, nose and throat- 15th edition-2000 (page 119)
- MARKS Steven C. MD,ARDEN RICHARD L , JAFFREY WILSECK - Nasal and Sinus surgery- 2000 edition. (Page 451)
- Dillon.R.S FRCS, east.C.A. frcs- Ear, nose and throat and head and neck surgery 1994.(page 46 to 47)
- LOGAN & TURNER’S - Maran.A.G.D, MD Arthur - B.A. Dale.B.et-al – Diseases of nose, throat and ear -10th edition (page 30 to 33)
- HAZARIKA.P, NAYAK.D.R, BALAKRISHNAN.R, SECOND EDITION – Text book of ear, noise, throat and head and neck surgery – 2010 (page 272)
9 / Signature of the Candidate
10 / Remarks of the Guide
11 / Name and Designation of the
11.1 Guide / DR.SHANKAR.G
PROFESSOR
DEPARTMENT OF ENT, VIMS,
BELLARY
11.2 Signature
11.3 Co-Guide (if any) / NO
11.4 Signature
11.5 Head of the Department / DR.SATYANANDA RAO
PROFESSOR AND HOD,
DEPARTMENT OF ENT, VIMS,
BELLARY.
11.6 Signature
12 / 12.1 Remarks of the chairman and principal
12.2 Signature.