Abstract
Objective
Establish whether selective application of combined silver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.
Methods
We performed a prospective randomised controlled trial. All children referred with recurrent epistaxis were seen in a research clinic. Patients with visible anterior septal vessels were invited to participate and were randomised to receive either treatment or control. Allocation was made using opaque, sealed and shuffled sequentially numbered envelopes.
Treatment patients received silver nitrate cautery followed by 4 weeks of Naseptin. Control patients received sham cautery (using the inactive end of the caustic applicator) followed by Naseptin for 4 weeks. The patients were reviewed after 8 weeks and the outcome measure was ‘no reported bleeding’ in the preceding 4 weeks. Any reported bleeding was defined as treatment failure. A power calculation was made based on a previous study by the department: 108 participants were required.
Results
229 children attended and 109 met the inclusion criteria and were randomised. Complete data is currently available for 80. Of those receiving cautery and Naseptin, 18/38 (47.4%) had no bleeding in the preceding 4 weeks and of those receiving only Naseptin, 12/42 (28.6%) had no bleeding. (Chi-squared=3, p=0.08). This gives a relative risk reduction of 26% and a number needed to treat of 5.5.
Conclusions
Silver nitrate cautery and 4 weeks of Naseptin cream is superior to Naseptin treatment alone in the management of recurrent paediatric epistaxis.
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