Many people experience at least one nosebleed in their lifetime. Though they can be frightening, they usually require nothing more than leaning forward and pinching your nostrils together for a few minutes to stop the bleeding.
However, if nosebleeds become recurrent or troublesome enough that your clothes start to resemble a performer at Fear Farm, nose cauterization, which is also known as nose cautery may be recommended.
Yeah, nose cauterization. Have you ever heard of it? This article will explain all there is to know about nose cauterization; its procedures, where it can be done, and other critical things you need to know about nose cauterization.
So, let’s proceed.
What is Nose Cauterization?
Nasal cautery or nose cauterization is a procedure used to treat nosebleeds (epistaxis). Nose cauterization1Nasal Cautery - Nationwide Children's Hospital 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).
Common causes of nosebleeds include:
- Sinus infections
- Frequent sneezing
- Trauma to the nose
Performing Nosebleed Cauterization
Nosebleed cauterization can help prevent nosebleeds2https://en.wikipedia.org/wiki/Cauterization if they become a recurring problem. During the procedure, the doctor will numb the inside of your nose. They will then use either a chemical swab or an electric current (known as electrosurgery) to seal the blood vessels. This stops the bleeding and helps prevent additional bleeding by building up scar tissue.
Generally, you are seated upright in a chair, but you may also be reclined, or lying down. Your ENT surgeon will first apply a numbing solution, either as a spray or on a small packing or cotton wool ball, to the nostrils.
This helps minimize any discomfort from the procedure, and can also help to initially slow any active bleeding. After any packs have been removed, the nasal cavity is thoroughly inspected to identify prominent blood vessels or bleeding points.
The silver nitrate stick is then applied to these points with light pressure for a few seconds at a time, to create a minor, precise burn, sealing the blood vessels.
If both sides of the nose are treated, your surgeon will be careful to minimize the amount of burning performed, and will try to avoid burning directly opposing areas of each nostril, so as to avoid complications.
After this is complete, your surgeon may apply a small amount of moisturizing or antibiotic ointment, or a small dissolvable dressing into the nostril against the treated areas. If there is any initial vigorous bleeding, your surgeon may need to use a small suction device to help clear away the blood.
In the rare event that bleeding becomes hard to control with cautery alone, your surgeon may need to place a small pack, back into the nose for a period of time (2-48 hours).
Watch the video below to know more on this procedure:
Why Would You or Your Child Need Nose Cauterization?
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 the nose, or bumping nose), from drying (desiccation) 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 at treating or removing these sources of tendency for bleeding.
What Should You Expect on the Day of the Nose Cauterization Procedure?
The procedure is typically performed either in the 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 meets 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.
What Should I Expect After You or Your Child have had Nose Cauterization?
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 recommended after the procedure. This helps to heal and decreases crusting.
If there is any development concerning symptoms after the procedure, including pauses in 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.
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, nose cauterization may be recommended.
Recovery After Nose Cauterization
For the first few hours after your procedure, make sure to take it easy. Don’t engage in any strenuous exercise or activity and try not to bend over or lift anything heavy. After that time, you should be able to resume your normal activities whenever you feel ready.
Nose cautery can help prevent nosebleeds. The doctor uses a chemical swab or an electric current to cauterize the inside of the nose. This seals the blood vessels and builds scar tissue to help prevent more bleeding.
For this procedure, your doctor made the inside of your nose numb. After the procedure, you may feel itching and pain in your nose for 3 to 5 days which is normal. Over-the-counter pain medicines can help with pain. You may feel like you want to touch, scratch, or pick at the inside of your nose. But doing this may cause more nosebleeds.
Your doctor will also likely recommend an antibacterial ointment or saline nasal spray to apply to the inside of your nose. Apply this several times a day for 10 days to keep the area moist and help prevent infection.
A care sheet gives you a general idea about how long it will take for you to recover. But each person recovers at a different pace. Follow the steps below to feel better as quickly as possible.
How can you care for yourself at home?
- Don't touch the part of your nose that was treated.
- Try not to bump your nose.
- To avoid irritating your nose, do not blow your nose for 2 weeks. Gently wipe it one nostril at a time.
If you get another nosebleed:
- Gently blow your nose to clear any clots.
- Sit up and tilt your head slightly forward. This keeps blood from going down your throat.
- Use your thumb and index finger to pinch your nose shut for 5 minutes. Use a clock. Do not check to see if the bleeding has stopped before the 5 minutes are up. If the bleeding has not stopped, pinch your nose shut for another 10 minutes.
Apply antibacterial ointment or saline nasal spray to the inside of your nose several times a day after your procedure. This will help keep the area moist and help with healing.
Until your doctor says it's okay:
- Don't bend over or lift anything heavy.
- Avoid heavy exercise or activity.
You can do your normal activities when it feels okay to do so.
Your doctor will tell you if and when you can restart your medicines. The doctor will also give you instructions like the following about taking any new medicines:
- If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
- Be safe with medicines. Read and follow all instructions on the label.
- If the doctor gave you a prescription medicine for pain, take it as prescribed.
- If you are not taking prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
- Avoid aspirin and NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) while your nose is healing. They can increase the risk of bleeding.
Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse advice line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.
When should you call for help?
Call your emergency care provider number anytime you think you may need emergency care. For example, call if:
- You passed out (lost consciousness).
- Call your doctor or nurse advice line now or seek immediate medical care if:
- You have pain that does not get better after you take pain medicine.
- You get another nosebleed and your nose is still bleeding after you have pinched your nose shut for 15 minutes.
- There is a lot of blood running down the back of your throat even after you pinch your nose and tilt your head forward.
- You have a fever.
- Watch closely for any changes in your health, and be sure to contact your doctor or nurse advice line if:
- You still get nosebleeds often, even if they don't last long.
- You do not get better as expected.
Things to Avoid
- Don’t pick or scratch at the inside of your nose. Even though it may feel itchy, touching the area is likely to cause more nosebleeds.
- Try not to hit or bump your nose on anything, as this may cause additional bleeding.
- Don’t blow your nose for two weeks or until your doctor has told you it is OK. Stick to wiping your nose gently if you need to, as blowing your nose can cause irritation.
- Don’t take aspirin and NSAIDs like ibuprofen while you heal as they can increase the risk of bleeding.
How Much Does Nose Cauterization Cost?
Benefits of Nose Cauterization
Generally, the procedure is brief and very effective in arresting minor nose bleeds, and preventing recurrence. It is performed under local anesthetic and so recovery is quick and can be repeated as required, as long as there is adequate healing.
Are There any Risks Associated with Nose Cauterization? - Is Nose Cauterization Safe?
Precisely performed, the risks of nasal cautery are minor. The most common risk is that the silver in the cauterized area drips out onto the skin of the upper lip and face, and can non-permanently discolor the skin, usually a dark brown. If this happens it disappears after a few days to weeks.
The minor discomfort may cause some patients to briefly feel light-headed, or rarely, faint – though this is very uncommon. An uncommon, but the important complication is septal perforation. There is a small chance that an area of cautery can become infected, and/or fail to heal, possibly leading to a small hole in the septum (the party wall dividing the nostrils).
If this does happen, it often doesn’t cause any symptoms, but may cause further nose bleeds, a feeling of nasal blockage and crusting, and occasionally a whistling noise when breathing through the nose. It can be repaired where required, with an operation.
Lastly, nose cauterization may need to be repeated, either on the same side or on the opposite side, once the first area of treatment has healed.
Alternatives to Nose Cauterization
There are a number of topical creams and ointments that your surgeon may use prior to considering nasal cautery – these are usually combinations of moisturizers, antiseptics or antibiotics, and sometimes blood vessel constrictors. Some examples include Vaseline®, Chlorsig®, Nasalate®, Bactroban® Nasal Ointment, FESS® nasal gel, paw paw cream.
Sometimes, small dissolvable dressings are used where cautery is less likely to be successful or tolerated – For example, in patients on blood-thinning agents, or where the bleeding is from a more diffuse, raw area of the nasal lining.
Some patients would prefer to have the procedure under a general anesthetic, and in these cases, electro-cautery is more likely to be used.
The Verdict on Nose Cauterization
Nasal cautery is generally very well tolerated and is often performed successfully in young children3Nasal Cautery - Melbourne ENT Group (MEG) as well as adults. The most common aspect of this part of the procedure is some brief stinging discomfort when the silver nitrate stick is applied to the nasal lining, even with good local anesthetic numbing.
Discomfort may actually ‘recur’ 30 mins to an hour after the procedure, as the numbing solution begins to wear off. This mild throbbing/aching sensation settles down over the next few hours, but may need some simple pain relief such as paracetamol or ibuprofen.
Afterwards, your surgeon will give you simple first aid advice, and encourage you to minimize nasal trauma such as nose blowing and excessive wiping for a week or so.
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Frequently Asked Questions on Nose Cauterization
For this procedure, your doctor made the inside of your nose numb. After the procedure, you may feel itching and pain in your nose for 3 to 5 days. Over-the-counter pain medicines can help with pain. You may feel like you want to touch, scratch, or pick at the inside of your nose.
This may take up to 4 weeks to settle down. Our Surgeons advise the use of a nasal saline spray (FESS) at least four times a day to help keep the nasal lining moist and facilitate recovery.
You should call your doctor if: You have pain that isn't helped by prescribed pain medications. You get a nosebleed that persists after more than 30 minutes of pinching your nose. There is blood running down the back of your throat.
The smell may retain packing or is commonly associated with turbinate resection or cauterization.
Additional resources and citations
- 1Nasal Cautery - Nationwide Children's Hospital
- 3Nasal Cautery - Melbourne ENT Group (MEG)