Background Adenoidectomy is a popular surgical technique in the feld of otolaryngology that is successful, safe, and efective. Difuse microvascular post-adenoidectomy bleeding, on the other hand, is still a common concern. Aim The objective of this study is to do a comparison between the efcacy of a hot saline pack versus topical tranexamic acid when administered topically in children who have had only adenoidectomy in terms of intra-operative blood loss and post-operative bleeding. Methods This prospective case-control study contained a total of 180 patients, divided into three classes. Class A: This included 60 patients with application of a hot saline pack in control of intra-operative adenoidectomy bleeding. Class B: This included 60 patients with application of a topical tranexamic acid pack in control of intra-operative adenoidectomy bleeding. Class C: This included 60 patients with the use of a pack to hold intra-operative adenoidectomy bleeding Results The mean intraoperative blood loss in class B was lower than classes A and C, the mean pre- and post-operative HB level was lower in class C than in classes A and B, the diference was statistically considerable between the three classes, comparison between classes showed statistically considerable diferences between classes A and C and also between classes B and C, while there was a statistically non-considerable diference between classes A and B. Conclusion The current study found that a topical tranexamic acid pack was more efective for post-adenoidectomy haemostasis than a hot saline pack, with a shorter time to haemostasis and fewer recurettage and electrocauterization procedures