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Background: Nasal obstruction due to hypertrophied turbinates (HT) is one of the common reasons for patients undergoing turbinate operations. This condition is associated with intraoperative nasal bleeding, which can obscure visibility of the field and prolong surgery time. Objectives: The purpose of this study is to compare dexmedetomidine-soaked nasal packing (NP) and intravenous (IV) dexmedetomidine (DEX) for managing bleeding during turbinate surgeries to reduce blood loss and improve surgical field quality. Methods: This randomized, double-blind trial was conducted on 60 patients aged between 18 and 65 years undergoing turbinate surgeries. Patients were randomly assigned into two equal groups: Group NP received DEX-soaked NP (1.5 µg/kg for 10 minutes) and an IV saline bolus followed by saline infusion. Group IV received a 0.5 µg/kg DEX bolus over 10 minutes, followed by a 0.1 - 0.4 µg/kg per hour IV infusion and saline-soaked NP. Results: The mean intraoperative blood loss was 124.1 ± 34.85 mL in group NP and 115.63 ± 31.89 mL in group IV, with no significant difference. Intraoperative hemodynamics, surgical field quality scores, time to first rescue analgesia, total postoperative pethidine consumption, pain score, patient satisfaction, and side effects were comparable. Conclusions: Dexmedetomidine NP is non-inferior to IV DEX for controlling intraoperative bleeding during turbinate surgery. Both methods provided comparable surgical field quality, patient satisfaction, and pain management outcomes. [ABSTRACT FROM AUTHOR]

A survey of otolaryngologists and advanced practice providers specializing in otolaryngology found that almost half of respondents always or almost always prescribed antibiotic prophylaxis after nasal packing for epistaxis, despite limited evidence supporting this practice. The frequency of antibiotic prescribing was not related to gender, degree, fellowship status, geographic region, or years of training. The results suggest a need for providers to carefully assess the appropriateness of routine antibiotic prescribing given the lack of benefits in the literature and potential serious adverse events. Shared decision-making with patients should play a greater role in prescribing practices until further research clarifies the uncertainty regarding antibiotic benefit. [Extracted from the article]

Background: Bioresorbable nasal packing is associated with a decreased incidence of adhesions and bleeding postoperatively after endoscopic sinus surgery (ESS). However, discomfort during postoperative debridement is still a major area of concern for patients. Our objective was to compare the efficacy of a peptide hydrogel to that of a chitosan‐based polymer in reducing pain during debridement after ESS. Methods: A prospective, multicenter, randomized, blinded trial was conducted in adults undergoing bilateral total ethmoidectomy for chronic rhinosinusitis. Participants served as their own controls with each subject receiving the hydrogel in a randomized ethmoid cavity and chitosan‐based polymer in the contralateral ethmoid cavity. Participants were evaluated at 1, 4, and 12 weeks postoperatively. Pain during debridement as well as endoscopic evaluation of mucosal healing and hemostasis were measured. Results: Thirty patients who underwent ESS were included in this trial. During the week 1 postoperative debridement, patients reported significantly less pain on the hydrogel‐treated side compared to the chitosan‐based polymer‐treated side. There were no significant differences in bleeding severity, Lund–Kennedy scores, debridement time, or need for further intervention between the two groups. Conclusion: This study demonstrated the efficacy of a peptide hydrogel in minimizing pain during postoperative debridement. [ABSTRACT FROM AUTHOR]

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion. [ABSTRACT FROM AUTHOR]

The goal of this American Rhinologic Society expert practice statement (EPS) is to summarize the best available evidence for technical factors that optimize outcomes in skull base reconstruction following endoscopic skull base surgery for intradural pathologies. These topics include the use of free mucosal grafts versus vascularized pedicled nasoseptal flaps; the use of autologous versus synthetic grafts; and the roles of lumbar drains, dural sealants, and nasal packing. This EPS was developed following the recommended methodology and approval process as previously outlined. As there are a myriad of techniques and limited agreement on the accepted principles of skull base reconstruction, this EPS aims to summarize the existing evidence and provide clinically meaningful guidance on these divergent practices. Following a modified Delphi approach, five statements were developed, four of which reached consensus and one of which reached near consensus. These statements and the accompanying evidence are summarized along with an assessment of future needs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Nosebleeds, or epistaxis, are a frequent emergency in the ear, nose, and throat (ENT) department.Epistaxis can arise from both local and systemic factors. Locally, bleeding can occur within the nasal cavity, either in the anterior or posterior region. The most common site of anterior epistaxis is Kiesselbach's plexus.Epistaxis management can be complex and requires a thoughtful approach, with most cases being successfully treated through conservative measures, while others may necessitate surgical intervention. MATERIALS AND METHODS: A hospital-basedprospective observational study was conducted in the Department of Otorhinolaryngology, Assam Medical College and Hospital for one year (1 st April 2023 to 31st March 2024) in patients presenting with epistaxis in Department of Otorhinolaryngology, AMCH. RESULTS: Most of the patients belonged to the age group of 41-50 years. Male: female ratio was 2.55%. Hypertension was the leading cause of nasal bleed in 28.125% of cases. This was followed by trauma in 25% of cases. Conservative management was the most common modality of treatment. CONCLUSION: This study provides insights into effective epistaxis management, emphasizing a tailored approach based on severity and cause, with conservative measures suitable for most cases and surgery reserved for a few. [ABSTRACT FROM AUTHOR]

Purpose: Removal of the current calcium alginate packing materials to the middle meatus in endoscopic sinus surgery (ESS) is usually accompanied by discomfort or pain owing to the hard and brittle nature of these materials. Plus moist HS-W® is a new calcium alginate packing material released in 2022 developed to overcome this issue by changing the uronic acid component. We aimed to compare the discomfort/pain during the removal of Plus moist HS-W® with Kaltostat®, as well as their suitability as packing materials in ESS. Methods: Kaltostat® and Plus moist HS-W® were used as packing materials in 22 and 21 patients who underwent ESS in 2021 and 2022, respectively. Patients were asked to rate the pain during the packing removal 10 days after ESS using the Numerical Rating Scale (NRS). The ratio of residual packing materials, number of suctions (insertions/extractions of the suction cannula), and time required to remove packing materials were measured. Postoperative complications such as hemorrhage, local infection, lateralization of the middle turbinate, and synechia of the middle meatus were also evaluated. Results: The Plus moist HS-W® group exhibited significantly lower NRS pain scores, a lower ratio of residual packing materials, a reduced number of suctions, and a shorter time required to remove the packing. No obvious postoperative complications occurred in both groups except for one suspicious case of a slight infection in the Kaltostat® group. Conclusion: Compared with Kaltostat®, Plus moist HS-W®, characterized by better gelatinization than Kaltostat®, benefits patients by minimizing discomfort/pain during removal. Level of evidence: Level 3. [ABSTRACT FROM AUTHOR]

Purpose: Posterior epistaxis is a common emergency in ENT practice varying in severity and treatment. Many management guidelines have been proposed, all of which are a product of retrospective analyses due to the nature of this pathology, as large-scale double-blind studies are impossible—even unethical—to conduct. The purpose of this review is to perform a thorough analysis and comparison of every treatment plan available and establish guidelines for the best possible outcome in accordance to every parameter studied. Given the extensive heterogeneity of information and the multitude of studies on this topic, along with the comparison of various treatment options, we opted for a literature review as our research approach. Methods: A review of the literature was performed using PubMed Database and search terms included "posterior epistaxis", "treatment", "management", "guidelines", "algorithm" "nasal packing", "posterior packing", "surgery", "SPA ligation", "embolization", "risk factors" or a combination of the above. Results: Initial patients' assessment invariably results in most cases in posterior packing. There seems to be a superiority in recent literature of early surgery over nasal packing as a definitive treatment. Embolization is usually used after surgery failure, except for specific occasions. Conclusion: Despite the vast heterogeneity of information, there seems to be a need for re-evaluation of the well-established treatment plans according to more recent studies. [ABSTRACT FROM AUTHOR]

Key Points: Nasal packing type was not associated with postoperative cerebrospinal fluid leaksNondissolvable packing conferred an increased risk for postoperative sinonasal infectionsNasal packing type did not influence short‐ and long‐term quality‐of‐life scores [ABSTRACT FROM AUTHOR]

Background: Due to a myriad of risk factors, epistaxis is a very frequent presentation to the emergency room (ER). This study aims to ascertain the prevalence of epistaxis in our population, risk factors, effectiveness of ER treatment, complications, and ER outcome.Materials and Methods: This was a prospective observational study performed in the ER of a referral tertiary care center in south India. Data were categorized, coded, and analyzed to determine the objective of the study. Results: During the study's six-month duration, 188 (0.6%) patients presented with epistaxis. The mean age was 42.9 (SD: 16.49) years, with a male preponderance of 143 (76.1%). A majority of these patients (n: 156; 82.9%) were triaged as priority II, with hypertension (n: 53, 28.2%) as the commonest comorbidities. Trauma-related epistaxis (n: 107, 56.9%) was the most frequent cause. Anterior nasal packing was carried out for 85 (45.2%) patients, posterior nasal packing was carried out for one (0.5%) patient, and bleeding had spontaneously resolved in the majority (n: 102; 54.3%) patients. Seven (3.7%; p-value: 0.001) patients had recurrent epistaxis, and of those, three (1.6%) required urgent resuscitation with crystalloid fluid and blood products. Two of these patients had bleeding dyscrasias, four had history of trauma, and one patient presented with uncontrolled hypertension. Two (1.1%) patients came back to us with recurrent bleeding within 12 h of discharge. Majority (69.2%; 130) were discharged stable, (23.9%; 45) were admitted for observation and (6.9%; 13) were discharged against medical advice. There was no mortality among these study populations. Conclusion: Middle-young, aged males most commonly presented with epistaxis. Most of them were secondary to trauma. Anterior nasal bleeding was the most common source and hemostasis could be obtained by anterior nasal packing. Majority could be discharged stable from the ER. However, this cohort had seen patients in life-threatening conditions, so the severity cannot be overlooked. [ABSTRACT FROM AUTHOR]

Effect of absorbable nasal packing saturated with ciprofloxacin and dexamethasone following endoscopic sinus surgery: A prospective cohort study Keywords: chronic rhinosinusitis; endoscopic sinus surgery; nasal packing; outcomes EN chronic rhinosinusitis endoscopic sinus surgery nasal packing outcomes 1801 1804 4 08/25/23 20230901 NES 230901 INTRODUCTION Enhancing wound healing in the immediate postoperative setting may reduce complications and improve outcomes after endoscopic sinus surgery (ESS).[[1], [3]] A certain combination of sinus rinses, nasal packing, antibiotics, or steroids is frequently prescribed. In this study we assess the effect of chitosan-based absorbable nasal packing saturated with ciprofloxacin and dexamethasone on postoperative wound healing using endoscopic Lund-Kennedy (LK) scores. [Extracted from the article]

Epistaxis means bleeding from nostrils, nasal cavity or nasopharynx. To summarize the available epistaxis treatment options. Methods: 61 articles published in the last 20 years were included. Duplicate records, irrelevant and inaccessible ones were excluded. Epistaxis can be treated with first aid measures such as external pressure and ice packing and applying topical agents, e.g. oxymetazoline that stops 65–75% of nosebleeds in A&E. Also, with electrocautery which is more effective and has fewer recurrences (14.5% vs. 35.1%) than chemical cauterization and applying tranexamic acid that promotes hemostasis in 78% of patients, versus 35% and 31% respectively in patients treated with oxymetazoline and nasal packing. Furthermore, nasal packing can be applied with non-absorbable materials, e.g. petroleum jelly, BIPP gauze, PVA nasal tampons (Merocel), Foley catheter, balloons (Rapid-Rhino), absorbable materials, e.g. nasal tampon (Nasopore), and with newer hemostatic materials which are more effective and with fewer complications, e.g. hemostatic gauzes (Surgicel), thrombin matrix (Floseal), gelatin sponge (Spongostan) and fibrin glue. Moreover, epistaxis can be achieved with endoscopic ligation of arteries, mainly SPA, which is more effective than conventional nasal packing (97% vs. 62%), and with endoscopic cauterization which is more effective than ligation. Finally, for intractable cases embolization can be applied using gelatin sponge, foam, PVA and coils with 80% success rate and comparable efficacy and complications to surgical methods. Epistaxis can be dealt with various methods depending on patient's history and available resources. Newer hemostatic agents in combination with endoscopic methods have advantages over traditional methods. [ABSTRACT FROM AUTHOR]

Epistaxis, commonly encountered in the Otolaryngology practice, refers to bleeding that occurs as a result of vascular pathologies and coagulation disorders. It can develop due to traumatic, iatrogenic, or spontaneous etiologies. In our study, we aim to retrospectively examine the epistaxis patients treated in our clinic to investigate the etiology causing epistaxis, associated diseases, and the use of anticoagulants-antiplatelets. Additionally, we plan to evaluate hemogram and coagulation parameters. The study included patients diagnosed with epistaxis and admitted for treatment at Samsun Education and Research Hospital ENT Clinic between 2019 and 2022. A retrospective analysis of the patients' medical records was conducted to gather data on demographic characteristics, comorbidities, medications used regularly, laboratory values, and clinical findings. A total of 130 patients were included in the study. No statistically significant difference was observed between the location of the bleeding focus and gender, presence of hypertension, use of antihypertensive medication, or anticoagulant use. When comparing patients with and without antiplatelet-anticoagulant use, a significantly longer nasal packing duration was found in patients who used these medications. In terms of the need for electrocauterization, statistically significant higher intervention rates were observed in patients who did not use anticoagulant medication. Our study identified a higher rate of surgical intervention in hospitalized epistaxis patients, potentially due to the inclusion of more severe cases requiring specialized care. Further research is needed to investigate the factors influencing the need for surgical management and to develop appropriate guidelines for the management of different severities of epistaxis. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. Methods: This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. Results: The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. Conclusion: It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways. [ABSTRACT FROM AUTHOR]

Background: Epistaxis is a common condition but with diverse etiology dependent on geography, season, climate, and demography. Aims and Objectives: To describe the demographic, clinical, and etiological profile and management strategies of epistaxis cases at a tertiary center in U.P. (west). Materials and Methods: Patients were identified from the emergency and outpatient department, and their demographic and clinical details were noted. Local examination was performed, and necessary investigations were carried out. Management strategies were noted. Duration of hospital stay and mortality, if any, was documented. Descriptive analytics were used. Data were represented as numbers and percentages, mean±standard deviation, and median. Results: A total of 189 epistaxis patients were enrolled in the study. The mean age of patients was 32.89±17.92 (range 1-85 years). The sex ratio (M: F) was 2.71. Majority of patients presented to the emergency department (60.3%) within 1 day (64.6%), had single episode (66.7%), the presence of old clot (72%) and the anterior location of bleeding (91.5%). 119 (63%) cases required admission. Nasal endoscopy and computed tomography scan were performed in 49 (25.9%) and 24 (12.7%) cases, respectively. The most common etiology was trauma (49.2%), followed by idiopathic cause (14.8%), hypertension (12.7%), and others. Nasal packing and cauterization were required in 16.4% and 15.9% of cases, respectively. Surgery was required in 5 (2.6%) cases. A minuscule percentage of cases required blood transfusion. There was no mortality. Conclusion: Epistaxis is a common emergency with males predominating over females. Causes are varied. Most patients can be managed conservatively with favorable outcomes if timely intervention is done. [ABSTRACT FROM AUTHOR]

Background: To help ensure adequate hemostasis immediately following potassium titanyl phosphate (KTP) laser treatment, many centres treating hereditary hemorrhagic telangiectasia (HHT) routinely use nasal packing post‐operatively. The purpose of this study was to compare hemostatic thrombin matrix with standard packing for postoperative bleeding, patient pain, and comfort. Methods: A prospective, randomized, double‐blinded, non‐inferiority study was conducted with participants at an HHT centre of excellence (COE) and randomized to the treatment group with reconstituted thrombin gelatin matrix (Surgiflo®) or control group with a biodegradable synthetic polyurethane foam (NasoPore®). Adult subjects with confirmed HHT and moderate to severe epistaxis (a minimum calculated epistaxis severity score [ESS] of 4.0) warranting KTP laser treatment were recruited. Data was collected 2 weeks post operatively by a blinded reviewer completing a visual outcomes evaluation and each patient completing a subjective symptoms questionnaire. Non‐parametric statistical analysis was employed. Results: Twenty‐eight adult patients were randomized to the treatment and control arms with comparable preoperative epistaxis severity scores. Postoperative nasal bleeding was equivalent. Significantly less pain was found in the treatment arm (p =.005). While there were trends towards less obstruction and increased satisfaction in the treatment group as well as less crusting in the control group, these findings were not statistically significant. Allocation to the treatment group was associated with an approximately $75 higher cost. Conclusions: When compared to NasoPore® for hemostasis, Surgiflo® hemostatic matrix performed equivalently while causing less discomfort in HHT patients following nasal KTP treatment. Level of evidence: 1b. [ABSTRACT FROM AUTHOR]

Septoplasty is a routinely done procedure to correct the deviated nasal septum. Nasal packing is primarily used to control bleeding in epistaxis as well as endonasal surgery. This study aims to compare complications such as pain, bleeding, septal hematoma, and synechiae formation using Visual Analogue Score in the patients undergoing Septoplasty with anterior nasal packing with roller gauze smeared in antibiotic ointment and Quilting suture without anterior nasal packing. The study is a prospective comparative study among 50 patients undergoing Septoplasty who were randomly allotted into 2 groups of Quilting suture and anterior nasal packing. It was observed that the pain experienced by ANP patients’ Median value was 7.0 which was significantly greater than the pain experienced by Quilting suture patients’ median value of 4.0 on VAS and nasal blockage within 24 h post-operative period among ANP patients’ VAS score median was 6.0 which was significantly greater than that experienced by patients undergoing Quilting suture, median being 3.0. The rate of synechiae formation was significantly lower in patients undergoing quilting sutures. It was found that a Quilting suture is more comfortable for the patient as it is less painful for the patient in comparison with anterior nasal packing with ribbon gauze smeared in the antibiotic ointment. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the safety and efficacy of Chitogel, with and without Deferiprone (Def) and Gallium Protoporphyrin (GaPP), as a promoter of wound healing to improve surgical outcomes after endoscopic sinus susgery. Design: A double‐blinded, randomised control human clinical trial was conducted in patients undergoing ESS as a treatment for chronic rhinosinusitis. Participants underwent functional ESS or FESS with drill out as required and were randomised to receive test product Chitogel, Chitogel in combination with Def or Def‐GaPP versus no packing (control). Setting: Ostial stenosis and persistent inflammation are the main reasons for revision endoscopic sinus surgery (ESS). Post‐operative (PO) dressings can improve PO wound healing and patient outcomes after ESS. Participants: Eighty two patients were included in this study with 79 patients completing the study with 40 undergoing full house FESS and 39 FESS plus frontal drillout. Main Outcome Measures: Patients were followed up at 2, 6 and 12 weeks PO, and outcome scores such as SNOT‐22, VAS and LKS, pre and post‐surgery (12 weeks) were compared. Results: Seventy nine patients completed the study, there was a significant reduction in SNOT‐22 score and improvement of VAS at 12 weeks in patients treated with Chitogel compared to control (p <.05). In those patients, the mean ostium area for the Chitogel and the Chitogel + Def + GaPP groups was higher across all three sinuses compared to the no‐treatment control group, without statistical significance. Sphenoid sinus ostium was significantly more patent in patients treated with Chitogel compared to the control at the 12‐week time point (p <.05). Conclusion: Chitogel as a PO dressing after ESS results in the best patient‐reported symptom scores and objective measurements. The combination of Def and GaPP to Chitogel though proving safe, had no effect on the ostium patency or mucosal healing. [ABSTRACT FROM AUTHOR]

Objective To summarize the epidemiology and clinical characteristics of nasal bone fracture in children in order to provide clinical basis for the prevention and treatment of nasal bone fracture. Methods The clinical data of children with nasal trauma admitted to our department in recent 5 years were analyzed retrospectively. They were divided into four groups according to age, growth, development, and behavioral ability. All cases underwent nasal bone closed reduction under general anesthesia. Statistical analysis was performed with SPSS 25.0. Results The incidence of nasal bone fracture was the most in school-age group, and the difference was statistically significant (χ² =103.5, P<0.01). Fall was the most common cause of nasal fracture in children. The proportion of unilateral fracture (79.91%) was much higher than either bilateral fracture (13.08%) or traumatic nasal septum deviation (7.01%). There was no significant difference between the satisfaction of postoperative nasal packing and unpacking (P>0.05). Conclusions Parents should strengthen care of children, especially of school-age children to prevent the nasal bone fracture. Nasal unpacking was prefer to for patients with no active bleeding in the nasal cavity after closed reduction in order to improve the comfort. [ABSTRACT FROM AUTHOR]

Nasal packing is the classic method adopted by many otolaryngologists to stabilize the nasal septum and decrease the occurrence of postoperative bleeding and septal hematoma after septoplasty. However, because of its associated postoperative morbidity, many surgeons started to adopt alternative methods. This study aimed to assess the outcome and benefits of septal quilting sutures in comparison to nasal packing after septoplasty. A prospective non-randomized comparative interventional study was carried out at two teaching hospitals in Mosul city from January 2020 to January 2021. A total of 60 patients who were candidates for septoplasty, were included in the study. According to the surgeon's preference; 30 patients had placement of septal quilting sutures (group A), and in the other 30 patients nasal packing was performed (group B). Patients were assessed for postoperative morbidity and early outcome in the first 24 h, 1 week and 1 month postoperatively. In the first 24 h after septoplasty, patients in group B had significantly higher levels of nasal/facial pain, headache, sleep disturbance, breathing difficulties and swallowing difficulties compared to group A (p < 0.001). Over the follow up period of 1 month, no significant differences were recorded regarding postoperative bleeding, hematoma, infection, adhesions formation and septal perforation between the two groups (p > 0.05). Septal quilting sutures technique is more favorable in the early period in terms of patient discomfort after septoplasty, better nasal block and nasal/facial pain, the absence of misery on pack removal, with minimal bleeding after surgery. [ABSTRACT FROM AUTHOR]

It has been observed that nasal packing following septoplasty contributes to co-morbidities like post-operative pain, bleeding and increased duration of hospital stay. Trans-septal suturing has been suggested as a safe and effective alternative with a view to obviate the need for nasal packing and the hence avoid the discomfort associated with it. To compare the outcome of trans-septal suturing technique with merocel nasal packing after septoplasty. This was a prospective comparative study done on 60 patients who underwent septoplasty. The patients were divided randomly into 2 groups, while Group A comprised of patients undergoing Post-operative nasal packing with poly vinyl alcohol sponge (also commercially called Merocel), Group B included patients who underwent nasal septal suturing after surgery. The postoperative pain, hemorrhage and duration of hospital stay were the main parameters that were assessed and a comparison was drawn between the post-operative outcome of two techniques. Post-operative global pain score was 62.18 ± 4.75 in the group A (patients with nasal packing) and 24.73 ± 4.29 (patients with trans-septal suturing) in group B ('p'value was < 0.0001). Post-operative bleeding was noticed in 19 patients (out of 30) in group A, and in 2 patients of group B ('p'value was < 0.0001). 27 out of 30 patients of Group A were discharged on day 2 whereas 24 out of 30 patients of Group B required only 1 day of hospital stay after the surgery ('p' value was < 0.0001). Trans-septal suturing technique reduces the duration of hospital stay, causes lesser post-operative bleeding and pain and is a relatively less painful technique than merocel nasal packing. [ABSTRACT FROM AUTHOR]

Introduction: Topical steroids are a mainstay in the treatment of chronic rhinosinusitis (CRS). Multiple delivery methods of topical steroids following sinus surgery have been investigated. The purpose of this trial is to evaluate the effect of triamcinolone‐impregnated absorbable nasal packing on healing following endoscopic sinus surgery (ESS). Methods: This is a prospective, randomized, double‐blind, placebo‐controlled trial. A total of 22 subjects (14 without polyps and eight with polyps) were enrolled and were randomized to receive triamcinolone‐impregnated packing in one sinus cavity and normal saline‐soaked packing in the contralateral sinus cavity. Endoscopic evaluation was completed at the first two postoperative visits, and Lund–Kennedy (LK) endoscopic scores and perioperative sinus endoscopy (POSE) scores were calculated at each visit. Results: The results of this study found no significant difference in the appearance of the sinuses at either postoperative visit. Mean LK scores for the triamcinolone and saline groups at the first and second postoperative visits were 2.09 ± 1.23 versus 2.18 ± 1.01 (p = 0.79) and 1.79 ± 1.08 versus 1.68 ± 1.16 (p = 0.77), respectively. POSE scores were 2.59 ± 1.71 versus 2.68 ± 1.62 (p = 0.86) and 1.74 ± 1.15 versus 1.95 ± 1.22 (p = 0.59). Conclusion: The results of this study demonstrated no significant difference in healing, crusting, polyps, edema, or secretions between the triamcinolone‐treated and non‐triamcinolone‐treated sinuses. There were no adverse effects from the use of triamcinolone‐impregnated absorbable packing. Further studies will be necessary to determine the impact of triamcinolone‐impregnated absorbable packing following ESS. [ABSTRACT FROM AUTHOR]

Objective: To determine histopathological changes in nasal mucosa associated with duration of nasal packing with Merocel tampons. Methods: This study included 24 healthy rabbits, 6 rabbits per group. In group A, no tampon was applied. In group B, Merocel nasal tampons were applied and removed after 24 hours. In group C, the tampons were removed after 48 hours. In group D, the tampons were removed after 5 days. Specimens were obtained from the septum of each rabbit, including cartilage. Histopathological examination was performed. Results: Significant differences were observed in terms of inflammatory infiltration and loss of cilia between groups A and B. Significant differences were also observed in terms of inflammatory infiltration, haematoma, cilia loss, epithelium dysplasia and cartilage degeneration between groups B and C. There were significant differences in terms of cilia loss, epithelium dysplasia and subepithelial fibrosis between groups C and D. Cartilage degeneration was mild in one animal in group B and in two animals in group C, and was moderate in four animals in group C. Conclusion: It is recommended that Merocel nasal tampons are removed within 48 hours to preserve nasal mucosal function. Keeping the pack longer may cause cartilage degeneration and other complications. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of trans-septal suturing with nasal packing following septoplasty in patients with the deviated nasal septum, in terms of frequency of postoperative pain, septal perforation, and synechiae formation. Materials and Methods: A randomized controlled trial was conducted in the ENT department of Benazir Bhutto Hospital Rawalpindi. Patients were divided into two groups. The total sample size of the study was 280 patients with 1:1 randomization in each group (140 in each group). Consecutive non-probability sampling was used for the recruitment of patients. All the patients underwent a septoplasty. Group A was provided with nasal packing while group B was with trans septal suturing. The study duration was 1 year (21-11-2016 to 21-11-2017). All the patients were followed at 24 hours for measurement of postoperative pain and at 1 and 4 weeks for septal perforation and synechiae formation. Ethical approval was taken from the ethical review board and consent was taken from patients. Data were analyzed using SPSS version 22. The Chi-square test was applied for observing the association between different variables. Inclusion Criteria ➣ Patients with deviated nasal septum. ➣ Patients' ages ranged from 17-35 years. ➣ Patients of both genders were included. Exclusion Criteria ➣ Patients with diabetes mellitus. ➣ Patients with allergic rhinitis. ➣ Patients with coagulopathies, pulmonary and cardiovascular disorders. ➣ Patients taking warfarin, aspirin, or heparin. Results: Among all the patients 280 (100%), there were 123(43.9%) males and 157(56.1%) females. The study found that the mean age of patients was 25.3±11.9. In group A patients 140, 110 patients showed efficacy while 30 patients did not show efficacy during the study time period. Similarly, 124 patients showed efficacy in Group B while 16 patients did not show efficacy. A significant association was found in both groups regarding pain at 24 hours (p=0.00) while an insignificant association was found with age (p>0.05). Conclusion: To conclude, the trans-septal suturing technique applied in septoplasty causes minimal pain and complications like septal perforation and synechiae formation, and patients resume routine life activities shortly after the surgery. [ABSTRACT FROM AUTHOR]

Purpose: This perfectly matched, double-blinded, placebo-controlled trial study was performed to investigate the efficacy of triamcinolone acetonide (TAA)-impregnated Gelfoam nasal pack in management of different endotypes of chronic rhinosinusitis with nasal polyps (CRSwNP) following endoscopic sinus surgery (ESS). Methods: One hundred and four patients with bilateral CRSwNP undergoing ESS were selected and randomized to receive TAA-soaked nasal packing in one nostril and saline-impregnated dressing contra-laterally. Validated Perioperative Sinus Endoscopy (POSE) scoring system was used to assess the participants' condition at postoperative months 1, 3, 6, 12, and 18. Results: The treatment side of eosinophilic CRSwNP (EosCRSwNP) group had significantly better endoscopic scores than the contralateral control side in all follow-up visits (P < 0.05 for all comparisons) except for the first postoperative month. No significant difference was detected between the TAA- and saline-treated nostrils in the non-eosinophilic CRSwNP (nonEosCRSwNP) subgroup during the follow-up period. Intergroup comparisons revealed a borderline better POSE score for the treatment side of the EosCRSwNP group compared with the treatment nostril of the nonEosCRSwNP group at months 12 (P = 0.041) and 18 (P = 0.044). At the end of the study period, the treatment side of the EosCRSwNP group demonstrated better clinical response than the saline-treated side in terms of the total POSE scores (P = 0.019), middle turbinate synechia (P = 0.008), middle meatal narrowing (P = 0.010), ethmoid polypoid changes (P = 0.039), ethmoid polyposis (P = 0.027), ethmoid cavity secretions (P = 0.042), and sphenoid severity (P = 0.018). Conclusion: TAA-soaked Gelfoam dressing following bilateral ESS was found to be an effective method for treating CRSwNP particularly for the eosinophilic endotype of the disease. [ABSTRACT FROM AUTHOR]

BACKGROUND & OBJECTIVE: One of the most common challenging complications after nasal surgeries is maintaining airways. The study aimed to use an alternative technique instead of nasal packing in the immediate postoperative period undergoing different nasal surgery under general anesthesia regarding airway management. METHODOLOGY: An interventional study was conducted at Aziz Fatimah Trust Hospital, Faisalabad, from March 20, 2018, to January 31, 2019. A total of 100 participants were enrolled in the study divided into two groups (A & B), 50 each. Group A patients were treated postoperatively with a modified nasal airway devised with a Nelton catheter and Group B patients with traditional nasal packing. The participants were assessed on different parameters which were statistically compared and analyzed. RESULTS: Group Descriptive statistics revealed that the Mean±SD of the age of group A and group B patients was 24.28±9.72 and 26.68±11.09 respectively, which had no significant difference between them {p-value (0.008)}. The postoperative parameters such as patient's comfort and sleep, surgeon satisfaction, ease of suction through Nelton catheter, and oxygen saturation were evaluated as significant variables in the evaluation of the study. p-value ≤0.05 and ≤0.005 were considered as significant and highly significant respectively. CONCLUSION: This modified nasal airway has proven to be easily replicable and reliable, and a cost-effective measure elucidated as a potential and exclusive outcome of the present study. [ABSTRACT FROM AUTHOR]

Background Nasal packing after an endoscopic endonasal approach (EEA) is a routine practice. There is a very urgent need for a level-I recommendation pertaining to the necessity of these packs and, if required, then the timing of its removal. However, the opponents of this practice mention its various disadvantages, among which infection is the most important. In our study, we have evaluated the bacteriological profile of the nasal packs, following endoscopic anterior skull base surgery. Materials and Methods Thirty consecutive cases (2017–18) of anterior skull base pathologies operated by EEA were included, and preoperative nasal swab and postoperative period, the nasal packs were sent for microbiological culture. The colony of bacteria grew, and clinical condition, histopathology and demographic profile of the patients were noted. Results Of the 30 patients, 40% (n = 12) showed an increase in nasal bacterial flora after packing, with methicillin-sensitive coagulase negative Streptococcus (MSCNS) in three patients, Escherichia fecalis (E. fecalis) in three patients, and methicillin-resistant coagulase negative Streptococcus (MRCNS) in two patients. Other rare organisms grew, including Acinetobacter baumanni with E. fecalis, Acinetobacter baumanni with MRCNS, Citrobacter koseni, and Escherichia fecium (E. fecium) with MRCNS and MRSA in one patient each. Conclusion Packing increases the bacterial load of the nasal cavity. This bacterial flora can be a potential source of meningitis. We advocate that packing should be avoided, and if at all required, should be removed within 3 days. A routine practice of nasal swab in the preoperative period and culture of the packs may give information on the possible organism that may cause meningitis and the appropriate antibiotic sensitivity of the organism. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective study assesses the risks and benefits linked to the non-use of nasal packing after a (rhino)septoplasty, compared with post-operative care with anterior nasal packing such as Merocel®. Methods: Complication rates observed during the first week after surgery were compared between groups with and without use of classic nasal packing over a large sample of 534 patients, who had undergone either a closed or open procedure, with bilateral turbinoplasty, and with or without osteotomies. Complications listed include epistaxis, haematoma, impetiginization, septal perforation, hyperalgesia, and dyspnoea. Results: No significant difference was observed between the group with and without packing regarding the immediate post-operative complications of epistaxis (4.4% of the cases with nasal packing versus 3% without, p = 0.918) and impetiginization (3% of the cases with nasal packing versus 4.2% without, p = 0.478). The technique used, as well as any osteotomies performed, had no impact on the results. Conclusion: Non-use of nasal packing after a (rhino)septoplasty is a safe alternative to classic post-operative methods. Provided that there is a rigorous surgical technique and strict clinical control, it should be used as a principal technique in any routine practice due to its safety for patients immediately post-surgery. [ABSTRACT FROM AUTHOR]

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment. [ABSTRACT FROM AUTHOR]

Nowadays, the endoscopic endonasal approach to sellar and parasellar region tumors is a common technique in neurosurgery, and surgical nuances, complications, and management strategies are shared in a multidisciplinary setting between neurosurgeons and ear, nose, and throat surgeons. Due to the heterogeneity of its variations, the role of the anterior nasal packing in endoscopic endonasal approach to the skull base surgery (EESBS) has not yet been unanimously accepted and no consensus or guidelines on its use exist. A survey containing 10 questions about indications, management advantages, and pitfalls of the use of anterior nasal packing in EESBS was created by using an online open-source tool (SurveyMonkey). The questionnaire was sent to 39 Italian neurosurgical departments, which routinely adopt the endoscopic endonasal approach. Almost half of 39 selected centers (19; 48.7%) answered our survey. The main results can be summarized as 1) anterior nasal packing after EESBS is considered useful by 84% of participants, 2) prevention of epistaxis is the principal indication for anterior nasal packing, 3) the type of approach and skull base reconstruction influence the use of anterior nasal packing, and 4) nasal discomfort is considered the principal negative aspect of nasal packing. Our study identified that anterior nasal packing is commonly adopted in certain conditions, namely when extensive nasal dissection is performed. Furthermore, the choice to adopt or not the anterior nasal packing should be tailored taking in account specific conditions, such as acromegaly and Cushing disease. It represents an important factor in reducing postoperative sinonasal complications of EESB. [ABSTRACT FROM AUTHOR]

Nasal septal hematoma (NSH) is relatively uncommon otorhinolaryngology emergency. Children is more prevalence due to the softer cartilage and loosely adherent of its mucoperichondrium. Nasal or facial trauma is the most common etiology while NSH following common cold is extremely rarely reported. Urgent management is needed to prevent serious complications like saddle nose deformity, nasal tip depression, abscess formation and subsequently intracranial sequalae like cavernous sinus thrombosis. We present a case of 11-year-boy presented with NSH following an episode of common cold. [ABSTRACT FROM AUTHOR]

Objective: During septoplasty, nasal packing is routinely used by surgeons for hemostasis and balancing the cartilage and bony skeleton of the nose. However, these new techniques are not totally mild and therefore new ways are adopted to check their efficiency and reason their value. The study was performed to compare the use of plastic intranasal splints with or without anterior nasal packing to determine the need of nasal packing after septoplasty. Study Design: Comparative Study. Setting: ISRA University Hyderabad. Period: March 2018 to April 2019. Material & Methods: A total of 50 patients presenting with nasal septum in this period were prospectively examined. For the purpose of comparative study, we divided the patients into two groups: Group A -Patients who underwent septoplasty with packing and Group-B -Patients who underwent septoplasty without packing. We recorded the pain felt using Visual analogue scale before and after the surgery and also noted the Mean Age gender wise and recorded treatment results for statistical analysis using SPSS Version-20. Results: In our data, a total flfty (50) patients comprising 28 Males (68%) and 22 Females (32%) were listed in the study. The mean± standard deviation VAS scores of Group-A was at 5.2 ±0.9 and Group-B is 2.9±0.61 showing less pain in Group B-without splints and packing. However the complication rate in patients without Splints and packing was only 18%. Conclusion: Thus we flnd septoplasty without nasal splints and packing is more effective and cause lesser bleeding and pain to patients. [ABSTRACT FROM AUTHOR]

Background: There have been few investigations examining the benefits, consequences, and patterns of use for prophylactic antibiotics for nasal packing in the emergency department setting. Given the frequency of epistaxis in the emergency department, it is an ideal setting to study the efficacy and utilization patterns of prophylactic antibiotics in nasal packing.Objective: Our aim was to assess both rates of utilization and evidence of benefit for prophylactic antibiotics in patients with nasal packing for epistaxis.Methods: A single-institution retrospective review of 275 cases of anterior nasal packing in an urban emergency department between September 2013 and April 2017 was performed. Chi-square statistical analysis was used to evaluate results.Results: Among 275 cases studied, there were no instances of toxic shock syndrome. Roughly 73% of patients with nonabsorbable packing received prophylactic antibiotics. Only one (1.1%) case of sinusitis was noted among the nonabsorbable packing with prophylaxis group, with no such complication in the nonprophylaxis group. In contrast, 95% of patients with absorbable nasal packing were not given prophylactic antibiotics. Analysis of all cases given prophylactic antibiotics vs. no prophylaxis, regardless of packing type, revealed no statistically significant difference in the development of acute sinusitis (1% vs. 0.56%; p = 0.6793).Conclusions: There was no observed advantage or disadvantage to using prophylactic antibiotics in anterior nasal packing in the emergency department, regardless of whether patients received absorbable or nonabsorbable packing. However, patients who receive nonabsorbable nasal packing were more likely to receive antibiotic prophylaxis. [ABSTRACT FROM AUTHOR]

BACKGROUND: The use of anticoagulants and high-flow oxygen therapy are therapies that may predispose to epistaxis. Both factors often coexist in patients affected by SARSCoV-2, which caused the recent global pandemic of COVID-19. OBJECTIVE: To investigate the clinical-epidemiological characteristics of patients with COVID-19 who develop epistaxis, as well as its triggers and management, among others. MATERIALS AND METHODS: A multicenter, retrospective, descriptive study in COVID-19 patients with a positive PCR test who presented epistaxis throughout the disease. Study was done from January 31st May 19th, 2020. Demographic data were collected on previous comorbidities, treatments, complications related to COVID-19, triggers, severity of epistaxis, treatment indicated and evolution, among others. RESULTS: A total of 18 patients between the ages of 54 and 88 were included, and 72% were male. They were attended in 9 different hospitals throughout Spain, presenting between 1 to 3 cases each. In 83.3% of the patients epistaxis had some specific trigger, being multiple in 16.6% of them. However, nasopharyngeal smear taken for PCR was not the cause in any case. The most frequent type of treatment was an anterior nasal packing.\\\CONCLUSIONS: Although patients with COVID-19 constitute a special risk group for epistaxis given their associated comorbidities, severe epistaxis is rare in this group of patients. The management of these patients is also complex due to the working conditions when assisting these patients and should always keep healthcare workers safe. [ABSTRACT FROM AUTHOR]

Objective: To do a comparison of the possibility of post-operative hemorrhage with and without nasal packing among the patients undergoing septoplasty. Study Design: Comparative study. Place and Duration of Study: Ear, nose, throat (ENT) Department, Pakistan Naval Ship, Shifa Hospital Karachi, from Apr 2019 to Oct 2019. Methodology: Ninety two patients who underwent septoplasty due to deviation of nasal septum at ENT department of Pakistan Naval Ship Shifa were included in the analysis. Random division of patients was done in both the groups. Group one did not undergo nasal packing after the surgery and group two underwent nasal packing after the surgical procedure. Chi-square was used to see the difference in post-operative hemorrhage, headache, discomfort and septal perforation between the two groups. Results: Out of 92 patients, 61 (66.3%) patients were male while 31 (33.7%) were female. Post operative bleeding was found in three (6.5%) patients in group one while 13 (28.2%) patients in group two had bleeding after the procedure. It was found that post-operative bleeding, headache and discomfort was statistically significant in the group 2, who’s patients had nasal packing after the procedure of septoplasty due to deviated nasal septum. Conclusion: Post-operative hemorrhage, headache and discomfort were more common among the patients with nasal packing as compared to those without nasal packing. Nasal packing after septoplasty should be discouraged without any obvious indication in the patients undergoing septoplasty. [ABSTRACT FROM AUTHOR]

To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints. [ABSTRACT FROM AUTHOR]

Purpose: Epistaxis is the most common ENT emergency. The aim was to determine population-based data on severe epistaxis needing inpatient treatment. Methods: Retrospective population-based cohort study in the federal state Thuringia in 2016 performed on all 840 inpatients treated for epistaxis in otolaryngology departments (60.1% male, median age: 73 years; 63.9% under anticoagulation). The association between patients' and treatment characteristics and longer inpatient stay (≥ 4 days) as well as readmission for recurrent epistaxis was analyzed using univariable and multivariable statistics. Results: The overall incidence of epistaxis needing inpatient treatment was higher for men (42 per 100,000) than for women (28 per 100,000). The highest incidence was reached for men > 85 years (222 per 100,000). Most important independent predictors for longer inpatient stay were localization of the bleeding not in the anterior nose (OR = 2.045; CI = 1.534–2.726), recurrent bleeding during inpatient treatment (OR = 2.142; CI = 1.508–3.042), no electrocoagulation (OR = 2.810; CI = 2.047–3.858), and blood transfusion (OR = 2.731; CI = 1.324–5.635). Independent predictors for later readmission because of recurrent epistaxis were male gender (OR = 1.756; CI = 1.155–2.668), oral anticoagulant use (OR = 1.731; CI = 1.046–2.865), and hereditary hemorrhagic telangiectasia (OR = 13.216; CI 5.102–34.231). Conclusions: Inpatient treatment of epistaxis seems to be variable in daily routine needing standardization by clinical guidelines and strategies to shorten inpatient treatment and to reduce the risk of readmission. [ABSTRACT FROM AUTHOR]

Septal correction is the commonest surgery by rhinologists worldwide. We aimed at studying the comfort level of the patient with standard postoperative nasal packing with Merocel and placing quilting sutures in septum leaving the nose unpacked in the postoperative period. We conducted the study in the tertiary care centre enrolling 82 patients in a quasi-randomised method of odd and even numbers placing them in the nasal packing group and the quilting group respectively. We used analogue scoring method for subjective assessment of comfort level in the postoperative period and the surgeon objectively assessed the patient on follow up. The results were tabulated and analysed. Postoperative pain, headache and sleep disturbance was significantly more in the nasal packing group. We found that the crusting is commonly seen in patients in the nasal packing group. Quilting the nasal septum and leaving the nasal cavity unpacked increases the comfort level of the patient in the postoperative period. The resultant pain, headache and sleep disturbance caused by nasal packing can be significantly avoided by using quilting the septum without nasal packing. We also observed that by avoiding nasal packing postoperatively, the patients were more comfortable and compliant with the treatment regimen and follow-up. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of trans-septal suturing technique with conventional nasal packing in septoplasty surgery in terms of frequency of severe post-operative pain. Material and Methods: This randomized control trial was conducted at ENT department, Allied Hospital, Faisalabad over six months from January 2016 to June 2016. 60 patients with symptomatic deviated nasal septum were randomly divided into groups X and Y representing the nasal packing group and trans-septal suturing group respectively. Classic septoplasty was performed in all patients. All patients were evaluated for post-operative pain on visual analogue scale at 1st postoperative day. Results: There were 30 (50 %) males and 30 (50%) females among a total of 60 patients. 18 year to 45 year was age range having mean age of 29 year. In our study, comparison of frequency of severe post-operative pain shows that 90% (n=27) in Group-X and 16.67% (n=5) in Group-Y had severe post-operative pain, Calculated p-value was 0.000 exhibiting a significant difference. Conclusion: Efficacy of trans-septal suturing technique is significantly higher when compared with conventional nasal packing in septoplasty surgery in terms of frequency of severe post-operative pain. [ABSTRACT FROM AUTHOR]

Objective: To compare the postoperative morbidity and duration of hospital stay among patients after anterior septoplasty with vs. without nasal packing in Ibn Sina Teaching Hospital and two private polyclinics (Hadhramout Hospital and Al-Madinah Polyclinic) in Mukalla city, Hadhramout, Yemen. Methods: A comparative, prospective clinical trial was carried out among patients with anterior deviated nasal septum who had anterior septoplasty performed. One hundred surgically treated patients were randomly divided into two equal groups according to the management protocol and evaluated by a surgeon after the procedures. Studied complications after septoplasty included; septal hematoma, septal perforation,postoperative adhesions, endonasal bleeding, nasal pain and headache, and respiratory discomfort. Data was collected and analyzed using SPSS statistical software version 16. Results: One hundred patients, males were 55 females were 45, the youngest patient was 20 years, the oldest patient was 50 years, the majority of patients were between 31-40 years. The highest incidence of postoperative bleeding was in the 3rd postoperative day in patients with nasal packing while it was minimal on the 3rd day in patients without nasal packing. Septal perforation was found in two patients with packing while perforation was seen in one patient without packing. Fifty patients who had nasal packing were found to have more postoperative morbidity like pain, headache, breathing discomfort.There was no postoperative haematoma and postoperative adhesions in both groups. Postoperative stay in the hospital was longer in patients who had undergone anterior septoplasty with nasal packing and shorter in patients without packing. Fifty patients without packing were discharged on the 1st day after the operation while 45 patients with packing were discharged on the 3rd postoperative day and five on the 2nd postoperative day. Conclusion: Anterior septoplasty without anterior nasal packing is a safe procedure with less postoperative morbidity and with a shorter hospital stay after operation. It revealed more acceptable functional outcomes compared to anterior septoplasty with nasal packing. [ABSTRACT FROM AUTHOR]

Purpose: Nasal packing is a common but unpleasant procedure in patients who undergo endoscopic sinus surgery (ESS). The aim of this study was to assess whether a glove-finger pack strategy would reduce pain compared to lidocaine-soaked packs after ESS. Methods: A prospective randomized controlled trial enrolling 120 consecutive patients affected by chronic rhinosinusitis, who underwent bilateral ESS. At the end of surgery 62 subjects received 10 cm non-absorbable pack soaked with 5 mL of 2%-lidocaine solution and 58 received a 10 cm non-absorbable pack coated with a latex free glove finger soaked with saline solution. Data concerning pain were collected using a 0 to 10 visual analogue scale at post-operative hours 1, 4, 8, and 16 and at pack removal (24 h ± 15 min). All post-operative analgesic rescue doses were registered. Also, bleeding was reported. Results: The mean VAS score during pack-removal was significantly lower in glove-finger group than in the lidocaine group (3.22 ± 2.16 vs 4.89 ± 2.90, p = 0.0012). There was no statistically significant difference between re-soaking lidocaine-soaked-packs with saline solution or lidocaine at pack removal time (p = 0.42). Conclusion: Glove-finger nasal pack seems to provide better pain control after ESS, when compared with lidocaine-soaked pack, especially at pack removal time. [ABSTRACT FROM AUTHOR]

Objective: To compare the postoperative morbidity and duration of hospital stay among patients after anterior septoplasty with vs. without nasal packing in Ibn Sina Teaching Hospital and two private polyclinics (Hadhramout Hospital and Al-Madinah Polyclinic) in Mukalla city, Hadhramout, Yemen. Methods: A comparative, prospective clinical trial was carried out among patients with anterior deviated nasal septum who had anterior septoplasty performed. One hundred surgically treated patients were randomly divided into two equal groups according to the management protocol and evaluated by a surgeon after the procedures. Studied complications after septoplasty included; septal hematoma, septal perforation,postoperative adhesions, endonasal bleeding, nasal pain and headache, and respiratory discomfort. Data was collected and analyzed using SPSS statistical software version 16. Results: One hundred patients, males were 55 females were 45, the youngest patient was 20 years, the oldest patient was 50 years, the majority of patients were between 31-40 years. The highest incidence of postoperative bleeding was in the 3rd postoperative day in patients with nasal packing while it was minimal on the 3rd day in patients without nasal packing. Septal perforation was found in two patients with packing while perforation was seen in one patient without packing. Fifty patients who had nasal packing were found to have more postoperative morbidity like pain, headache, breathing discomfort.There was no postoperative haematoma and postoperative adhesions in both groups. Postoperative stay in the hospital was longer in patients who had undergone anterior septoplasty with nasal packing and shorter in patients without packing. Fifty patients without packing were discharged on the 1st day after the operation while 45 patients with packing were discharged on the 3rd postoperative day and five on the 2nd postoperative day. Conclusion: Anterior septoplasty without anterior nasal packing is a safe procedure with less postoperative morbidity and with a shorter hospital stay after operation. It revealed more acceptable functional outcomes compared to anterior septoplasty with nasal packing. [ABSTRACT FROM AUTHOR]

Epistaxis is defined as hemorrhage from nose where source of bleeding is inside the nose. There are many factors which can precipitate epistaxis. A number of treatment modalities are used for its treatment, conservative measures and nasal packing being the commonest method of treatment. Conservative method is an effective method of treatment and avoids potential complications of nasal packing. Objectives: To assess efficacy of conservative mode of treatment for epistaxis. Study Design: Prospective study. Settings: Department of Otorhinolaryngology, E.N.T. Unit-I, Allied Hospital/Faisalabad Medical University, Faisalabad. Period: Three months i.e. from 16-10-2018 to 15-01-2019. Sample Size: 60. Material and Method: Procedure: 60 patients were enrolled according to inclusive and exclusive criteria. Conservative measures were applied to patients including cold water gargles, nasal pinching and Trotter's method. Patients were observed for control of epistaxis and number of patients noted in whom conservative measures were not successful and nasal packing was done. No patient among the sample needed the surgical intervention due to failed conservative measures or nasal packing. Frequency and percentage calculated for data and chi-square test applied and level of <0.05 taken significant. Results: 60 patients enrolled with age range from 5-75 years and mean age as 39.53 years. Out of 60 patients, 38 were male and 22 were females. Out of 60 patients, 42 patients (70%) were treated successfully using conservative measures and 18 patients (30%) were treated with nasal packing. Conclusion: Based upon results of this study, it is concluded that conservative method of treatment of epistaxis is an effective and safe method and avoids potential complications which can occur due to nasal packing. [ABSTRACT FROM AUTHOR]

Purpose: Nasal packing is frequently used after septoplasty and some complications caused by nasal packing are unavoidable. A nasal septal retainer has recently been developed. We evaluated the safety and clinical efficacy of the retainer in septoplasty, and the subjective symptoms of patients with the retainer were compared with Merocel nasal packing. Methods: A prospective, randomized, controlled study was performed in patients who had undergone septoplasty. In total, 39 patients were randomized to receive Merocel (n = 17) or the retainer (n = 22) after septoplasty. The deviation of nasal septum and nasal mucosa was evaluated by endoscopy. The clinical efficacy and subjective symptoms were compared using the visual analog scale. Results: During the packing/retaining period, the mean scores of headache, nasal obstruction, epiphora, and facial pressure in the retainer group were significantly lower than in the Merocel group (P < 0.05); the mean scores of nasal pain, nasal itching, rhinorrhea, dysphagia, and sleep disturbance in the retainer group were lower than in the Merocel group, but the difference did not reach statistical significance. On the removal of Merocel/retainer, nasal pain was significantly lower in patients with the retainer (P < 0.05). In the retainer group, the incidence of grade 1 bleeding was 45.5%, and grade 0 bleeding was 54.5%. In the Merocel group, the incidence of grade 2 bleeding was 23.5%, grade 1 was 47.1%, and grade 0 was 29.4%. Conclusions: The nasal septal retainer is suitable for use after septoplasty with more beneficial effects than nasal packing. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to compare the analgesic effects of tramadol-absorbed merocel nasal packings and lidocaine-absorbed merocel nasal packings using visual analog scale (VAS) in the postoperative period in patients undergoing septoplasty operation. Materials and methods: Our study was applied as a retrospective. Informations about the patients were accessed via their medical records. Our study was performed on 122 patients aged between 18 and 50 years. Patients were divided into three groups according to the application of lidocaine, tramadol and 0.9% NaCl on merocel nasal packings. In the postoperative period, VAS (visual analog scale) scores, side effects, additional analgesic requirements were recorded for 24 h starting from PACU (post anesthetic care unit). Results: There was no difference between the number of male and female patients (p > 0.05). Postoperative pain was evaluated with VAS score periodically in postoperative 5 min–24 h in all groups. When we compared the groups with each other, there was a statistically significant difference between the tramadol–lidocaine and tramadol–control group (p < 0.05). Conclusion: Tramadol infiltrated to nasal packings decrease the need of additional analgesics in the postoperative period, increases patients' satisfaction, decreases the length of hospital stay, and as a result, reduced the rate of secondary infections. [ABSTRACT FROM AUTHOR]

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. Methods: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel®, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat. Results: Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p <.05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p <.05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p >.05). Conclusion: Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery. [ABSTRACT FROM AUTHOR]

Background: Nasal packings can help in control of postoperative bleeding and healing following functional endoscopic sinus surgery (FESS) and nasal surgeries, but traditional non-resorbable packs have several inherent drawbacks. Objectives: This study was done to evaluate the effect of carboxy methyl cellulose (CMC) gel and merocel nasal packs after sinonasal surgery regarding postoperative bleeding, pain, pressure headache and formation of synechia. Patients and Methods: A total of 40 patients who had undergone sinonasal surgery were studied prospectively. At the end of the operation each patient was packed with dissolvable CMC gel in the right side of the nose and merocel in the left side. The haemostatic effect of the CMC and merocel was assessed during the recovery period. Results: six (15%) of the patients packed with CMC had primary postoperative bleeding during the recovery period. Bleeding appeared in four (10%) patients packed with merocel. We observed significant intergroup differences in the level of pain and pressure headache. The CMC group was superior to merocel group and there was a significant low level of pain and pressure headache in the CMC group. Two (5%) of CMC patients and six (15%) of merocel patients developed a synechia at the 4 weeks period. Four (10%) of CMC patients and Ten (25%) of merocel patients developed synechia at the 8 weeks period post operative. Conclusion: We found that dissolvable CMC pack is associated with very low levels of localised pain, pressure headache and with low levels of postoperative bleeding and synechia formation. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of nasal packing and septum "8" suture in nasal septum plasty. Methods: 60 patients with deviation of nasal septum who were scheduled to undergo septoplasty in our hospital from July 2017 to July 2018 were selected. The patients were divided into control group and experimental group by random number table, each 30. Two groups of patients underwent endoscopic septum plasty under nasal endoscope. The control group was treated with nasal packing, and the experimental group was treated with septum "8" suture. The clinical efficacy and nasal mucosal edema were compared between the two groups. Visual analogue pain score(VAS) was observed at different time points in the two groups, and postoperative complications of nasal septum were recorded in two groups of patients. Results: The total effective rate at 7 d after operation in the experimental group was 96. 67%(29/30),which was significantly higher than 80. 00%(24/30)in the control group, the difference was statistically significant(P<0. 05). Compared with preoperative, the VAS scores of the two groups increased at 12 h after operation, the VAS scores decreased at 24 h after operation and 48 h after operation(P<0. 05). Compared with 12 h after operation, the VAS scores of the two groups decreased at 24 h after operation and 48 h after operation, and the VAS scores of 48 h after operation were lower than that of 24 h after operation(P<0. 05). The VAS scores of 12 h after operation, 24 h after operation and 48 h after operation in the experimental group were lower than those of the control group(P<0. 05). The number of patients with grade 0 nasal mucosal edema in the experimental group were significantly higher than those in the control group, and the number of patients with grade 1 nasal mucosal edema were significantly lower than those in the control group(P<0. 05). There were no significant differences in the number of patients with grade 2 nasal mucosal edema between the two groups(P>0. 05). There was no significant difference in the incidence of nasal septal complications between the two groups(P>0. 05). Conclusion:Compared with the nasal packing method, the "8" suture of nasal septum in nasal septum plasty is more effective, which can relieve the pain, improve the nasal mucosal edema, and do not increase the incidence of complications. It has certain clinical application value. [ABSTRACT FROM AUTHOR]

Purpose: Nasal packing is an option for bleeding control after endoscopic sinus surgery and septoplasty. Although new packing materials have been developed, patients still suffer from pain and require additional analgesics treatments. In this study, a prospective, randomized, and double-blind controlled trial was designed to evaluate the effect of fentanyl-soaked packing on pain after endoscopic sinus surgery and septoplasty. Methods: One hundred fifty-two patients who underwent nasal surgeries due to chronic rhinosinusitis or nasal septal deviation were enrolled in this study. At the end of operation, 50 mcg fentanyl-soaked biodegradable synthetic polyurethane foams packing Nasopore or Merocel were applied to a group of 79 patients, and saline-soaked ones were applied to another group of 73 patients. To evaluate the influence of fentanyl on postoperative nasal pain, patients’ conditions were assessed via means of Numeric Rating Scale, patient satisfaction, and Ramsay Sedation Scale. In addition, symptoms of headache or sore throat and any signs of cardiopulmonary-relevant indicators were monitored. Results: The fentanyl group had significantly decreased Numeric Rating Scale and increased patient satisfaction in every operation type for the majority of postoperative time periods (P < .05) with reduced postoperative headache and sore throat compared to the control group. The fentanyl group showed a higher score on Ramsay Sedation Scale than the control group (P < .05 in group including endoscopic sinus surgery). There were no significant differences in cardiopulmonary-relevant indicators between the 2 groups (P > .05). Conclusion: Fentanyl group showed significantly reduced postoperative pain without serious adverse effects. We suggest that topical fentanyl application to nasal packs can be a useful method to reduce pain during the early postoperative period after endoscopic sinus surgery and septoplasty. [ABSTRACT FROM AUTHOR]