Efficacy and Safety of Simultaneous Bilateral Nasal Cauterization in Pediatric Recurrent Anterior Epistaxis: A Prospective Randomized Controlled Trial

Abstract

Objective

We compared the efficacy and safety of simultaneous bilateral silver nitrate cautery (SNC), bipolar electrocautery (BEC), and radiofrequency coagulation (RFC) for the treatment of pediatric bilateral recurrent anterior epistaxis (RAE).

Materials and Methods

Children with bilateral RAE were prospectively randomized to receive SNC (n = 40), BEC (n = 40), or RFC (n = 40). The primary outcome measures were successful hemostasis and re-bleeding at 4 weeks, 6 months, and 12 months. Secondary outcomes included the requirement for postoperative analgesia, visual analog scale (VAS) pain scores, and procedure-related complications.

Results

In total, 212 nostrils of 106 patients were analyzed. The rates of successful hemostasis were 73.4%, 85.9%, and 97.1% in the SNC, BEC, and RFC groups, respectively (P < .01). At 4 weeks, the re-bleeding rates were 45.3%, 19.2%, and 2.9% in the SNC, BEC, and RFC groups, respectively (P < .01). At 6 months, re-bleeding occurred in 59.4% of SNC patients, 11.5% of BEC patients, and 0% of RFC patients (P < .001). At 12 months, the re-bleeding rates were 70.3%, 5.1%, and 0.0% in the SNC, BEC, and RFC groups, respectively (P < .001). Significant differences were observed in VAS scores for nasal crusting across the three groups at all follow-up points; however, no significant difference was detected between SNC and RFC. In contrast, septal perforation was observed in 5.1% of BEC patients, with mucosal necrosis in 6.4% of treated nostrils. In the RFC group, septal perforation developed in 2.9% of patients.

Conclusion

RFC demonstrated higher hemostatic success and lower recurrence of epistaxis compared with SNC and BEC in the treatment of bilateral RAE, while bilateral cross-cauterization with RFC should still be used with caution given the incidence of septal perforation. Additionally, stepwise cauterization with BEC (treating each side after healing of the opposite side) should be considered when managing pediatric bilateral RAE.