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Cautery or cream for epistaxis in children
  1. Angaj Ghosh,
  2. Rupert Jackson
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}

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Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar

Clinical scenario

A child presents to the emergency department with a nosebleed that came on spontaneously and that has not responded to simple first aid measures. The bleed appears to be from the front of the nose and the patient has no underlying disease. You wonder whether silver nitrate cautery or application of nasal antiseptic cream is the best method of obtaining haemostasis.

Three part question

In [children with spontaneous epistaxis and no underlying disease] is [silver nitrate cautery better than nasal antiseptic cream] at [stopping bleeding and preventing recurrences]?

Search strategy

Medline 1966–12/00 using the OVID interface. {(exp epistaxis OR OR nosebleed$.mp) OR [(exp hemorrhage OR OR OR bleed$.mp) AND (exp nose OR OR exp nasal mucosa OR nasal OR OR]} AND (exp cautery OR cauter$.mp OR exp silver nitrate OR nasal OR exp anti-infective agents OR anti-infective LIMIT to human AND english.

Search outcome

Altogether 198 papers found of which 196 were irrelevant or of insufficient quality. The remaining two papers are shown in table 3.

Table 3


This BET combines two patient groups—children with primary anterior epistaxis at first presentation and children with recurrent epitaxis. The final outcome being the same—stopping any further bleeds.

Clinical bottom line

Cautery and naseptin are equally effective. Given the ease of application naseptin is the treatment of choice.

Report by Angaj Ghosh, Senior Clinical Fellow Search checked by Rupert Jackson, Specialist Registrar