Nasal cautery, or nasal cauterization, is a procedure used to treat nosebleeds (epistaxis). Nasal cautery is where a chemical or electrical device is applied to the mucous membranes in the nose to stop bleeding.
This procedure can be performed in the office with topical anesthetic or can be performed in an operating room under general anesthesia. Sometimes this procedure is performed in conjunction with other procedures to improve nasal breathing (ie: sinus surgery, nasal endoscopy, nasal cautery or septoplasty)
Typically, children benefit from nasal cautery when they have recurrent nosebleeds. These episodes can occur from a prominent blood vessel in the nose that bleeds from trauma (nose picking, rubbing nose, or bumping nose), from drying (dessication) of the mucous membranes lining the nose, or from another reason. Certain underlying medical conditions can make children more prone to nosebleeds, including individual or familial bleeding disorders, platelet disorders, cancers or medications used to treat other conditions.
If an underlying medical condition or medication is the cause of the nosebleeds, first attempts are aimed treating or removing these sources of tendency for bleeding.
In addition, nasal creams, ointments, gels (emollients), nasal saline spray and increased environmental humidification can help improve the nosebleeds by decreasing the dryness in the nose. This makes the nose less prone to bleeding.
Avoidance of trauma (nose picking, manipulation), especially in young children, is important.
If nosebleeds continue despite these attempts, nasal cautery may be recommended.
The procedure is typically performed either in the pediatric ENT clinic procedure room, or in an operating room. The procedure usually takes about 5-10 minutes, but can take longer depending on the severity and any additional combined procedures planned. The surgeon provides an idea of how much time is expected, but this may change during the procedure. If done awake in the office, topical anesthetics and decongestants are typically used to decrease discomfort.
Before and after surgery: a pediatric nurse prepares the child for the procedure, assists the pediatric ENT surgeon during the procedure, and cares for the child after the procedure.
Anesthesiology: If the procedure takes place in the operating suite, the child is placed under general anesthesia by a pediatric anesthesiologist. At Nationwide Children’s, subspecialty-trained pediatric anesthesiologists regularly provide pediatric anesthesiology services for patients undergoing surgical procedures. It is important that the parent meet with the anesthesiologist prior to the procedure.
Surgery: A pediatric ENT surgeon may use specialized telescopes to systematically evaluate the nasal airway in conjunction with specialized nasal instruments. If additional procedures are needed, additional special instruments may be used to perform these procedures.
After the procedure: This is typically an outpatient procedure, unless combined with other procedures requiring overnight stay in the hospital.
The child may be more fussy than usual. Some minor nosebleeds or nasal drainage is normal after the procedure and is a normal part of the healing process.
Tylenol or ibuprofen is typically appropriate for pain control. Sometimes stronger narcotic pain medications may be prescribed for additional pain control.
Typically frequent use of topical moisturizing and/or antibiotic ointment in the nose is recommend after the procedure. This helps healing and decreases crusting.
If the child develops any concerning symptoms after the procedure, including pauses in the breathing, color change of the skin (particularly if the lips, face, or hands are turning blue), appearing lethargic or tired, severe bleeding or any other sudden change from his/ her normal behavior, please seek immediate medical attention.
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