Clinical Question: Does petroleum jelly reduce the likelihood that epistaxis will recur in children?

Setting: Outpatient (specialty)

Study Design: Randomized controlled trial (single-blinded)

Synopsis: In this small but well-designed study, investigators identified 105 children one to 14 years of age who were referred to otolaryngologists for recurrent epistaxis. The median duration of symptoms was 12 months, and the median duration of bleeding was five minutes. The children were randomized (allocation concealed) to receive one of two letters: instructions to apply petroleum jelly twice daily for four weeks and keep a nosebleed diary, or simply instructions to keep a nosebleed diary. Patients were assessed after eight weeks, and the primary outcome was the percentage of children with recurrent bleeds in the previous four weeks. Analysis was by intention to treat, and the physician assessing outcomes was blinded to treatment assignment and did not ask about treatment adherence until the end of the visit.

The two groups were similar at baseline. They also were similar after the intervention; 27.5 percent of children in the treatment group and 33.9 percent of children in the control group (P = .47) had no bleeds during the four weeks before the visit and after the intervention. The study had limitations, though. Approximately 14 percent of patients never came in for evaluation (this was evenly split between groups), and most parents were noncompliant with the diaries. Therefore, the researchers used parental recall instead of the diaries to assess the primary outcome.

Bottom Line: In this highly selected group of patients with recurrent epistaxis, petroleum jelly applied twice daily for four weeks did not reduce the number of nosebleeds in the subsequent four weeks. This outcome raises questions about this commonly recommended treatment. However, it may work in children with less severe disease in the primary care setting, and there was the potential for recall bias by parents in this study. (Level of Evidence: 2b)