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

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


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.


Chemical cautery, Epistaxis, Silver nitrate, Xylometazoline

Full Text:



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.