Bilateral nasal septal chemical cautery: a safe and effective outpatient procedure for control of recurrent epistaxis, our experience in 134 patients.

PURPOSE: To assess the effectiveness and complications of bilateral nasal septal cautery using silver nitrate in anterior nasal epistaxis.

METHODS

This prospective study was carried out on 180 consecutive patients presenting with epistaxis to a general ENT clinic. Local anaesthetic cautery was performed using 5% lidocaine hydrochloride and 0.5% phenylephrine hydrochloride spray in all the patients except eight children that were 4 years or younger that were done under general anaesthetic. Visible vessels in Little's areas were cauterised using two silver nitrate sticks each side. Patients were prescribed naseptin cream and followed-up. We classified re-bleeds as follow: 0-1 episodes: significant improvement, 2-3 episodes: moderate improvement, 4 + episodes: no improvement.

RESULTS

We analysed 134 (74%) patients who were seen at follow-up. Age range was 5-88 years (mean 25, median 15), there were 89 (67%) males. Children made up 60% (81) of the study population (aged 16 years and under), of these 56 (69%) were male. Significant improvement was seen in 93% (124) of the study population, but there were relapses in two children (1.5%) and only moderate improvement in eight patients (6%). There was no significant complication in the study population, but 11 patients had crusting at the sites of cautery at follow-up.

CONCLUSIONS

Bilateral silver nitrate cauterisation is an effective method of treating recurrent epistaxis with low risk of complications.