Concierge ENT · UK
Nasal septum cauterisation for recurrent nosebleeds, by a consultant ENT surgeon.
A short office procedure to seal the bleeding vessel in Little’s area - with conservative measures tried first, the right anaesthetic on the day, and a rhinologist who knows never to cauterise both sides at once.
Why patients choose us
- 01
A consultant ENT surgeon, not a walk-in
A named rhinologist identifies the bleeding point and treats it properly - not a rushed silver-nitrate touch in a busy A&E.
- 02
Conservative measures first, honestly
Naseptin, Bactroban, humidification and technique advice come before the cautery stick. We say when it is actually needed.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What private nasal cautery costs in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
Office silver nitrate cautery in our network: £250–£500, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Office silver nitrate cautery (unilateral) | £250–£500 | 10–15 min | Same visit |
| Second session (opposite side, later date) | £250–£500 | 10–15 min | Same visit |
| Theatre electrical/RF cautery under LA | £600–£1,200 | 20–30 min | Same visit |
| Theatre cautery under GA | £1,200–£2,400 | Half-day | Same visit |
| KTP laser cautery (HHT, multiple sites) | £1,500–£3,000 | 30–45 min | Same visit |
| ENT consultation only | £200–£350 | 30 min | Same visit |
Prices vary by clinic, by which ENT surgeon does the case, and by whether office silver nitrate is enough or theatre-based electrical cautery is needed. We come back with a firm quote within one working day.
The problem
Conservative measures first, cautery when they are not enough.
Recurrent nosebleeds are quietly one of the most over-treated ENT problems in the private market - cautery offered before Naseptin, both sides done at once, or a posterior bleed sent to an office. We fix all three.
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Have you tried the basics?
Two weeks of Naseptin, humidification and no picking clears most bleeds. We say so before booking a cautery.
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Which side is bleeding?
A rhinologist with a headlight identifies the actual vessel - not a blind touch across the whole septum.
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Both sides at once? No.
Bilateral cautery in one session risks a septal perforation. If both need doing, we stage them.
The journey
From enquiry to recovery - what happens, in order.
One clinician from first message to review - including the aftercare window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A short visit to the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. How often the nosebleeds happen, which side, medications, and whether conservative measures have been tried.
- 02
Before
We come back with a recommendation
Within one working day: whether office silver nitrate is enough, or whether theatre electrical cautery is the right call. An indicative price.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Any anticoagulant is reviewed with the team beforehand and you are told exactly how to prepare.
- 04
On the day
Arrival at the clinic
Arrival, consent and a rhinoscopic examination with a headlight. Decongestant and local anaesthetic spray applied.
- 05
On the day
The procedure itself
10 to 15 minutes in a rhinology chair. Silver nitrate applied to the bleeding vessel and surrounding mucosa - one side only per session.
- 06
On the day
Home the same day
A short recovery, Naseptin or Bactroban to take home, written aftercare, and back to school or work the same day.
- 07
After
Recovery and review
Mild crusting settles over one to two weeks. No nose-blowing or picking. A review is arranged if bleeds recur.
Typical end-to-end: 1–2 weeks from enquiry to procedure. Full healing: 1–2 weeks.
When it helps
When nasal cautery is the right step.
The situations we see most, plus the one red flag that means A&E rather than an office appointment.
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Recurrent anterior nosebleeds
Repeated bleeds from Little’s area (Kiesselbach plexus) despite conservative measures - the commonest reason for cautery.
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Digital trauma in children
Nose-picking on a dry or crusted septum is by far the commonest paediatric cause. Cautery once conservative care has failed.
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Dry nasal mucosa
Central heating, air conditioning and mouth-breathing dry the septum. A prominent vessel then bleeds on minimal contact.
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Anticoagulant or antiplatelet use
Warfarin, DOACs, aspirin or clopidogrel make small bleeds larger. Cautery works, but medications are reviewed first.
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HHT (hereditary telangiectasia)
Multiple fragile vessels across the septum - a specialist rhinology case, often better served by KTP laser than silver nitrate.
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Post-viral or post-surgical crusting
A recent cold, sinus surgery or septoplasty can leave friable mucosa that bleeds repeatedly until it is cauterised.
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Uncontrolled hypertension
Bleeds are heavier and harder to stop when blood pressure is high. We check BP and coordinate with your GP before cautery.
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Red flag: heavy posterior bleed
Blood pouring down the back of the throat, unable to stop with 20 minutes of pinching - this is a posterior bleed and needs A&E, not an office visit.
Procedure options
Silver nitrate is not the only option.
What each option on the table actually involves - and which fits which problem.
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Office silver nitrate cautery
A 75–95% silver nitrate stick applied to the bleeding vessel for 5–10 seconds under topical anaesthetic. The first-line, and enough in most cases.
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Theatre electrical / RF cautery
Monopolar or bipolar coagulation of a larger or refractory bleeding point. Needs intense local or a general anaesthetic.
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KTP laser cautery
Specialist rhinology, mostly for HHT with multiple telangiectatic sites where silver nitrate is impractical or ineffective.
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Combined techniques
Silver nitrate for the main vessel plus adjuvant electrical cautery for a satellite point - chosen in the room, not in advance.
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Conservative measures first
Naseptin or Bactroban ointment for 2 weeks, petroleum jelly, humidification and technique advice. Always tried before the cautery stick.
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Anticoagulation review
Warfarin, DOAC, aspirin or clopidogrel reviewed with your prescriber. Never stopped without advice - the risk each way is real.
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Posterior packing (severe bleed)
Not cautery. A different procedure for posterior epistaxis with nasal tampons or a Foley balloon - typically an A&E or admission situation.
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ENT consultation only
An honest discussion of whether cautery is needed at all, and which type fits - no obligation.
Our vetted UK network
A small panel of rhinologists, we picked them.
Consultant ENT surgeons with a rhinology interest, across London and the major UK cities. Not listed publicly - introductions are made privately, once we understand your case.
Selection criteria
How we choose every ENT surgeon in our network.
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Consultant ENT surgeons with a rhinology interest, not trainees
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Proper headlight rhinoscopy and identification of the bleeding point
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Conservative measures discussed before the cautery stick comes out
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Never bilateral septal cautery in the same session - perforation risk taken seriously
Safety and recovery
What to expect afterwards - honestly.
Nasal cautery is a short, safe office procedure. The things worth planning are your aftercare ointment, the no-blowing window, and knowing what a septal perforation is and how to avoid it.
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One side only per session
Bilateral cautery of the same septal cartilage area risks a septal perforation. If both sides need treating, we stage them weeks apart.
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Stinging is normal, briefly
A short stinging sensation as the silver nitrate contacts the mucosa. It settles within minutes and the area is numbed beforehand.
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Black staining is transient
Silver nitrate leaves a black mark on the treated area for a few days. It is not a burn and it fades.
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No nose-blowing for one to two weeks
A gentle sniff is fine; a hard blow lifts the healing crust and restarts the bleed. Sneeze with the mouth open.
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Naseptin or Bactroban for two weeks
A short course of ointment moisturises the mucosa and reduces staph carriage, which lowers the chance of recurrence.
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Humidification helps
A bedroom humidifier, or a bowl of water on the radiator, keeps the septum from drying out and cracking again.
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Septal perforation is uncommon
It happens with over-aggressive cautery or bilateral treatment in one session - both are avoided by an experienced rhinologist.
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Recurrence rate is low
Around 80–95% of anterior septal bleeds are controlled with one session of silver nitrate. A minority need a second session or electrical cautery.
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Red flags
Heavy bleeding you cannot stop with 20 minutes of firm pinching, or blood pouring down the back of the throat, needs A&E - not another cautery.
Reading your procedure note
Your procedure note in four parts. Read the last one first.
Whichever technique was used, the note the ENT surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and side treated
Why the procedure was done - recurrent right- or left-sided epistaxis - and which side of the septum was cauterised on the day.
- 02 Technique
Anaesthetic and cautery method
Whether co-phenylcaine spray or lidocaine gel and adrenaline pledgets were used, and whether silver nitrate or electrical cautery was applied.
- 03 Findings
Bleeding point and adjacent mucosa
Notes on the identified vessel in Little’s area, any satellite points, and the condition of the surrounding septal mucosa.
- 04 Impression
Aftercare, ointment, review timing
Read this first: Naseptin or Bactroban plan, no-blowing window, humidification advice, and whether a review is needed if bleeds recur.
Recognised by major UK insurers
Cover for nasal cautery varies by insurer - usually funded for recurrent epistaxis after a GP referral. We confirm cover before booking.
Frequently asked
Everything we get asked about nasal cautery.
Quick answers on pain, cost, aftercare, and when a nosebleed needs A&E rather than an office visit.
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What is nasal septum cauterisation?
A short office procedure to seal a bleeding vessel on the front of the nasal septum - Little’s area, or Kiesselbach plexus. Silver nitrate is applied to the vessel for 5–10 seconds after the nose is numbed with a decongestant spray. It is the standard treatment for recurrent anterior nosebleeds when conservative measures have failed.
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Does nasal cautery hurt?
Not much. The nose is numbed first with a co-phenylcaine spray (lidocaine and phenylephrine) or lidocaine gel with adrenaline pledgets. You feel a brief stinging as the silver nitrate touches the mucosa, then it settles. No injections into the nose.
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Why can only one side be cauterised at a time?
Because bilateral cautery of the same area of septal cartilage in a single session cuts the blood supply from both sides and risks a septal perforation - a small hole through the cartilage. If both sides need treating, sessions are staged four to six weeks apart.
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How much does private nasal cautery cost in the UK?
Around £250–£500 for office silver nitrate cautery, £600–£1,200 for theatre-based electrical or RF cautery under local, and £1,200–£2,400 under general anaesthetic. KTP laser (usually for HHT) sits at £1,500–£3,000. An ENT consultation is £200–£350.
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What should I try before cautery?
Firm pinching of the soft part of the nose for 15–20 minutes continuously while sitting upright and leaning forward, ice on the bridge, then two weeks of Naseptin (chlorhexidine and neomycin) or Bactroban ointment, petroleum jelly at night, and a humidifier. Most simple bleeds settle with this. Cautery is for recurrence despite it.
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How long does recovery take?
You go home the same day and back to school or work immediately. Mild crusting on the treated area lasts one to two weeks. No nose-blowing, no picking, gentle sniffs, ointment for two weeks. Sneeze with your mouth open.
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Can children have nasal cautery?
Yes - nose-picking on a dry septum is the commonest cause of childhood nosebleeds and silver nitrate cautery works well. Very young children (under three) sometimes need theatre and a light general anaesthetic because the local anaesthetic and sitting still are difficult.
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When should I go to A&E instead?
If firm pinching for 20 minutes does not stop the bleed, if blood is pouring down the back of your throat, if you feel faint or if you are on strong anticoagulants and the bleed is heavy - these suggest a posterior bleed or a coagulation problem, which need packing, embolisation or admission rather than an office cautery.
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