Around 10% of general population suffers from spontaneous nose bleeding (not related to a surgical intervention), of which 10% needs specific medical management (1).

Intranasal bleeding (epistaxis) are from various origins:

General causes: clotting disorders, genetic diseases

Traumatic causes: face and nasal bones fracture, intranasal drugs intake, nasal surgery, nasal intubation, fibroscopy

Tumoral causes: cancers (sinus, nasopharynx,…), benign tumors (nasopharyngeal fibroma)

Inflammatory causes: infectious rhinitis

Surgical causes: sinus surgery, ENT/maxillofacial cancer surgery, endoscopic pituitary surgery (neurosurgery)

Epistaxis can provoke the following symptoms: 

anemia, cold sweat, paleness, fatigue, dizziness or sensation of thirst, excitation or somnolence.

In rare cases, it can be life-threatening (2)

Intranasal bleeding is very common, costly and have a negative impact on patients quality of life. In particular chronic cases (3), epistaxis also greatly impact caregivers quality of life. The “disease” incidence is  increasing due to population ageing and, mechanically, the growth of the number of patients suffering from cardiovascular diseases and treated with anticoagulants.

 

 


(1) Changing Trends in the Management of Epistaxis, Traboulsi H et al. International Journal of Otolaryngology Volume 2015
(2) https://biology.stackexchange.com/questions/19827/can-nosebleeds-cause-death
(3) Patients « Rendu-Osler »

About 12% of the population suffers from chronic sinusitis (1), i.e. 900 million patients worldwide. It is the 5th most frequent disease amongst people aged below 65 years (2). It is more frequent than cardiovascular diseases.

Chronic sinusitis is an inflammatory disease in which sinus mucosa is swollen and inflamed (Figure 1).

 

FIGURE 1 –Sinusitis : illustration

 

Chronic sinusitis is caused by:

allergies (rhinitis)

deviated nasal septum

nasal polyps

other medical conditions (e.g. HIV)

Chronic sinusitis can provoke the following symptoms: 

respiratory issues and loss of sense of taste and smell.

chronic headaches and body pain

recurrent infections (including meningitis)

Persistence of those symptoms can seriously impair daily patients wellness, which causes:

frequent physician visits, regular sick leaves, chronic fatigue and even depression (3)

Approximately 45% of patients suffering from chronic rhinosinusitis suffer from asthma (4)

Close to 65% of patients with AIDS have chronic sinusitis as a comorbidity (5)

Chronic sinusitis also increases the risk of ischemic and hemorrhagic stroke (6)

Disease incidence is also increasing (7, 8, 9). This could be explained by pollution growth (industrial or caused by urgent expansion) and antibiotics resistance (10, 11), which usage in sinusitis represents 21% of total antibiotics prescriptions (12) in adults in the US.

 

 


(1) Prevalence and Incidence of Diagnosed Chronic Rhinosinusitis in Alberta, Canada. Yuan Xu et al. JAMA Otolaryngol Head Neck Surg. 2016;142(11):1063-1069. doi:10.1001/jamaoto.2016.2227
(2) Hamilos DL. Chronic rhinosinusitis: epidemiology and medical management. J Allergy Clin Immunol.2011;128:693-707; quiz 708-709.
(3) Benninger MS, Ferguson BJ, Hadley JA, et al. Adult chronic rhinosinusitis: definitions, diagnosis, epidemiology, and pathophysiology. Otolaryngol Head Neck Surg. 2003;129:S1-S32.
(4) Rodney J. Schlosser, M.D.,Depression in chronic rhinosinusitis: A controlled cohort study. Am J Rhinol Allergy 30, 128–133, 2016; doi: 10.2500/ajra.2016.30.4290
(5) Rugina M, Serrano E, Klossek JM, Crampette L, Stoll D, Bebear JP, Perrahia M, Rouvier P, Peynegre R. Epidemiological and clinical aspects of nasal polyposis in France; the ORLI group experience. Rhinology. 2002 Jun;40(2):75-9.
(6) Shah AR, Hairston JA, Tami TA. Sinusitis in HIV: microbiology and therapy. Curr Allergy Asthma Rep. 2005 Nov. 5(6):495-9
(7) Lee WH, Kim J-W, Lim J-S, Kong IG, Choi HG (2018) Chronic rhinosinusitis increases the risk of hemorrhagic and ischemic stroke: A longitudinal follow-up study using a national sample cohort. PLoS ONE 13(3): e0193886. https://doi.org/ 10.1371/journal.pone.0193886
(8) Jeffrey D. Suh, and David W. Kennedy. Treatment Options for Chronic Rhinosinusitis. Proc Am Thorac Soc Vol 8. pp 132–140, 2011. DOI: 10.1513/pats.201003-028RN
(9) EPOS 2005
(10) https://emedicine.medscape.com/article/232791-overview#a7
(11) Khanna and Gharpure.  Correlation of increased sinusitis and urban air pollutionInd. J. Sci. Res. and Tech. 2012 1(1):14-17/
(12) Sharp HJ, Denman D, Puumala S, Leopold DA. Treatment of acute and chronic rhinosinusitis in the United States, 1999-2002. Arch Otolaryngol Head Neck Surg. 2007;133:260–265