Naseptin or Cautery in adult epistaxis?
Date First Published:
June 30, 2010
Last Updated:
June 30, 2010
Report by:
Catherine Jackson, ST5 EM (UHSM)
Search checked by:
Barbara Scobie, UHSM
Three-Part Question:
[In adults presenting to the emergency department with epistaxis] [would naseptin or cautery be superior] [in preventing reoccurrence?]
Clinical Scenario:
A 60 year old gentleman presents to the emergency department with a spontaneous epistaxis.
The bleed is anterior, from one nostril and stops with simple pressure application
The patient is extremely concerned about this happening again asks what can be done to stop it?
You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?
The bleed is anterior, from one nostril and stops with simple pressure application
The patient is extremely concerned about this happening again asks what can be done to stop it?
You wonder if you should attempt to cauterise the bleeding point, apply naseptin or do nothing at all to try to prevent reoccurrence of the nosebleed?
Search Strategy:
Medline using OVID interface 1950-Oct week 1 2010
Search Details:
{(exp epistaxis OR epistaxis.mp OR nosebleeds.mp) OR [(exp hemorrhage OR hemorrhage.mp OR haemorrhage.mp OR bleed.mp) AND (exp nose OR nose.mp OR exp nasal mucosa OR nasal mucosa.mp OR nasal.mp OR nares.mp)]} AND (exp cautery OR cautery.mp OR exp silver nitrate OR nasal cautery.mp OR exp anti-infective agents OR anti-infective agents.mp) LIMIT to human AND English AND adults
Outcome:
176 papers found, 175 irrelevent
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis P. Murthy, E. L. K. Nilssen, S. Rao & L. G. Mcclymont 1999 UK | 66 consecutive patients with recurrent epistaxis | RCT | Improvement in symptoms | No statistical difference between cautery alone and naseptin and cautery | Small numbers Weak outcomes 16 subjuscts not included in analysis No method of recruitment stated |
Author Commentary:
The evidence in this field in sparse. There are no studies with directly compare naseptin and cautery alone. In addition there are no RCTs which compare the two interventions against no intervention at all.
Bottom Line:
There is little clinical evidence to prove whether cautery or naseptin is superior in preventing the reoccurrence of epistaxis. More research is needed in this field.
References:
- P. Murthy, E. L. K. Nilssen, S. Rao & L. G. Mcclymont. A randomised clinical trial of antiseptic nasal carrier cream and silver nitrate cautery in the treatment of recurrent anterior epistaxis