Nasal Cautery for Nosebleeds

What causes nosebleeds (epistaxis)?

The nose is lined with a special kind of moist skin called mucosa (or sometimes mucus membrane). The nose has a rich blood supply because one of its main functions is to warm and moisturize the air we breathe. These many blood vessels lie within and just underneath the mucosa. Nosebleeds happen when the mucosa is damaged and a blood vessel is exposed and breaks open. Nosebleeds in children are usually caused by nose-picking, dry air, frequent nose-blowing, nasal infections, and injuries to the nose.

At least half of children 6 to 10 years old will experience a nosebleed. If your child has frequent nosebleeds in childhood they do not typically continue into adulthood.

When is cautery considered for nosebleeds?

When the first nosebleed happens, the injured vessel takes a few days to heal completely. It is common for scabs and crusts to fall off or get picked out before the blood vessel is completely healed. This leads to bleeding that often occurs one or more times per day.

Cautery is considered when home treatment measures, such as nasal ointments, saline sprays, humidification, nasal rest, and time fail to substantially lessen or prevent nosebleeds.  When performed by an ear, nose, and throat provider nasal cautery is usually quite successful at decreasing frequency and severity of nosebleeds.

How is cautery performed?

Cautery consists of applying a chemical (silver nitrate) or heat energy (electrocautery) to the nasal lining to burn away problematic blood vessels. In young children and some older children, this is typically scheduled to be done in the operating room under general anesthesia. In older children and teenagers, chemical cautery can sometimes be performed in clinic with either no anesthesia or a small amount of topical numbing medicine. If general anesthesia is required you will have a chance to talk with the anesthesiologist on the day of surgery to discuss any questions you may have about the safety and risks of anesthesia.

Are there any instructions I need to follow before surgery?

Your child must have a physical examination by his or her primary care provider within 30 days before surgery.. The provider you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.

For your child's safety, it is very important they have an empty stomach when anesthesia is given. Please follow Children’s Hospitals’ Eating and Drinking Guidelines. If you do not follow these guidelines, your child's surgery will be cancelled.

What can I expect after nasal cautery?

Your child will wake up in the recovery room after surgery. When your child is awake, they will then be taken to the discharge area to complete their recovery. You can be with your child once he or she has been moved to the discharge area.

• There can be mild to moderate nasal soreness for a few days after the procedure. This can be treated with Tylenol® (acetaminophen) as needed. You will receive discharge paperwork indicating how much medicine can be used.
• There can also be small amounts of bleeding noted in days after surgery. Do not use Children's or adult Motrin® (ibuprofen) for 3 days after nasal cautery since it can increase the risk of bleeding.
• Depending on your procedure, use ointments such as Aquaphor® or bacitracin on the nasal septum for a few days after surgery. Your surgeon will give specific instructions for your child.

Questions?

The information provided in this brochure is not specific to your child. This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child’s physician.

If you have any questions, please call your Ear, Nose, and Throat clinic

Reviewed 11/2022

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