Nasal Cautery - Procedure and Associated Risk Factors

Introduction:

Nasal cautery or nasal cauterization is a minor procedure that helps treat the nose bleed, also known as epistaxis. Nose bleeds occur when the nose erodes, exposing the blood vessels that break down, causing bleeding. This can occur due to trauma, hypertension (high blood pressure), and infections.

In nasal cautery, a chemical or electrical device is applied to the mucous membrane of the nose to stop bleeding. This procedure is usually performed with local anesthesia, or it can also be performed under general anesthesia.

What Is Nose Bleed?

Nose bleed is also known as epistaxis. This usually occurs when one of the blood vessels in the nose bursts due to trauma, infection, allergic reaction, nose-picking, or a foreign object in the nostril. This is common in the case of children and is not that serious, but if the bleeding does not stop or a person has frequent or prolonged nosebleeds, medical attention is needed.

The blood vessels of the nose are very fragile, and the vessels present in the nasal septum (the tissue between the nostrils that divides the nose into two parts) are the common ones that get burst easily, causing a nosebleed.

What Are the Causes of Nose Bleeds?

Nose bleeding or epistaxis can be caused by various factors that include -

Local Causes -

• Bursting of fragile blood vessels, commonly in warm, dry air or after a heavy workout.

• Chronic sinusitis.

• Nose picking (epistaxis digitorum).

  Related Topics

  ---

  Pediatric Tracheostomy - An Overview

  What are the ways to treat infection of nasal passage?

  What to Do If You or Your Child Suddenly Start Bleeding from the Nose?

• Due to the presence of foreign bodies.

• Irritants such as cigarette smoke.

• Medications such as topical corticosteroids.

• Rhinitis (swelling of the mucous membrane of the nose).

• Nasal septal deviation or perforation.

• Trauma.

Systemic Causes -

• Hemophilia (a bleeding disorder in which blood does not clot).

• Hypertension (high blood pressure).

• Leukemia (a type of cancer affecting the ability of the body to infection).

• Liver disease.

• Medications (such as Aspirin, anticoagulants, and nonsteroidal anti-inflammatory drugs).

Who Can Get Nose Bleeds?

Any person can get nose bleeds, however, certain people are more likely to get nose bleeding as compared to others which include -

• Children between the age of two to ten. Putting objects and fingers, dry air, cold, and allergies make them more prone to nosebleeds.

• Adults between the age of 40 to 60 are more likely to have a nosebleed as they start to have systemic conditions like hypertension, taking blood-thinning drugs, or having a bleeding disorder.

• In pregnant women, the blood vessels in the nose expand in pregnancy, putting more pressure on the fragile blood vessels of the nose.

What Is Nasal Cautery?

Nasal cautery is a minor and effective surgical procedure to treat nose bleeds due to damaged blood vessels. Nasal cauterization aims to seal the ruptured blood vessels with the help of electric currents or chemicals.

In the case of chemical cauterization, a cautery device, usually a silver nitrate stick, is used, which releases nitric acid, causing a minor controlled chemical burn at the bleeding point. This is performed under local anesthesia and one nostril at a time, but it can also be performed in both nostrils in rare cases.

In the case of electric cauterization, an electric cautery device is used and performed under general anesthesia.

How Is This Procedure Performed?

The nasal cautery is typically performed by an ENT specialist (ear, nose, and throat) and in an operating room. It usually takes around 10 to 15 minutes but can take longer, depending on the severity of the condition or any additional planned procedure. The steps include the following -

• The patient is to sit upright in a chair, but it can also be reclined according to convenience.

• Firstly, topical anesthesia, either spray or gel or a small packing or cotton ball, can be placed in a nostril. This helps in reducing the discomfort and stopping any active bleeding in the nose.

• After that, packs are removed, and the nasal cavity is thoroughly inspected for bleeding points or ruptured blood vessels.

• Then, the silver nitrate cautery stick is applied to the bleeding points with slight pressure for a few seconds. This will create a minor precise burn and will seal the blood vessels.

• In case both nostrils are being treated, the surgeon will consider the amount of burning performed and try to minimize it. In addition, making a burn on the direct opposite areas of each nostril is also avoided to avoid any complications.

• After the procedure, the surgeon will apply a small amount of antibiotic or moisturizing ointment, or a small dissolvable dressing can be applied to the treated areas.

• If the bleeding cannot be stopped, the surgeon might need to place a small pack in the nose for 2 to 48 hours.

What Are the Post-operative Instructions?

Cautery is a very effective technique for treating nose bleeds. Some of the following instructions have to be followed to avoid any complications such as -

• Blowing from the nose should be avoided for at least one week.

• Sneeze with an open mouth.

• Keeping the head in an elevated position.

• Avoid any rigorous physical activity.

• Avoid lifting heavy objects.

• The medicine or ointment has to be applied regularly.

During this procedure, the chemical applied by the cautery forms a scab that appears dark grey. It is advised to the patient to protect this operated area from any trauma or disturbance as it can hinder the healing and may cause bleeding again.

What Are the Risks Associated With This Procedure?

The risks of this procedure are minor if performed adequately. However, given below are some of the risks associated with cauterization, such as -

• The most common risk associated with chemical cauterization is the dripping of silver on the skin of the upper lip and face leading to discoloration of the skin, usually dark brown, which disappears after a few days or weeks.

• Some patients can have minor discomfort, such as feeling light-headed or fainting (rarely).

• Septal perforation is an uncommon complication that can occur if the operated area gets infected and does not heal, leading to a small hole in the nasal septum. This may lead to nose bleeding, a feeling of nasal blockage, and occasionally a whistling sound while breathing from the nose.

• Moreover, in some cases, cautery may also need to be repeated either on one or both sides once the initial area of treatment has healed.

Conclusion:

Nasal cautery is a very brief and effective procedure for treating minor nose bleeds and preventing their recurrence. It is a safe procedure with rare complications and can be repeated until adequate healing.