Outcome of Silver Nitrate Cauterization in Adults with Anterior Epistaxis at a Tertiary Care Hospital in Peshawar, Khyber Pakhtunkhwa

Saqib Aziz Dawar, Hanif Ullah, Ali Inam, Shehreyar Khan, Shehzad Saeedullah, Abdullah Khan, Isteraj Shahabi


Introduction: Epistaxis is a common emergency presentation (7-14% population annually) which may pose difficulties in management. Although only 6% require formal medical intervention but they can be serious and even life threatening.

Objective: To document the outcome and efficacy of silver nitrate cauterization in patients with anterior epistaxis presenting to a tertiary care hospital of Peshawar, KP.

Materials & Methods: Fifty patients presenting with spontaneous anterior epistaxis of moderate degree were included in this study conducted on Outpatient basis from March 01, 2017 to September 30, 2017 in the department of Otorhinolaryngology-A unit of Hayatabad Medical Complex, Peshawar, based on prospective data collection and convenience sampling. Cases were managed with silver nitrate cautery and followed for ten weeks to document recurrent epistaxis. Data were analyzed manually for descriptive statistics.

Results: Fourteen (28%) patients were females and 36(72%) were males with age ranging from 18-40 years. Thirty-two (64%) patients had a prominent bleeder. In 8(16%) patients the bleeder was seen after local packing with xylocaine solution. In 8(16%) patients the bleeder was difficult to localize and was identified by repeated local packs of xylocaine mixed with adrenaline. Five patients (10%) had recurrent epistaxis within the first week after discharge, and cautery was repeated again with no further recurrence.

Conclusion: Silver nitrate cauterization was effective in controlling spontaneous anterior epistaxis of moderate severity.

Keywords: Anterior Epistaxis, Adult Epistaxis, Silver Nitrate, Chemical Cauterization.

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Sungupta A, Maity K, Ghosh D, Basak B, Das SK, Basu D. A study on role of nasal endoscopy for diagnosis and management of epistaxis. Journal of the Indian Medical Association 2010;108(9):597‐8.

Watkinson JC. Epistaxis. In: Kerr AG, Mackay IS, Bull TR editor(s). Scott‐Brown's Otolaryngology. 6th Edition. Vol. 4: Rhinology, Oxford: Butterworth‐Heinemann, 1997:4/18/1‐19.

Petruson B, Rudin R. The frequency of epistaxis in a male population sample. Rhinology. 1975;13(3):129–33.

Davies K, Batra K, Mehanna R, Keogh I. Pediatric epistaxis: epidemiology, management and impact on quality of life. Int J PediatrOtorhinolaryngol. 2014;78(8):1294–7. Available from: https://doi.org/10.1016/j.ijporl.2014.05.013.

Shrestha I, Pokharel M, Shrestha BL, Dhakal A, Amatya RCM. Evaluation of aetiology of Epistaxis and its management in Dhulikhel Hospital. Kathmandu Univ Med J. 2015;49(1):49-55.

Fatakia A, Winters R, Amedee RG. Epistaxis: a common problem. The Ochsner Journal. 2010;10:176-8.

Kucik CJ, Clenney T. Management of epistaxis. Am Fam Physician. 2005 Jan;71(2):305-11.

Rushing J. Managing epistaxis. Nursing Critical Care. 2011 Mar;6(2):48. doi: 10.1097/01.CCN.0000394498.04772.d7.

Pope LER, Hobbs CGL. Epistaxis: an update on current management. Postgrad Med J 2005;81:309-14.

Pashen D, Stevens M. Management of epistaxis in general practice. Australian Family Physician. 2002 Aug;31(8):1-5. Available from: https://www.racgp.org.au/afpbackissues/2002/200208/20020801pashen.pdf.

Pallin DJ, Chng YM, McKay MP, et al. Epidemiology of epistaxis in US emergency departments, 1992 to 2001. Ann Emerg Med, 2005;46:77–81.

Kodiya AM, Labaran LS, Musa E. Epistaxis in Kaduna, Nigeria: a review of 101 cases. African Health Sciences. 2012;12(4):479-82.

Link TR, Conley SF, Flanary V, Kerschner JE. Bilateral epistaxis in children: efficacy of bilateral septal cauterization with silver nitrate. Int J Pediatr Otorhinolaryngol. 2006 Aug;70(8):1439-42.

Bequignon E, Verillaud B, Robard L, et al; SFORL work-group. Guidelines of the French Society of Otolaryngology (SFORL). First-line treatment of epistaxis in adults. European Annals of Otorhinolaryngology Head and Neck disease. 2017;134:185-189.

Newton E, Lasso A, Petrcich W, Kilty SJ. An outcome analysis of anterior epistaxis management in the emergency department. J Otolaryngology Head and Neck Surgery. 2016;45:24.

Calder N, Kang S, Fraser L, Kunanandam T, Montgomery J, Kubba H. A double-blind randomized controlled trial of management of recurrent nosebleeds in children. Otolaryngology - Head and Neck Surgery 2009;140(5):670-4.

Faistauer M, Faistauer A, Rafaeli SG, Roithmann R. Clinical outcome of patients with epistaxis treated with nasal packing after hospital discharge. Braz J Otorhinolaryngol. 2009;75(6):857-65. Available from: https://doi.org/10.1016/S1808-8694(15)30550-4.


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