A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary epistaxis in children

Abstract

Ahmed E Ahmed,1 Essam A Abo El-Magd,2 Gamal M Hasan,3,4 Osama M El-Asheer3 1Pediatric Department, Qena University Hospital, Faculty of Medicine, South Valley University, Qena, Egypt; 2Otorhinolaryngology Department, Aswan University Hospital, Faculty of Medicine, Aswan University, Aswan, Egypt; 3Pediatric Department, Assiut University Children's Hospital, Faculty of Medicine, Assiut University, Assiut, Egypt; 4Pediatric Department, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia Background: Epistaxis is a common medical problem in pediatric population. Although in most cases it is mild and self-limiting, a proportion of childhood epistaxis is massive, recurrent, or resistant to conventional management. Objective: To compare effectiveness of propranolol as a treatment option for childhood epistaxis versus conventional silver nitrate cautery. Study design and methodology: This is a prospective interventional comparative study that was carried out during a period of 1 year (January 1, 2013 to December 31, 2013) at Qena University Hospital and Assiut University Children's Hospital. One hundred children aged 6–12 years who presented with epistaxis to Qena University Hospital and Assiut University Children's Hospital during the study period and fulfilling the inclusion criteria were included in the study. They were randomly assigned into one of two interventional groups, where 50 children were treated with oral propranolol (propranolol treatment group) and another 50 children were treated with conventional silver nitrate cautery (cauterization treatment group) for their epistaxis. Propranolol was given at a dose of 1.5–2 mg/kg/day (divided into three doses). Patients were followed for 6 months after their discharge for recurrence of epistaxis. Results: Both groups of patients showed minimal recurrent epistaxis with rates of 14% for propranolol treated group and 12% for cauterization group, with no statistically significant difference between both groups. Local pain was found to be more in patients treated with silver nitrate cauterization. Conclusion: Treatment of primary epistaxis with propranolol or silver nitrate cautery showed equal rates of recurrence, and local nasal pain was slightly more among silver nitrate cauterization treated group. Propranolol could be a favorable treatment option for patients with primary epistaxis. Further studies that include multiple centers and larger number of patients are recommended for more clarification of the effectiveness of such treatment option. Keywords: propranolol, silver nitrate cautery, epistaxis, children