Efficacy and Safety of Simultaneous Bilateral Nasal Cauterization in Pediatric Recurrent Anterior Epistaxis: A Prospective Randomized Controlled Trial.
Zhengcai Lou, Hailing Yang, Chaowei Zhao et al.
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In 30 seconds
This prospective randomized controlled trial compared simultaneous bilateral silver nitrate cautery (SNC), bipolar electrocautery (BEC), and radiofrequency coagulation (RFC) in children with bilateral recurrent anterior epistaxis. Among 106 patients analyzed, RFC had the highest successful hemostasis rate: 97.1%, compared with 85.9% for BEC and 73.4% for SNC (P < .01). Re-bleeding was also less frequent with RFC at 4 weeks, 6 months, and 12 months. Septal perforation occurred with both RFC and BEC, leading the authors to advise caution with bilateral RFC and consider staged BEC.
Key findings
- Successful hemostasis was 97.1% with RFC, 85.9% with BEC, and 73.4% with SNC (P < .01).
- At 12 months, re-bleeding rates were 0.0% with RFC, 5.1% with BEC, and 70.3% with SNC (P < .001).
- Septal perforation occurred in 2.9% of RFC patients and 5.1% of BEC patients; mucosal necrosis occurred in 6.4% of BEC-treated nostrils.
Why it matters
The trial suggests that cautery technique may substantially affect durable bleeding control in children with bilateral recurrent anterior epistaxis. The lower recurrence observed with RFC is clinically relevant, but the reported septal perforations underscore that improved hemostasis does not eliminate procedural risk. These comparative results can inform discussion of technique and safety while recognizing the need for caution with simultaneous bilateral treatment.
What to keep in mind
The abstract reports 106 patients analyzed despite 120 being randomized, without explaining the difference. Follow-up outcomes are reported through 12 months.