Epistaxis: comparison of chemical cautery with topical vasoconstrictor in adult anterior epistaxis

Raj Tajamul Hussain; Farah Deeba; Mariya Ali; Rauf Ahmad

doi:10.18203/2320-6012.ijrms20203445

Authors

Raj Tajamul Hussain Department of ENT, Government Medical College, Srinagar, Jammu and Kashmir, India
Farah Deeba Department of ENT, Government Medical College, Srinagar, Jammu and Kashmir, India
Mariya Ali Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Rauf Ahmad Department of ENT, Government Medical College, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20203445

Keywords:

Chemical cautery, Epistaxis, Silver nitrate, Xylometazoline

Abstract

Background: To compare efficacy of 75% silver nitrate chemical cautery as opposed to topical vasoconstrictor spray (xylometazoline 0.1%) in adult anterior epistaxis.

Methods: This randomized controlled trial study was carried out at SMHS Hospital Srinagar from Jan 2019 to Dec 2019. 110 subjects that presented to ENT & HNS emergency with epistaxis and fulfilled the inclusion criteria were selected. Subjects were randomly distributed into two groups. Group-A individuals were treated by cauterization with 75% silver nitrate and Group-B individuals were treated with topical vasoconstrictor spray (xylometazoline 0.1%). All the subjects were reviewed at 1 month and success was determined in terms of control of epistaxis from same side of nose.

Results: The mean age of the cohort was 48.5yrs (age range, 17-59). There were total 60 (54.4%) males and 50 (45.4%) females among the cases. Both the groups were comparable as regards the age, sex, duration and frequency of epistaxis. 91.2% cases in Group-A (silver nitrate cautery) and 73.5% cases in Group-B (xylometazoline spray 0.1%) had no further epistaxis at one-month follow-up (p=0.014).

Conclusions: Chemical cauterization with silver nitrate is a feasible and safe technique for the treatment of adult anterior epistaxis and is more effective than topical vasoconstrictor spray.

Metrics

Metrics Loading ...

References

Akinpelu OV, Amusa YB, Eziyi JA, Nwawolo CC. A retrospective analysis of aetiology and management of epistaxis in a south-western Nigerian teaching hospital. West Afr J Med. 2009;28:165-8.

Pond F, Sizeland A. Epistaxis. Strategies for management. Aust Fam Physician. 2000;29:933-8.

Yueng-Hsiang C, Jih-Chin L. Unilateral Epistaxis. New England J Med. 2009;361(9):14.

Ciaran SH, Owain H. Update on management of epistaxis. The West London Medical J. 2009;1:33-41.

Walker TWM, Macfarlane TV, McGarry GW. The epidemiology and chronobiology of epistaxis: an investigation of Scottish hospital admissions 1995-2004. Clin Otolaryngol. 2007;32:361-5.

McGarry GW. Epistaxis. In Michael Gleeson Ed. Scott Brown’s otolaryngology 7th ed. vol. 2. London: Hodder Arnold publication; 2008: 1603-1608.

Wurman LH, Sack JG, Flannery JV, Lipsman RA. The management of epistaxis. Am J Otolaryngol. 1992;13:193-209.

Kamble P, Saxena S, Kumar S. Nasal bacterial colonization in cases of idiopathic epistaxis in children. Int J Pediatr Otorhinolaryngol. 2015;79:1901-4.

Johnson N, Faria J, Behar P. A comparison of bipolar electrocautery and chemical cautery for control of pediatric recurrent anterior epistaxis. Otolaryngol Head Neck Surg. 2015;153:851-6.

Barr GD. Silver nitrate cautery and epistaxis. Arch Emerg Med. 1989;6:233.

Krempl GA, Noorily AD. Use of oxymetazoline in the management of epistaxis. Annals of Otology, Rhinology & Laryngology. 1995 Sep;104(9):704-6.

Doo G, Johnson DS. Oxymetazoline in the treatment of posterior epistaxis. Hawaii medical J. 1999;58(8).

Umar AS, Rahat ZM, Hussain SS, Khan MZ, Fareed G. Unilateral anterior epistaxis electrocautery versus chemical cautery. Pak Armed Forces Med J. 2013;63(3):408-11.

Wang L, Vogel DH. Posterior epistaxis: comparison of treatment. Otolaryngol Head Neck Surg. 1981 Nov;89(6):1001-6.

Simmen DB, Raghavan U, Briner HR, Manestar M, Groscurth P, Jones NS. The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol. 2006 Sep;20(5):502-5.

Spacciapoli P, Buxton D, Rothstein D, Friden P. Antimicrobial activity of silver nitrate against periodontal pathogens. J Periodontal Res. 2001;36:108-13.

Glynn F, Amin M, Sheahan P, McShane D. Prospective double blind randomized clinical trial comparing 75% versus 95% silver nitrate cauterization in the management of idiopathic childhood epistaxis. Int J Pediatr Otorhinolaryngol. 2011;1(75): 81-4.

Amin M, Glynn F, Phelan S, Sheahan P, Crotty P, McShane D. Silver nitrate cauterization, does concentration matter? Clin Otolaryngol. 2007;32(3):197-9.

Razdan U, Raizada RM, Chaturvedi VM. Efficacy of conservative treatment modalities used in epistaxis. Indian J Otolaryngol Head Neck Surg. 2004;56(1):20-2.

Ruddy J, Proops DW, Pearman K, Ruddy H. Interventions for recurrent idiopathic epistaxis in children. Int J Pediatr Otorhinolaryngol. 1991;21:139-42.

Calder N, Kang S, Fraser L, Kunanandam T, Montgommery J, Kubba H. A double blinded randomized controlled trial of management of recurrent nosebleeds in children. Otorhino-laryngol Head Neck Surg. 2009;140(5):670-4.

Khan MA, Akram S, Khan M, Usman HB. Comparison of chemical cautery versus topical vasoconstrictors in idiopathic pediatric anterior epistaxis. Pakistan Armed Forces Med J. 2018 Oct 30;68(3):535-8.

Shargorodsky J, Bleier BS, Holbrook EH, Cohen JM, Busaba N, Metson R, et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg. 2013 Sep;149(3):390-8.

Toner JG, Walby AP. Comparison of electro and chemical cautery in the treatment of anterior epistaxis. J Laryngol Otol. 1990;104:617-8.