Alum Usage for Control of Epistaxis as an Alternative to Silver Nitrate

Abstract

Background and Aim: Silver nitrate is well known as an effective topical treatment for epistaxis. It has some disadvantages like the local burn extension and the noxious smell that stimulates lacrimation and sneezing. Alum, on the other hand, has been used in the medical field to control bleeding by different specialties. If alum which does not have silver nitrate disadvantages can control epistaxis more efficiently, it would be a better alternative. The aim of this study is to compare the efficacy and the outcome of silver nitrate and alum in control of epistaxis. Methods: This is an experimental animal study on 15 rabbits divided into 3 groups. A similar incision was made in the nose of all rabbits in the 3 groups. In the first group silver nitrate was used to stop bleeding, in the second alum was used and the third was left for spontaneous cessation of bleeding. The mean time needed for cessation of bleeding was measured and compared. One week later, one biopsy from the healed incision was taken from group 1 and another biopsy from group 2 for histopathology. Results: The bleeding stopped faster in the second group, for which alum was used, in comparison to the other two groups. The histopathological findings in the biopsies taken showed better healing in the wound on which the alum was used. Conclusions: Alum is a better alternative to silver nitrate in control of epistaxis. It controls bleeding in a shorter time, and also result in better healing characteristics when compared to silver nitrate.

References

1. 1.Little JJ. An effective method of controlling secondary hemorrhage. Laryngoscope 1932;42:207-8.
2. 2.Lioyd S, Almeyda J, Di Cuffa R, Shah K. The effect of silver nitrate on nasal septal cartilage. Ear Nose Throat J 2005;84:41-4.
3. 3.Pond F., Sizeland A. Epistaxis. Strategies for management. Aust Fam Physician 2000;29:933-8
4. 4.Hanif, J, Tasca RA, Frosh A, Ghufoor K, Stirling R. Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times. Clin Otolaryngol Allied Sci 2003;28:368-70.
5. 5.Ahmed AE, Abo El-Magd EA, Hasan GM, El-Asheer OM. A comparative study of propranolol versus silver nitrate cautery in the treatment of recurrent primary 34 Majmaah Journal of Health Sciences ,Vol. 8, Issue 3, September - 2020 , Muharam - 1442 Alum Usage for Control of Epistaxis as anAlternative to Silver Nitrate epistaxis in children. Adolesc Health Med Ther 2015;30:165-70. [6]WangL.,VogelD.H.Posteriorepistaxis: comparison of treatment. Otolaryngol Head Neck Surg 1981;89:1001-6.
6. 6.Simmen D. B., Raghavan U., Briner H. R., Manestar M., Groscurth P., Jones N. S. The anatomy of the sphenopalatine artery for the endoscopic sinus surgeon. Am J Rhinol 2006;20:502–5
7. 7.Sevki C, Levent A, Ender G, Firdevs M. Reduction of house-dust mite allergen concentrations in carpets by aluminium potassium sulfate dodecahydrate (alum). Allergy Asthma Proc 2006;27:350-3.
8. 8.Nurmi M, Puntala P, Torniainen K. Alum irrigation in the treatment of severe haemorrhage from the bladder. Ann Chir Gynaecol 1987 Jan;76:173–5.
9. 9.Schootstra R, van Driel MF, Hassankhan R, van deWerff R, Oremus ET, Uges DR, et al. The use of an alum irrigation in the treatment of massive bladder haemorrhage. Pharm Weekbl Sci 1989;11:175–8.
10. 10.Mohammed FI, Shafagoj YA. Antiaggregation effect of alum on human platelets. Int J Clin Pharmacol Ther 2001;39:322–4.
11. 11.Goel AK, Rao MS, Bhagwat AG, Vaidyanathan S, Goswami AK, Sen TK. Intravesical irrigation with alum for the control of massive bladder hemorrhage. J Urol 1985;133:956–7.
12. 12.Goswami AK, Mahajan RK, Nath R, Sharma SK. How safe is 1% alum irrigation in controlling intractable vesical hemorrhage?. J Urol 1993;149:264–7.
13. 13.Shahriari R., Salari S, Shahriari S. In vitro study of concentration-effect and time-course pattern of white alum on Escherichia coli O157:H7 growth. Afr J of Tradit Complement Altern Med 2017;14:311-8. [15 Rafieian N, Abdolsamadi H, Moghadamnia A, Jazayeri M, Seif-Rabiee M, Salmanzadeh M, et al. Efficacy of alum for treatment of recurrent aphthous stomatitis. Caspian J Intern Med 2016;7:201-5.
14. 14.Abt D, Bywater M, Engeler DS, Schmid HP. Therapeutic options for intractable hematuria in advanced bladder cancer. Int J Urol 2013;20:651–60.
15. 15.Seear MD, Dimmick JE, Rogers PC. 1990. Acute Aluminum Toxicity Af- Majmaah Journal of Health Sciences ,Vol. 8, Issue 3, September - 2020 , Muharam - 1442 35 Alum Usage for Control of Epistaxis as anAlternative to Silver Nitrate ter Continuous Intravesical Alum Irrigation for Hemorrhagic Cystitis. Urology 1990;36:353-4.
16. 16.Ostroff EB, Chenault OW Jr.Alum irrigation for the control of massive bladder hemorrhage. J Urol 1982;128:929–30.
17. 17.Arrizabalaga M, Extramiana J, Parra JL, Ramos C, Díaz González R, Leiva O. Treatment of massive haematuria with aluminous salts. Br J Urol 1987;60:223–6.
18. 18.Kennedy C, Snell ME, Witherow RO. Use of alum to control intractable vesical haemorrhage. Br J Urol 1984;56:673–5.
19. 19.Praveen BV, Sankaranarayanan A, Vaidyanathan S. A comparative study of intravesical instillation of 15(s) 15 Me alpha and alum in the management of persistent hematuria of vesical origin. Int J Clin Pharmacol Ther Toxicol 1992;30:7–12.
20. 20.Ghahestani SM, ShakhssalimN. Palliative Treatment of Intractable Hematuria in Context ofAdvanced Bladder Cancer:A Systematic Review. Urol J 2009;6:149-56.
21. 21.Miodosky M, Abdul-Hai A, Tsirigotis P, Or R, Bitan M, Resnick IB, et al. Treatment of post-hematopoietic stem cell transplantation hemorrhagic cystitis with intravesicular sodium hyaluronate. Bone Marrow Transplant 2006;38:507–11.
22. 22.Paes TRF, Marsh GDJ, Morecroft JA, Hale JE. Alum solution in the control of intractable haemorrhage from advanced rectal carcinoma. Br J Surg 1986;73:192.
23. 23.Kavoussi LR, Gelstein LD, Andriole GL. Encephalopathy and an elevated serum aluminum level in a patient receiving intravesical alum irrigation for severe urinary hemorrhage. J Urol 1986;136:665–7.
24. 24.Phelps KR, Naylor K, Brien TP, Wilbur H, Haqqie SS. Encephalopathy after bladder irrigation with alum: case report and literature review. Am J Med Sci 1999;318:181–5.
25. 25.Murphy CP, Cox RL, Harden EA, Stevens DA, Heye MM, Herzig RH. Encephalopathy and seizures induced by intravesical alum irrigations. Bone Marrow Transplant 1992;10:383–5.
26. 26.Perazella M, Brown E. Acute aluminum toxicity and alum bladder irrigation in patients with renal failure.Am J Kidney Dis 1993;21:44–6.
27. 27.Shoskes DA, Radzinski CA, Struthers NW, Honey RJ. Aluminum toxicity and death following intravesical alum irriga- 36 Majmaah Journal of Health Sciences ,Vol. 8, Issue 3, September - 2020 , Muharam - 1442 Alum Usage for Control of Epistaxis as anAlternative to Silver Nitrate tion in a patient with renal impairment. J Urol 1992;147:697–9.
28. 28.Perini JA, Angeli-Gamba T, Alessandra-Perini J, Ferreira LC, Nasciutti LE, MachadoDE. TopicalapplicationofAcheflan on rat skin injury accelerates wound healing: a histopathological, immunohistochemical and biochemical study. BMC Complement Altern Med 2015;30:203.