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A double-blind randomized controlled trial of management of recurrent nosebleeds in children

Nicholas Calder1, Swee Kang, Lyndsay Fraser

  • 1Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland. ncalder@hotmail.com

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|April 28, 2009
PubMed

Insights

Silver nitrate cautery combined with antiseptic nasal cream offers a statistically significant benefit for managing pediatric epistaxis compared to antiseptic cream alone. This combined treatment improves symptoms in over 90% of children with nosebleeds.

Area of Science:

  • Otolaryngology
  • Pediatric Medicine
  • Medical Treatments

Background:

  • Epistaxis, or nosebleeds, is a common pediatric condition.
  • Current management often involves conservative measures.
  • The efficacy of combining silver nitrate cautery with antiseptic nasal cream requires further investigation.

Purpose of the Study:

  • To determine if a treatment regimen of silver nitrate cautery and 4 weeks of antiseptic nasal cream is superior to antiseptic cream alone for pediatric epistaxis.
  • To evaluate the effectiveness of combined therapy in reducing recurrent nosebleeds.

Main Methods:

  • A double-blind randomized controlled trial was conducted.
  • Children with epistaxis and visible anterior septal vessels were randomized.
  • Participants received either silver nitrate cautery plus antiseptic cream or sham cautery plus antiseptic cream for 4 weeks.

Main Results:

  • A total of 109 patients were randomized, with 93 providing results.
  • Children receiving silver nitrate cautery and antiseptic cream showed a statistically significant improvement in symptoms (91.3%) compared to those receiving only antiseptic cream (70.2%).
  • While not statistically significant for complete cessation of bleeding (45.7% vs 29.8%), the combined treatment demonstrated a notable benefit.

Conclusions:

  • Silver nitrate cautery with antiseptic cream provides a small but statistically significant benefit for pediatric epistaxis when subjective symptom improvement is the primary outcome.
  • The number needed to treat (NNT) was approximately 4.7, indicating a favorable treatment effect.
  • This regimen represents a valuable therapeutic option for managing recurrent nosebleeds in children.
Abstract

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