Silver Nitrate

How it works

On contact with moist mucosa it releases silver ions that precipitate tissue proteins, producing a controlled coagulative chemical burn that seals superficial bleeding vessels.

Prescribing in practice

• Cauterise only one side of the septum at any single sitting and avoid cauterising both sides opposite each other, as bilateral septal cautery risks septal perforation.
• Apply to a clean, topically anaesthetised, accessible anterior bleeding point under direct vision; it is unsuitable for posterior or briskly active bleeds where the source cannot be seen.
• Limit the contact area and duration to the visible vessel, as excess application causes unnecessary mucosal injury and can leave grey-black argyric staining.

Monitoring

No systemic monitoring is required; review for re-bleeding, septal healing and any persistent crusting or discomfort at follow-up.

Counselling the patient

• Expect a temporary grey or black mark and mild stinging at the treated spot.
• Avoid nose-picking, forceful blowing and nasal trauma while it heals.
• Use any prescribed nasal moisturiser and seek review if bleeding recurs.

Evidence & guidelines

Chemical cautery of Little's area is an established first-line measure for recurrent anterior epistaxis in UK ENT and emergency practice.