Nasal Cauterization, or, Scott Faints

If a person has been having frequent nose bleeds, it is most likely caused by an exposed blood vessel in their nose. Even if the nose is not bleeding at the time, it is cauterized to prevent future bleeding. The different methods of cauterization include burning the affected area with acid, hot metal, lasers, or silver nitrate. Such a procedure is naturally quite painful. Sometimes liquid nitrogen is used as a less painful alternative, though it is less effective. In the few countries that permit the use of cocaine for medicinal purposes, it is occasionally used topically to make this procedure less uncomfortable, cocaine being the only local anesthetic which also produces vasoconstriction, making it ideal for controlling nosebleeds.

- Wikipedia, “Cauterization“

I’ve been having frequent nose bleeds my whole life, as best I can recall. I finally went in to an ENT this morning to get the sucker cauterized. They don’t use cocaine for it around here, or lasers, or hot metal, or acid. They do sometimes use electric cauterization, but my ENT starts with silver nitrate and goes from there. The silver nitrate comes on a stick and the thing looks exactly like one of those big fireplace matches. But they don’t light it. The Wikipedia article says that they wet it, then rub it around in there. It also says that the stick is called a “lunar caustic”, which sounds pretty cool. You can buy these sticks on Amazon. These wouldn’t be a lot of fun at home, I don’t believe. I didn’t notice my ENT wetting it, but she might have. But let me back up.

This was the first time I’ve seen this (or any) ENT, so she wanted to get a good look up in the old nose. She sprayed up in there with some numbing stuff, which tasted extremely bitter as it came out the back of my nose into my throat, then let that sit there for five or ten minutes. While she was rummaging around in a drawer for something, I saw she had one of those “head mirrors” in there. I chuckled at that, since I don’t think I’ve ever seen one of those in real life before. Check out the Straight Dope column on the subject, from 1993:

Just about all doctors used head mirrors at one time and they became, along with the stethoscope, one of the symbols of the profession. But they could be a bit of a hassle to use and they did make you look like a space alien, so today many doctors prefer a penlight or other examining device. Some ENT (ear-nose-throat) specialists still use head mirrors, though, so look one up if you get nostalgic.

Fifteen years later and it’s still true. Though to be honest, she never put on the head mirror, it just sat in the drawer the whole time.

Anyway, the doctor then ran some thin flexible probably fiber-optic scope up my left nostril, then my right, both time inserting it far enough that I could feel it coming out my ears. Wayyyyy past the spot where I get my nosebleeds, anyway. And I only get them in one nostril. But, you know, doctors always need to look around. The scope was uncomfortable. Not painful, but not pleasant.

She determined that I had a misshapen septum and some nasal polyps, all of which contribute to my frequent mouth-breathing. I’m not sure I’ve ever heard of anybody ever going to an ENT and not being told they have a misshaped septum, which could be surgically corrected to let them breathe better. So that wasn’t a surprise. The polyps, on the other hand… meh. She said they were pretty symmetric across both nostrils, and that and other signs indicated they were probably not, you know, cancer. But she’d still like to at least get a biopsy sometime to make sure. Or maybe they should be removed, to improve breathing and sinus function. In which case they’d grow back, but if you’re lucky, it would take eight to ten years. Or maybe they should just be removed at the same time I get that septum surgery that everyone on earth seems to need.

I shrugged — with a knowledgeable shrugging air about me — quite a bit during this discussion. I mouth breathe a lot but it doesn’t bother me much and I can’t smell much of the time, which is a little worse, but I’ve also seen what the recovery from nasal surgery looks like and my personal opinion at this time is that it isn’t worth it.

On to the main event: the cauterization. I’d had a nose bleed in the middle of the night, actually, so locating the spot was a piece of cake. She cleaned and suctioned it to get off a bit of scab (I didn’t feel a thing) then started rubbing the silver nitrate matchstick on the spot. Starting from slight discomfort, this grew into a small pain, then a medium sized one, and a bit beyond that. She sprayed some more numbing stuff in there and kept going a little bit. The pain wasn’t that bad, really.

But between the scoping and the cauterization, I guess my body said “enough”. I had what might be a vasovegal episode. As she was finishing up, I started getting that shocky feeling you get — you know, like when you cut yourself deeply on the thumb or something? I’ve had this happen once before, when getting a chalazion in my eyelid incised. Next I started feeling lightheaded, a bit dizzy. The doctor made sure I was ok and had me lie back for a while. I think at its worst I might have passed out or been on the verge of it: I suddenly felt like I had been sleeping and wasn’t sure what was going on for a few seconds. As the doctor left the office to wait for me to recover, I started sweating profusely. Soon I was feeling better, not dizzy, not shocky, but the intense cold sweat lingered and soaked through the front of my shirt.

Soon that was over too, and the doctor gave me post-procedure instructions: saline spray four times a day, antibiotic ointment twice. She warned me I might have a mild sore throat as the silver nitrate tricked down. In fact, I already did. As the numbing stuff wore off, my nose felt worse and worse too. It’s been an uncomfortable four hours since then, but I think I can feel it getting better already.

Update, Dec 8, 2008:

It took longer than I expected to feel healed up from the cauterization. I was never debilitated, but my nose hurt on and off for days, and not just at the cauterization site. Instead, the pain kind of crept around the cartilage areas of the lower nostril, and I’d also get sympathetic pains in my teeth and jaw on that side. The scabs that formed inside my nose would be very annoying as well.

For a procedure that doesn’t need any pain meds, it’s pretty annoying.

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