Randomized controlled trial comparing Nd:YAG laser photocoagulation and bipolar electrocautery in the management of epistaxis.

Abstract

The objective of this study is to evaluate the efficacy and degree of comfort of Nd:YAG laser photocoagulation compared to bipolar electrocautery in the management of epistaxis. Seventy-two consecutive patients with a history of epistaxis were randomly assigned to receive treatment in an outpatient setting consisting of either bipolar electrocautery (group 1) or Nd:YAG laser photocoagulation (group 2). The study was conducted in university-affiliated teaching hospital. Seventy-two consecutive patients who suffered from anterior epistaxis and presented to the Otolaryngology Department at the Eye, Ear, Nose and Throat Hospital, Fudan University, between June 2015 and August 2015. The following outcome measures were assessed: bleeding intensity, bleeding frequency 4 and 16weeks after treatment (0=no bleeding, 1=reduced bleeding, 2=the same, and 3=worse), participant perception of discomfort during treatment (grade 0-10, where 10 is the worst pain), and therapy duration and complications. At 16weeks, 91% of the laser patients versus 91% of the bipolar electrocautery patients had no reported bleeding. The outcome scores at 4 and 16weeks after treatment showed no significant difference between the two groups (P=0.5 and P=0.98, respectively; P>0.05). The median pain levels experienced during the office laser and bipolar electrocautery procedures were 3.0 and 4.0, respectively, and the median durations of the laser and electrocautery therapies were 3.0 and 4.0, respectively. Neither groups had complications. It can be concluded that Nd:YAG laser photocoagulation and bipolar electrocautery are both effective in the treatment of epistaxis. These two therapies are recommended. As a whole, these two therapies, performed in an office setting, are timely, efficacious, and well tolerated in the treatment of epistaxis.