Skip to main content

Intranasal cautery for the management of adult epistaxis: systematic review

  • R W J Mcleod (a1), A Price (a1), R J Williams (a2), M E Smith (a3), M Smith (a4) and D Owens (a1)...
Abstract Background:

Cauterisation techniques are commonly used and widely accepted for the management of epistaxis. This review assesses which methods of intranasal cautery should be endorsed as optimum treatment on the basis of benefits, risks, patient tolerance and economic assessment.


A systematic review of the literature was performed using a standardised methodology and search strategy.


Eight studies were identified: seven prospective controlled trials and one randomised controlled trial. Pooling of data was possible from 3 studies, yielding a total of 830 patients. Significantly lower re-bleed rates were identified (p < 0.01) using electrocautery (14.5 per cent) when compared to chemical cautery (35.1 per cent). No evidence suggested that electrocautery was associated with more adverse events or discomfort. Limited evidence supported the use of a vasoconstrictor agent and operating microscope during the procedure. The included studies had considerable heterogeneity in terms of design and outcome measures.


Consistent evidence suggests that electrocautery has higher success rates than chemical cautery, and is not associated with increased complications or patient discomfort. Lower quality evidence suggests that electrocautery reduces costs and duration of hospital stay.

Corresponding author
Address for correspondence: Mr Robert Mcleod, ENT Department, University Hospital of Wales Main Building, Heath Park, Cardiff University, Cardiff CF14 4XN, Wales, UK E-mail:
Hide All
1 Key, G. Stopping nosebleeds in the elderly: pressure, cautery, or packing? Geriatrics 1981;36:7480
2 Frazee, TA, Hauser, MS. Nonsurgical management of epistaxis. J Oral Maxillofac Surg 2000;58:419–24
3 Barnes, ML, Spielmann, PM, White, PS. Epistaxis: a contemporary evidence based approach. Otolaryngol Clin North Am 2012;45:1005–17
4 Badran, K, Arya, AK. An innovative method of nasal chemical cautery in active anterior epistaxis. J Laryngol Otol 2005;119:729–30
5 Bray, D. A third hand for nasal cautery. Clin Otolaryngol 2007;32:209
6 Alderson, D. Simple device for chemical cauterization of posterior bleeding points in the nose. J Laryngol Otol 2000;114:616–17
7 Benson, M, Carlsson, L, Adner, M, Jernas, M, Rudemo, M, Sjogren, A et al. Gene profiling reveals increased expression of uteroglobin and other anti-inflammatory genes in glucocorticoid-treated nasal polyps. J Allergy Clin Immunol 2004;113:1137–43
8 Eng, CY, Hilmi, O, Ram, B. “Sheathed” silver nitrate stick to cauterise posterior epistaxis. Ann R Coll Surg Engl 2004;86:475–6
9 Judd, O. Novel method for safe cauterisation of posterior epistaxis. J Laryngol Otol 2009;123:910–11
10 Maitra, S, Gupta, D. A simple technique to avoid staining of skin around nasal vestibule following cautery. Clin Otolaryngol 2007;32:74
11 Nikolaou, G, Holzmann, D, Soyka, MB. Discomfort and costs in epistaxis treatment. Eur Arch Otorhinolaryngol 2013;270:2239–44
12 Mackway-Jones, K. The management of anterior epistaxis. J Accid Emerg Med 1999;16:61–2
13 Toner, J, Walby, A. Comparison of electro and chemical cautery in the treatment of anterior epistaxis. J Laryngol Otol 1990;104:617–18
14 Khan, M, Conroy, K, Ubayasiri, K, Constable, J, Smith, ME, Williams, RJ et al. Initial assessment in the management of adult epistaxis: systematic review. J Laryngol Otol. In press
15 Soyka, MB, Nikolaou, G, Rufibach, K, Holzmann, D. On the effectiveness of treatment options in epistaxis: an analysis of 678 interventions. Rhinology 2011;49:474–8
16 Henderson, AH, Larkins, A, Repanos, C. The use of bipolar electrocautery in adult epistaxis management: using audit of one hundred and twenty-four cases to define a standardised protocol. Clin Otolaryngol 2013;38:554–8
17 Ando, Y, Iimura, J, Arai, S, Arai, C, Komori, M, Tsuyumu, M et al. Risk factors for recurrent epistaxis: importance of initial treatment. Auris Nasus Larynx 2014;41:41–5
18 Shargorodsky, J, Bleier, BS, Holbrook, EH, Cohen, JM, Busaba, N, Metson, R et al. Outcomes analysis in epistaxis management: development of a therapeutic algorithm. Otolaryngol Head Neck Surg 2013;149:390–8
19 Nicolaides, A, Gray, R, Pfleiderer, A. A new approach to the management of acute epistaxis. Clin Otolaryngol 1991;16:5961
20 Mattoo, O, Yousuf, A, Mir, A, Muzaffar, R, Pampori, R. Control of anterior epistaxis: a comparative analysis of the decongestive effect of xylometazoline and adrenaline in idiopathic epistaxis in emergency settings. Clin Rhinol 2011;4:130–5
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 7
Total number of PDF views: 56 *
Loading metrics...

Abstract views

Total abstract views: 391 *
Loading metrics...

* Views captured on Cambridge Core between 27th December 2017 - 20th March 2018. This data will be updated every 24 hours.