Topical 15% trichloroacetic acid versus silver nitrate cauterization in the management of idiopathic childhood epistaxis: a prospective randomized clinical trial

Abstract The purpose of the study is to compare the outcomes of trichloroacetic acid (TCA) to silver nitrate chemical cauterization in managing pediatric epistaxis. In this prospective randomized assessor-blinded clinical trial, of 172 randomized patients, 157 pediatric patients with idiopathic anterior epistaxis were divided into 2 groups in a ratio 1:1, where group (A) was treated with silver nitrate 25% after local anesthesia application and group (B) was treated with 15% TCA locally applied to the bleeder. Patients were assessed upon recurrence, pain, and crusting at 1st, 2nd, 4th, and 12th week post-intervention. The incidence of epistaxis was not significantly different between the two groups. Pain was significantly greater in the TCA group ( P = 0.008*). Nasal crusting was slightly greater in the TCA group, but the difference was not statistically significant. Conclusion : Although not widely utilized in the management of pediatric epistaxis, TCA is considered an effective chemical cautery agent for the management of childhood epistaxis, with results comparable to those of silver nitrate in terms of recurrence but was slightly worse in terms of pain after intervention. Trial Registration : Number NCT06836791, Date of registration 02/19/2025. What is Known: • Epistaxis is a very distressing complaint in pediatric otorhinolaryngology. • One of the utilized modalities nowadays that proved efficacy in the management of epistaxis is the chemical cauterization of the prominent vessels in Little’s area. What is New: • This is the first study to compare the efficacy of silver nitrate to TCA in epistaxis treatment. • TCA is considered an effective chemical cautery agent for the management of childhood epistaxis, with results comparable to those of silver nitrate agent.