title: Nasal Hirudiniasis--an unusual cause of epistaxis.
abstract: BACKGROUND
  Common causes for unilateral nasal bleeding in adults are benign or malignant tumours, deviated nasal septum, nasal trauma and foreign bodies. Nasal leech infestation has not been identified as a cause of nasal bleeding in most of the textbooks of Ear Nose and Throat. Over 3 years, at Combined Military Hospital Muzaffarabad, and Combined Military Hospital Abbottabad, we have dealt with 38 such cases presenting with epistaxis where the cause was found to be leech infestation.
  
  
  METHODS
  A descriptive study was carried out at Combined Military Hospital Muzaffarabad and Combined Military Hospital Abbottabad over a period of 3 years. All patients whose epistaxis was due to leech infestation were included in the study regardless of age and sex.
  
  
  RESULTS
  A total of 38 such cases presented with nasal Hirudiniasis as a cause of unilateral epistaxis. 29 were male and 09 female. All of the patients related their problem to the intake of fresh water of stream origin. The mean duration of symptoms was 12 weeks SD 3.0.
  
  
  CONCLUSIONS
  It is concluded that nasal Hirudiniasis (nasal leech infestation) is a cause of unilateral epistaxis in areas like Muzaffarabad, Azad Kashmir and Abbottabad, where leeches are a common inhabitants of fresh water streams.
authors.affiliation: Department of ENT, Combined Military Hospital, Muzaffarabad, Pakistan.
authors.forename: Sheikh Saadat Ullah
authors.initials: SS
authors.lastname: Waleem
authors.forename: Saeed
authors.initials: S
authors.lastname: Ullah
mesh_terms: D000328:Adult; D000818:Animals; D004844:Epistaxis / Q000469:parasitology* / Q000628:therapy; D005260:Female; D006801:Humans; D007865:Leeches; D008297:Male