Unmasking Nasal Septal Hematoma/Abscess: A Systematic Review and Meta-analysis of Demographics, Symptoms, and Management

Sunday, September 29, 2024

1:18 PM – 1:24 PM EDT

Location: MBCC, 206

Disclosure(s):

Douglas P. Nanu, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Daniel C. Adelsberg, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Nicholas P. Radulovich, BS, BA:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Nasal septal hematoma (NSH) or nasal septal abscess (NSA) have a significant risk of morbidity if missed, misdiagnosed, or mismanaged. Approximately 0.8%-1.6% of patients with nasal injuries experience NSH. We aim to discuss the demographics, symptoms, bacteriology, treatment and sequelae associated with NSH/NSA.

Methods: PRISMA 2020 guidelines were followed. CINAHL, PubMed, and Scopus were searched from inception until October 15, 2023. Inclusion criteria included patients who were diagnosed with a traumatic NSH/NSA. Studies were excluded if NSH/NSA was due to surgical procedures. Demographics included N of patients, patient age and gender. Symptoms, antibiotics given, bacteriology, and sequelae were analyzed. Non-normally distributed data was expressed as median (range, IQR). Meta-analysis of continuous measures (mean, median), and proportions (%) with a 95% confidence interval (CI) was conducted. Studies were assessed for bias via the Johanna Briggs Institute (JBI) appraisal tool.

Results: Out of 4,290 studies screened, 30 studies (N = 598) were included. In total, 72.1% were males (95% CI: 67-78). The total median age was 12.7 years (range: 5-63, IQR = 23.9). The mean time from trauma to diagnosis was 7.3 days (SD = 4.3). Common symptoms at presentation included nasal obstruction/congestion at 60.3% (95% CI: 37.1-81.4), nasal pain at 30.0% (17.2-44.6), swelling at 20.4% (8.7-35.5), headache at 15.5% (7.3-26), and fever at 13.9% (7.3-22.2). The most common pathogens isolated included S. aureus at 56.5% (49-63.8), streptococcus species at 8.9% (5.2-14), and K. pneumoniae at 6.3% (3.2-10.8). Antibiotics given included amoxicillin-clavulanate at 10.3% (4.5-18.2), metronidazole at 9.5% (1.1-24.9), ampicillin-sulbactam at 8.9% (0.4-26.5), and unspecified antibiotics at 39.7% (13.8-69.2). The most common sequelae were nasal septal deformity/cartilage destruction at 14.3% (7.7-22.6).

Conclusions: NSA/NSH has a 7-day delay in diagnosis from the time of trauma. First-line practitioners should be made aware of the signs and symptoms of this condition to minimize the risk of morbidity.

Presenting Author(s)

Douglas P. Nanu, BS

Medical Student
Washington State University Elson S. Floyd College of Medicine
Renton, WA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Co-Author(s)

Daniel C. Adelsberg, BS

Medical Student
Department of Otolaryngology, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo
Buffalo, New York, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.
SN

Shaun A. Nguyen, MD

Clinical Research Director
Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC
Charleston, South Carolina, United States

Disclosure information not submitted.
Nicholas P. Radulovich, BS, BA

Medical Student
Washington State University - College of Medicine
Bellevue, WA, United States

Disclosure(s):
faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Senior Author(s)

Michele M. Carr, DDS, MD, PhD

Professor
Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Department of Otolaryngology
Williamsville, New York, United States

Disclosure information not submitted.