Interventions for recurrent nosebleeds of unknown cause in children

Burton MJ, Doree C

Published Online:

January 21, 2009

Nosebleeds in children usually just stop by themselves or after pinching the nose. However some children get repeated nosebleeds with no specific cause (recurrent idiopathic epistaxis). The most common treatments are cautery and/or antiseptic cream. Cautery (sealing with heat) can be painful even with local anaesthetic, and usually involves using a silver nitrate stick to seal off a visible blood vessel inside the nose that may be rupturing. Other options include ointments and nasal sprays. The review of trials found there is not enough evidence to compare the effectiveness of different treatment options. More research is needed to show the best options for reducing recurrent nosebleeds of unknown cause in children.

Abstract (click to read)

Background:

Recurrent idiopathic epistaxis (nosebleeds) in children is repeated nasal bleeding in patients up to the age of 16 for which no specific cause has been identified. Although nosebleeds are very common in children, and most cases are self-limiting or settle with simple measures (such as pinching the nose), more severe recurrent cases can require treatment from a healthcare professional. However, there is no consensus on the effectiveness of the different clinical interventions currently used in managing this condition.

Objectives:

To assess the effects of different interventions for the management of recurrent idiopathic epistaxis in children.

Search strategy:

We searched the Cochrane ENT Group Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library Issue 4, 2007), MEDLINE (January 1950 to October 2007), EMBASE (January 1974 to October 2007), CINAHL (January 1982 to October 2007) and reference lists of relevant articles.

Selection criteria:

We identified all randomised controlled trials (with or without blinding) in which any surgical or medical intervention for the treatment of recurrent idiopathic epistaxis in children was evaluated in comparison with either no treatment, a placebo, or another intervention, and in which the frequency and severity of episodes of nasal bleeding following treatment was stated or calculable. The full text articles of all the retrieved trials of possible relevance were reviewed by the two authors and the inclusion criteria applied independently.

Data collection and analysis:

We graded trials for methodological quality using the Cochrane approach. Data extraction was performed in a standardised manner by one author and rechecked by the other, and where necessary investigators were contacted to obtain missing information. A meta-analysis was not undertaken because of the heterogeneity of the treatments, procedures and quality of the included trials. A narrative overview of the results is therefore presented.

Main results:

Three studies (two randomised controlled trials (RCTs) and one controlled clinical trial (CCT)) involving 256 participants satisfied the inclusion criteria. One RCT compared Naseptin® antiseptic cream with no treatment, the second RCT compared Vaseline® petroleum jelly with no treatment and the CCT compared Naseptin® antiseptic cream with silver nitrate cautery. Overall, results were inconclusive, with no statistically significant difference found between the compared treatments. No serious adverse effects were reported from any of the interventions, although children receiving silver nitrate cautery reported that it was a painful experience (despite the use of local anaesthetic).

Authors' conclusions:

The optimal management of children with recurrent idiopathic epistaxis is unknown. High quality randomised controlled trials comparing interventions either with placebo or no treatment, and with a follow-up period of at least a year, are needed to assess the relative merits of the various treatments currently in use.

This record should be cited as:

Burton MJ, Doree C. Interventions for recurrent idiopathic epistaxis (nosebleeds) in children. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004461. DOI: 10.1002/14651858.CD004461.pub2

Assessed as up to date:

September 30, 2007

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Primary Review Group:

Ear, Nose and Throat Disorders Group

Health topics:

Ear, nose, & throat > Nose & sinus > Nosebleed

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Interventions for recurrent nosebleeds of unknown cause in children

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