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

Affiliation

Department of Otolaryngology, City Hospital, Dudley Road, Birmingham, UK. [Email]

Abstract

OBJECTIVE : 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.

Keywords

Bilateral cautery,Epistaxis,Little’s area,Silver nitrate,

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