Epistaxis is one of the most common emergencies presenting to the ENT service, and silver nitrate cautery is the mainstay of epistaxis treatment in most centres worldwide. This review aimed to ascertain the historical evidence behind current common practice.

A review was conducted of historical published literature pertaining to epistaxis management.

Silver in medicine dates back to 4000 BC, with silver nitrate first being used in 69 BC. Modern medical use for epistaxis is documented in case reports over the last 200 years.

The precise origin and evidence-based practice of using silver nitrate for epistaxis is not well-established or understood. The mechanism of action is questionable; novel research of silver nitrate for this common ENT emergency presentation may be required.

This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate.

This technique aims to prevent unwanted damage to surrounding nasal mucosa.

Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa.

This study compared the efficacy of microwave ablation and silver nitrate cautery as treatments for idiopathic recurrent anterior epistaxis in adults.

A case series with chart review was conducted. Adults with recurrent anterior epistaxis intra-operatively treated via microwave ablation or silver nitrate chemical cautery of the anterior nasal septum were enrolled. The primary outcomes were the proportion of patients in each group for whom bleeding ceased within 24 hours of treatment, and the time to successful haemostasis. The secondary outcomes were re-bleeding rates at 1 and 12 weeks and 6 months, and complications.

The haemostasis success rate within 24 hours’ treatment of convex lesions was significantly higher in the microwave ablation group than in the cautery-only group. Of patients with convex lesions, the recurrence rate to six months was significantly higher in the cautery group than in the microwave ablation group, but this was not the case for those with flat lesions.

Microwave ablation afforded rapid and simple haemostasis for adults with recurrent anterior epistaxis in an out-patient setting. Microwave ablation had significant advantages compared to silver nitrate cautery when used to treat epistaxis in patients with convex lesions.

Silver nitrate cautery and bipolar electrocautery are commonly used in the treatment of epistaxis. Currently, there are no recommendations on optimum contact times or power for nasal cautery. ENT consultant practice in the UK has not previously been evaluated.

This study examined the burn depth associated with silver nitrate (75 per cent concentration) cautery and bipolar electrocautery on porcine septum samples, using varying contact times and power. ENT consultants completed a survey evaluating their practice.

ENT consultant practice of nasal cautery was shown to vary widely. Silver nitrate cautery with a contact time of less than 30 seconds does not cause a full thickness burn. The findings lend some support to bilateral cauterisation with silver nitrate. Bipolar electrocautery should be set at lower than 10 W and with a contact time of less than 4 seconds to reduce the risk of complications associated with a full thickness burn.

Sir Morell Mackenzie (1837–1892), the pre-eminent early laryngologist in the UK, is nowadays perhaps better remembered for his role in the management of the Crown Prince of Germany in 1887, than for his major contribution to the development of laryngology as a specialty. In this article we focus upon his text The Pharmacopoeia of the Hospital for Diseases of the Throat (fourth edition), and attempt a comparison of Victorian ENT treatments with today's management of ENT diseases.

Some of these Victorian treatments bear a resemblance to modern day practices. Others have not withstood the test of time, in particular: silver nitrate sticks for syphilitic ulcers of the larynx (not epistaxis); nebulised sulphuric acid, which was used as a stimulant; nasal bougies, including scotch pine and lead acetate; chloroform vapour for the treatment of hay fever; ‘London paste’, a non-surgical treatment for the reduction of the tonsils, (which was perhaps the Victorian equivalent of coblation); and zinc chloride darts, which were plunged into intractable goitres.

Some of these remedies bear no resemblance to today's evidence-based practices, while other treatments (such as silver nitrate) are still in common use. In Victorian times, however, Mackenzie's books were widely read throughout Europe and were the standard references for a specialty in its infancy. The Pharmacopoeia was published in 1872, and major advances in medicine have been made since then. We have no way of knowing which treatments in today's British National Formulary will still be in use in 140 years.