Introduction: Epistaxis is a widespread distressing complaint in otolaryngology. Spontaneous pediatric nosebleeds are a major source of distress to patients and their caregivers due to their repetitive and idiopathic nature. Apart from conservative measures, chemical cauterization is a main pillar of treatment due to being minimally invasive and highly efficient. Silver nitrate is the main agent used for epistaxis control. Trichloroacetic acid "TCA" is used in a widely used cauterization agent. There are no enough previous studies assessing TCA efficacy in managing idiopathic epistaxis.

Purpose: To compare the outcomes of TCA to silver nitrate chemical cauterization in managing pediatric epistaxis.

Method: Prospective randomized double blinded clinical trial, 160 pediatric patients with idiopathic anterior epistaxis were divided into 2 groups in a ratio 1:1 where group (A) treated with silver nitrate 15 % after local anesthesia application (B) were treated with 15% TCA locally applied to the bleeder. Patients were assessed upon recurrence, pain and crusting during and 3 months after completing their treatment protocol.

Results: Recurrence of epistaxis showed a non-significant difference between the two groups.The pain was significantly higher in TCA group (P=0.006*). Crusting was slightly higher in TCA group, but it was statistically non-significant.

Conclusion: TCA is considered an effective chemical cautery agent for the management of childhood epistaxis with comparable results to silver nitrate agent.

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