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Evidence summaries

Interventions for Recurrent Idiopathic Epistaxis in Children

There is insufficient evidence to assess the effectiveness of treatment options for children with recurrent idiopathic epistaxis. However if silver nitrate nasal cautery is undertaken 75% may be preferable to 95% as it appears to be more effective in the short term and causes less pain.Level of evidence: "D"

A Cochrane review [Abstract] 1 included 5 studies (4 RCTs, one quasi-randomised controlled trial, CCT) with a total of 468 subjects. The RCTs compared 0.5% neomycin + 0.1% chlorhexidine (Naseptin® ) antiseptic cream with no treatment, Vaseline® petroleum jelly with no treatment, 75% with 95% silver nitrate nasal cautery, and silver nitrate cautery combined with Naseptin® against Naseptin® alone, and the CCT compared Naseptin® antiseptic cream with silver nitrate cautery. Overall, results were inconclusive, with no statistically significant difference found between the compared treatments upon completion of the trials, however 75% silver nitrate was more effective than 95% silver nitrate at 2 weeks following application. The group treated with 75% silver nitrate had 88% complete resolution of epistaxis compared to 65% in the group treated with 95% silver nitrate (P = 0.01). No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic). The pain scores were significantly less in those treated with 75% silver nitrate, the mean score being 1 compared to a mean score of 5 in those treated with 95% silver nitrate; this was statistically significant (P = 0.001).

    References

    • Qureishi A, Burton MJ. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database Syst Rev 2012;(9):CD004461. [PubMed]

Primary/Secondary Keywords