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In the postoperative period following septoplasty, various types of tamponades and nasal splints are used. They play an important role in surgical outcomes. The use of intranasal packing and splints still remains controversial in the medical literature. Since the beginning of the 21st century, the method of transmucoseptal sutures following septoplasty has been utilized as a reliable alternative to intranasal packing. Recent studies recommend the use of intranasal splints instead of tamponades, reporting a positive impact on postoperative bleeding, patients’ comfort, the prevention of erosions and trauma to the nasal mucosa, and the development of synechiae.

Objectives Previous studies have shown that hot saline solution (HSS) nasal irrigation is effective against nasal bleeding and is used to treat nasal hemorrhage. In a pilot study, we evaluated hot saline nasal irrigation in comparison to a routinely used nasal packing in terms of self‐reported complications and mucosal healing after functional endoscopic sinus surgery. Methods Patients undergoing surgery for bilateral chronic rhinosinusitis received polyvinyl acetate (PVA) nasal packing in the left nostril, and the right nostril was rinsed with 47°C sterile saline immediately after surgery. Patients' experiences of pain, bleeding, and other types of uncomfortable experiences were measured using a visual analog scale for each nostril before, during, and immediately after nasal packing removal. Two weeks post‐surgery, the assessments were repeated including an endoscopic evaluation of the mucosa by the surgeon. Results Twenty‐seven patients completed the study. Prior to removal of the packing, the patients experienced significantly more pain and other uncomfortable experiences in the nostril treated with nasal packing, as compared to the nostril solely rinsed with hot saline. After removal, patients reported significantly more uncomfortable experiences from the packing treated nostril. Two weeks post‐surgery, no difference in mucosal healing was observed between the two nostrils. Conclusions The results from this study indicate that irrigation with HSS could be an alternative postoperative treatment to conventional PVA nasal packing. Hot saline irrigation may contribute to patients experiencing improved control of postoperative bleeding, pain, and less suffering of other causes as well as health‐economic benefits, without affecting the mucosal healing up to 2 weeks post‐surgery. Level of Evidence 1b

Background 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. Materials and Methods 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. Results 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. Conclusions 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.

Background/aims Despite epistaxis being a common presentation to emergency departments there is a lack of guidelines, both nationally and internationally, for its management. The authors reviewed the current management of epistaxis and then introduced a new pathway for management to see if care could be improved. The aims were to evaluate the impact of the pathway on reduction of emergency department breaches, emergency ambulance transfers and hospital admissions. Methods The study was an interrupted time series analysis over 29 months and included 903 participants. A pathway for the management of adults with non-traumatic epistaxis was designed and implemented in a university teaching hospital with an emergency department annual attendance rate of 105 495 in 2019–20. Results The pathway led to a 14-minute longer stay in the emergency department, a 5% increase in emergency department breaches, an 8.2% reduction in admissions, a 3.6% reduction in emergency ambulance transfers, a 14.1% increase in nasal cautery and a 3.2% reduction in nasal packing. Conclusions The authors calculate that these results equate to roughly 56 hospital bed days saved, providing better care closer to home for patients, in addition to beneficial knock-on effects for other emergency department and admitted patients.

Background: Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial. Methods: We will perform a systematic review of nasal packing’s effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed. Results: This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors. Conclusion: This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty.

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®. 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. 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. 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.

Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.

Problem description Otorhinolaryngology services are not available in all hospitals and atraumatic epistaxis is a common presentation to Emergency Departments (ED). Not all ED staff are experienced in managing epistaxis and there appeared to be a high rate of re-bleeding after treatment provided. We aimed to improve outcome for ED patients presenting with atraumatic epistaxis and staff conditions by creating a Departmental pathway outlining a management plan and ensuring all equipment needed was readily available. Methods A retrospective 6-month audit was done to assess current management and re-bleed percentage rates post nasal packing. A team was assembled, stocked a trolley, created an Atraumatic epistaxis ED pathway and promoted its use by staff. Repeated Plan-Do-Study-Act cycles were undertaken. Chosen measures were (1) Reduced re-bleed rates post nasal packing from initial audit levels; (2) Increased nasal packing duration; (3) Improved qualitative feedback by ED doctors (4) 100% E.N.T. trolley stock. Results Audit showed minimal use of vasoconstrictor spray, a 7-hour mean nasal pack duration, a re-bleed rate post nasal packing of 39% and staff reports of difficulties accessing items required. After introduction of the E.N.T. trolley, there was positive staff feedback regarding improved availability of treatment items and full stocking of the trolley was achieved after repeated cycles. Following introduction of the Epistaxis pathway and staff education, average re-bleed rates post nasal packing dropped* from 39% to 20% in the first cycle; 21% in the third cycle; 25% in the fourth cycle and 14% in the fifth cycle- (*Isolated re-bleed average of 40% observed in the second cycle). Mean nasal packing duration increased from 7 h to 9, 10, 10, 12 and 8 h in the 2-monthly cycles successively. Conclusion The project's aims of improving epistaxis patients' outcomes and improved convenience for ED staff were achieved.

Introduction Following septoplasty, the usual norm is to pack the nose using polyvinyl alcohol or white petroleum jelly impregnated gauze. But due to side effects like pain, respiratory problems, headache or pain during pack removal, trans-septal suturing is recommended as it provides stability and prevents septal hematoma formation without causing the above mentioned complaints. This study aims to conduct an in-depth comparison of the outcomes of the two aforementioned methods in an Indian population.Materials and Methods A prospective randomized comparative study was done for 30 patients between 18-50 years undergoing septoplasty, while excluding those requiring additional surgical interventions. Trans-septal suturing was done for 15 patients and polyvinyl alcohol nasal packing for the rest. Visual Analogue Scale was used to record discomfort levels 1 day post-operatively. A vast multitude of symptoms were assessed during regular visits for 3 months after surgery. Results Post-operatively, nasal pain, headache, dyspnoea, sleep disturbance, post-nasal drip, crusting, and epiphora were found to be reduced in patients who underwent trans-septal suturing when compared with packing, deeming it to be a superior choice of method. However, nasal bleeding was comparable in both groups. Conclusion Trans-septal suturing reduces pack related problems and post-operative complications, without significantly increasing the duration of surgery. Hence, we recommend the practice of placing sutures to positively improve patients’ quality of life post-surgery.

Nasal packing is a skill which all primary care physicians should possess. The current curriculum does not include this skills training in undergraduate studies. The aim of this study is to evaluate the efficacy of structured nasal packing module for 3rd MBBS students in the skills lab and to evaluate the improvement of student's confidence level in managing . Project proposal approval was obtained from the Institutional review board in Saveetha Medical College & Hospital. After obtaininginformed consent, 114 students of III MBBS-Part I was included in the study. They were divided into 3 batches. Students were given study material and video at least one day before the session. A brief lecture followed by a demonstration of nasal packing was done. Students were allowed to practice nasal packing on mannequins in the presence of faculty. Confidence level questionnaire were given to assess their confidence level before and after practicing on mannequins. Question 1 was on instrument use, 2 on traditional anterior nasal packing, 3 on pack and 4 on postnasal pack with ’s catheter. The mean confidence level scores before and after hands on training on mannequin were 9.18 and 12.45 respectively. T-test and Wilcoxon Signed Ranks Test was done to compare the results. There was a statistically significant improvement in the confidence level of students following hands on training (p value: 0.000). Practicing nasal packing on mannequins improved the confidence level of students in managing patients with

Introduction- The Eustachian tube provides an anatomic communication between the middle ear and nasopharynx, and maintains pressure equality across the tympanic membrane. Objective- To see the effect of anterior nasal packing on Otological symptoms, middle ear pressure and hearing Materials and method- This prospective study was carried out during period of September 2018 till August 2019. 100 ears were taken in the study. Middle ear pressure and hearing threshold were evaluated by Tympanometry and Audiometry respectively. Results- Postoperatively two days after anterior nasal packing, there was increase in no. of patient ears with ear fullness, ear ache, tinnitus, hearing threshold and abnormal negative middle ear pressure. After removal of nasal packing up to twelve weeks, improvement in middle ear pressure and hearing threshold was seen. Conclusion- Anterior nasal packing causes decrease in middle ear pressure and increase in hearing threshold. Key words- Eustachian tube, Middle ear pressure, Hearing threshold

Background and Objective:Septoplasty is one of the most common nasal surgeries. After septoplasty, the nasal pack is routinely used to control bleeding, which can lead to complications such as pain and anxiety. This study aims to compare the effect of septoplasty with and without nasal packing on outcomes and complications of the surgery. Materials and Methods:In this randomized clinical trial, 50 patients undergoing septoplasty surgery at Besat Hospital, Hamadan, Iran, (during 2018 and 2019) were selected among the patients and randomly allocated in two groups of septoplasty with nasal pack (group A, 25 patients) and septoplasty without nasal pack (group B, 25). Anxiety score, pain score, bleeding rate, hematoma, respiratory status and local infection were compared in both groups. Data were analyzed by SPSS software. Results:The incidence of complications of throat irritation, tearing and headache and facial pain during the first 24 hours after septoplasty in group A was 48%, 76% and 64%, respectively, and in group B, it was 12%, 0% and 0%, respectively (P Conclusion:The use of nasal packs following septoplasty can cause throat irritation, tearing, increased pain, anxiety and respiratory problems in patients and it seems to have no effects on the duration of bleeding during 24 hours after the surgery.

Objective: To assess safety and efficacy of an asymmetrical balloon in the treatment of epistaxis in adult patients (≥18 years) managed in an emergency setting. Methodology: Pilot, open label, monocenter, prospective, interventional non comparative study in adult patients. The patients were hospitalized for 48h, timepoint at which the device was removed. Primary endpoints were the assessment of bleeding arrest and pain score evaluated on a Visual Analogic Scale. Secondary endpoints were the nature and number of adverse events reported and patient quality of life evaluated with the RhinoQoL questionnaire. Results: Ten patients were included, and nine were treated. In Intent to Treat (ITT), bleeding was stopped upon positioning in 9/10 patients. Efficacy was maintained in 8/10 patients during treatment. Pain was moderate at insertion, inflation and during treatment and mild upon and post-removal. Minor bleeding recurrence occurred in two patients during the post-treatment period. The reported adverse events considered device-related were consistent with the ones observed with other intranasal devices. The mean and median RhinoQoL impact scores tend to decrease upon the different control visits. Conclusion: This pilot study provides promising preliminary safety and efficacy data for CAVI-T™ in the management of epistaxis in an emergency setting.

Background: Nasal packing after functional endoscopic sinus surgery (FESS) is used as a standard procedure to control the postoperative bleeding, promote the mucosal healing and to prevent synechiae formation, but traditional non-resorbable packs have several disadvantages. The optimum solution to minimize these disadvantages may be accomplished using the new biodegradable packs. Objectives: This study was done to compare between the effect of carboxy methyl cellulose (CMC) foam nasal pack and latex gloved merocel (LGM) nasal pack in the same patient after FESS regarding the prevention of postoperative bleeding, pain and synechiae formation. Patients and Methods: A prospective, randomized, single-blinded controlled study was performed in 35 patients with bilateral chronic rhinosinusitis who were collected from ENT outpatient clinic of Al-HusseinUniversityHospital from Feb. 2019 to Nov. 2019. All patients underwent bilateral FESS by a single surgeon. At the end of the operation, each patient was packed with dissolvable CMC foam nasal pack in one nasal cavity and latex gloved merocel nasal pack in the other side. The hemostatic effect of the CMC foam and latex gloved merocel was assessed during the recovery period. Pain levels were recorded by the patients on a visual analogue scale 2, 6, 12 and 24 hours after surgery and at the time of packing removal. The effectiveness of prevention of synechiae formation was assessed endoscopically 4 and 8 weeks after surgery. Results: There was no statistically significant difference between CMC group and LGM group as regard their effect on control the postoperative bleeding. Only five (14.3%) of the CMC group had primary postoperative bleeding, and it occurred in three (8.6 %) of gloved merocel group. The mean level of patient pain was 0.98 (Range: 0-2) in CMC group, but was 1.65 (Range: 1-3) in latex gloved merocel group which is statistically significant. As regarding synechiae formation, the difference between both groups was statistically insignificant at the 4 weeks period] Two (5.7%) of CMC group and five (14.3 %) of LGM group developed a synechiae [and statistically significant at the 8 weeks period] three (8.6%) of CMC group and nine (25.7 %) of gloved merocel group developed synechiae]. Conclusion: Dissolvable CMC foam nasal pack was associated with very low levels of localized pain, and with low levels of postoperative bleeding and synechia formation.

The nasal packing material after closed reduction of nasal bone fracture may be bioabsorbable or nonbioabsorbable. To investigate the usefulness of the packing method using bioabsorbable and nonbioabsorbable materials simultaneously, a chart review was retrospectively performed involving 255 patients. Group A (n = 119), Nasopore (bioabsorbable) was cut appropriately and packed, and subsequently, supportive packing with Merocel (nonbioabsorbable) was performed. Group B (n = 78), nasal packing was performed with Vaseline roll gauze. Group C (n = 49), packed only Merocel. Pain and rhinorrhea were significantly lower in Merocel + Nasopore group (P

Purpose To investigate the effect of local usage of prilocaine and its combination with tramadol on the pain and anxiety levels of patients during nasal packing removal. Methods A total of 117 patients who were treated with the Merocel nasal packing after septoplasty were included in the study. Patients whose Merocel nasal packings infiltrated with prilocaine (P group), prilocaine combined with tramadol 1 mg/kg (P + T1 group), prilocaine combined with tramadol 2 mg/kg (P + T2 group), or normal saline solution (Control group) before nasal packing removal were compared for their pain, sedation, and anxiety related to this removal procedure. The visual analog scale (VAS), Ramsay sedation scale (RSS), and State-Trait Anxiety Inventory (STAI) scale were assessed to evaluate the pain, sedation, and anxiety levels of the patients. Results Groups were found similar according to sex, age, and preoperative STAI scores. The VAS score was significantly lower in P, P + T1, and P + T2 than control group during nasal packing removal (p < 0.001, p < 0.001, and p < 0.001, respectively). However, state anxiety inventory (STAI-S) and RSS were found significantly improved only in P + T1 and P + T2 (STAI-S: p = 0.032, RSS: p = 0.002, STAI-S: p = 0.000, RSS: p < 0.001, respectively). In the comparison of P + T1 and P + T2, no significant difference was found in VAS, RSS, and STAI-S (p = 0.604, p = 0.154, and p = 0.264, respectively). Conclusion The combined infiltration of prilocaine and tramadol 1 mg/kg into the nasal packing is effective in reducing the pain and anxiety of patients during nasal packing removal.

The present study includes evaluation 60 ears of 30 nasal patients admitted to department of Otolaryngology and Head-Neck Surgery at Banghabandhu Sheikh Mujib Medical University. Each patient underwent nasal surgery followed by anterior nasal packing for 48 hours. All patients were investigated by tympanometry prior to surgery, 2nd post operative day before pack removal and on 7th post operative day 5 days after pack removal. This study shows that nasal packing result in Eustachian tube dysfunction and negative middle ear pressure which is reversible in nature. Bangladesh J Otorhinolaryngol; April 2017; 23(1): 27-31

This plain language summary explains nosebleeds, also known as epistaxis (pronounced ep-ih-stak-sis), to patients. The summary applies to any individual aged 3 years and older with a nosebleed or history of nosebleed who needs medical treatment or wants medical advice. It is based on the 2020 "Clinical Practice Guideline: Nosebleed (Epistaxis)." This guideline uses research to advise doctors and other health care providers on the diagnosis, treatment, and prevention of nosebleeds. The guideline includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to help patients ask questions and make decisions in their own care.

Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p

Background: This study is to evaluate the necessity of prescribing prophylactic antibiotics for nasal packing in spontaneous epistaxis. There are few published papers of infective complications in such patients. Methods: This prospective study analysed 149 consecutive patients admitted to AL-Kindy teaching hospital with spontaneous, epistaxis, who underwent nasal packing over 2 years period . in the first year, 78 patients received prophylactic antibiotics , In the second year 71 patients were not given prophylatic antibiotics. Exclusion criteria included antibiotics prescribed for unrelated pathology and post-operative epistaxis. Signs and symptoms of acute otitis media, sinusitis and toxic shock syndrome were assessed using clinical examination and a questionnaire. Results: :Fourteen out of 149 patients experienced otalgia, mostly following posterior nasal packing. No patient in both groups had evidence of any infective complication. Conclusion: we do not recommend the use of prophylactic antibiotics for patients undergoing nasal packing for spontaineous epistaxis.

Study objective The primary objective of this study is to compare the effectiveness of 3 treatment protocols to stop anterior epistaxis: classic compression, nasal packing, and local application of tranexamic acid. It also aims to determine the frequency of rebleeding after each of these protocols. Methods This single-center, prospective, randomized controlled study was conducted with patients who had spontaneous anterior epistaxis. The study compared the effect of 3 treatment options, tranexamic acid with compression but without nasal packing, nasal packing (Merocel), and simple nasal external compression, on the primary outcome of stopping anterior epistaxis bleeding within 15 minutes. Results Among the 135 patients enrolled, the median age was 60 years (interquartile range 25% to 75%: 48 to 72 years) and 70 patients (51.9%) were women. The success rate in the compression with tranexamic acid group was 91.1% (41 of 45 patients); in the nasal packing group, 93.3% (42 of 45 patients); and in the compression with saline solution group, 71.1% (32 of 45 patients). There was an overall statistically significant difference among the 3 treatment groups but no significant difference in pairwise comparison between the compression with tranexamic acid and nasal packing groups. In regard to no rebleeding within 24 hours, the study found rates of 86.7% in the tranexamic acid group, 74% in the nasal packing group, and 60% in the compression with saline solution group. Conclusion Applying external compression after administering tranexamic acid through the nostrils by atomizer stops bleeding as effectively as anterior nasal packing using Merocel. In addition, the tranexamic acid approach is superior to Merocel in terms of decreasing rebleeding rates.

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.

Background: Nasal packing is commonly done after septal surgeries. Nonabsorbable nasal pack is used to minimize bleeding from surgery site, support the mucoperichondrial flaps, and minimize the risk of formation of septal hematomas and adhesions. However, these materials cause pain and discomfort in-situ as well as during removal. This study was done to evaluate the effect of 2% lignocaine rehydration of nasal pack on pain during pack removal. Methods: This prospective study was conducted on 60 patients who had undergone septoplasty. The patients were divided into 2 groups: Lignocaine and Normal saline group, with 30 patients each. In the Lignocaine group, 2.5 ml of 2% of lignocaine was diluted with 2.5 ml of distilled water and was injected into the nasal pack; and in Normal saline group, 5 ml of normal saline was injected into the nasal pack. Nothing was injected to the left nostril, which acted as a control, in both groups. All patients were asked severity of pain during removal of nasal packing by VAS. Results: In lignocaine group, mean pain score was 3.73 ± 1.63 on lignocaine side and 6.23 ± 1.69 on control side (U=109.5, p

Background: In this study, we evaluated how the Merocel and nasal splint packing placed in the nose after septoplasty surgery affects the olfactory and mucociliary functions of the nose in the early period, and compared the 2 packing with each other. Material and Method: The study included 60 patients with isolated septal deviation and 30 patients in the control group. The patients were randomly divided into 2 groups. Nasal splint was inserted after septoplasty in group A (n = 30). Merocel was inserted in group B (n = 30). The Sniffin sticks test and saccharin test were applied to the patients before surgery and 15 days after the surgery. The same tests were applied to the control group consisting of 30 patients and the results were compared. Results: No complications, such as postoperative bleeding, submucoperichondrial hematoma, or abscess formation, were found in both groups. Mucociliary function was improved after septoplasty, and it was statistically significant, but there was no statistically significant difference between both packing groups. A statistically significant difference was found for the odor test in patients who used nasal splint packing in comparison with patients who used Merocel in the early period. Conclusion: The odor test showed significant differences between the 2 groups and this was statistically significant in the early period. Mucociliary function was better after surgery, but there was no statistical difference in the different nasal packing groups.

Background Emergency Department (ED) patients presenting with spontaneous epistaxis who have anterior nasal packing are routinely prescribed systemic prophylactic antibiotics in spite of the lack of supporting evidence-based literature. Although there is literature that discusses infection rates with nasal packing for epistaxis and prophylactic antibiotics prescribing practices of otolaryngologists, this is the first study to our knowledge that examines the practices of emergency physicians. Objectives The main objective of this study was to compare the infection rate between patients who were and were not prescribed prophylactic systemic antibiotics for anterior nasal packing in spontaneous epistaxis and to examine current management practices of antibiotic prescribing for these patients. Methods A retrospective review of ED patients ≥ 18 years old with the discharge diagnosis of epistaxis was performed over a 5-year period. Patients who had multiple visits to the ED for epistaxis or recent nasal or sinus surgery were excluded. Results Over half of the patients, 57/106 (53.7%), who had anterior packing were prescribed prophylactic systemic antibiotics. Of these patients, 69/106 (65%) returned for a follow-up visit. There were no documented infections for any of these patients regardless of whether or not they were prescribed antibiotics. There was no significant difference with respect to rate of infection found between these two groups (the p-value = 0.263). Conclusion The absence of infection supports previous findings and suggests that prophylactic antibiotic use for nasal packing in spontaneous epistaxis patients is not necessary. Further randomized controlled studies are necessary to definitively support this practice change.

We experienced 16 cases of overcorrection among 524 cases of packing following nasal bone fracture (NBF) reduction. In these cases, the packing was removed immediately.From July 2017 to October 2020, 535 cases of NBF were reduced by closed reduction. Nasal packing was applied in 524 cases (97.9%). In all cases, postoperative X-rays (both nasal bone lateral view and Water's view) were taken. The degree of overcorrection was measured in the nasal bone lateral views.Among the 524 patients who underwent nasal packing, overcorrection was noted in 16 cases (3.1%). The average degree of overcorrection was 2.09 ± 0.70 mm. In these patients, the packing was removed immediately and X-rays were taken directly after packing removal. The degree of overcorrection decreased; however, no significant difference was found (1.83 ± 0.71 mm, P = 0.081, [paired t test]).In this study, overcorrection was noted in 3.1% of patients in whom nasal packing was applied. After packing removal, the degree of overcorrection decreased but was not significant. Postoperative X-rays should be taken after reduction of NBF and nasal packing, and if overcorrection is noticed, the packing should be removed immediately.

Aim Nasal packing is one of the mainstays of inpatient treatment for epistaxis. However, no current guidelines exist on optimal duration of nasal packing. This paper seeks to determine the optimal duration of nasal packing in terms of re-bleeding. Method A retrospective cohort study was conducted on patients admitted over a two-year period. Data collected included re-bleeding events following pack removal, age, gender, site of epistaxis, hypertension, trauma and anticoagulation medication. Results The rate of re-bleeding increased with length of pack duration; over 12 hours was associated with greater re-bleeding rates (p = Conclusions A packing duration of less than 12 hours is associated with lower rates of re-bleeding. Admitting teams should therefore aim to ensure that patient pathways involve early pack removal.

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 0.05). 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.

After endoscopic endonasal reduction (EER) for medial blowout fracture (BOF), nasal packing may be necessary for sustaining the reduced orbital contents. This study aimed to introduce a new packing technique using Merocel in a glove finger. We retrospectively reviewed 131 patients with a mean age of 42.2 years (range, 13–80 years), who underwent EER for medial BOF, followed by a postoperative nasal packing of Merocel in a glove finger, between March 2016 and December 2019. Sex, age, side and cause of trauma, pre-operative diplopia and enophthalmos, duration from the occurrence of trauma to surgery, postoperative diplopia, enophthalmos, complications like sinusitis, and revision surgery were evaluated. The most common cause of injury was physical assault in 47 cases and a fall or slip event in 34. Pre-operatively 22 patients had diplopia and 1 patient had enophthalmos. Mean duration after trauma to the surgery was 13.2 days (range, 1–29 days). The mean operative time was 34.1 minutes (range, 10–70 minutes). Four weeks after operation, the nasal packing was removed at an outpatient clinic, with minimal pain, discomfort, and bleeding and no evidence of infection or inflammation. A computed tomography scan performed at 3 months postoperatively showed no re-bulging. The computed tomography image of 1 patient showed frontal sinus haziness; the patient had a headache and underwent endoscopic sinus surgery for symptomatic relief. Three patients had diplopia and 1 had enophthalmos at final follow-up. No other major postoperative complications were noted. Merocel in a glove finger packing technique proved itself to be safe and effective after EER for medial BOF.

Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specificallyA clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given.Patients with nonabsorbable nasal packing placed.Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model.The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective.Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence.3a.

Key point: • Being one of the commonest presenting emergencies, epistaxis can increase the pressure on the health service; in times similar to COVID-19 pandemic such pressure can be crucial and challenging to deal with. • Non-absorbable nasal packing and home discharge for selected patients can be a safe and efficient alternative treatment method with low readmission rates (5.3 %); such management can be of tremendous help when the hospital capacity is overwhelmed. • Although such protocols can be challenging to generalize, the presented protocol seems safe, easily adoptable without any significant complications.

This clinical trial aimed to investigate the effects of different nasal packing methods and transseptal suture technique on swallowing after septoplasty. This randomized prospective study consists of 180 consecutive patients with septal deviation. All the patients underwent septoplasty. All the patients were randomly assigned to three groups. In group A, transseptal sutures were used for septal stabilization. In group B, both nasal passages were packed with Merocel tampons for septal stabilization. In group C, both nasal passages were packed with Doyle silicone splints for septal stabilization. For the evaluation of swallowing, the Eating Assessment Tool (EAT-10) questionnaire and a visual analog scale (VAS) were administered to all the patients preoperatively and on the second and seventh postoperative days. One hundred and twenty two of the patients (67.7%) were female and 58 of them (32.2%) were male. The mean age was 32.41 ± 12.37 years (range: 18–57 years). Both EAT-10 and VAS scores on the second postoperative day were significantly higher than the preoperative scores in all the groups (p

The core of BOR surgery is full of fundamental decisions and the principles to be respected are many and demanding. The surgeon should work progressively from the depth of the nose towards the more superficial elements of the external framework. Any action should be done conservatively and preferably utilizing the instruments and techniques that maximize the preservation of bone and cartilage tissue. Each piece of cartilage removed must be stored in sterile saline solution in anticipation of its possible use during the final phases of the surgery; in the last few minutes even a small cartilage fragment can be decisive for the final result. Every modification of the nasal framework should be corresponded by a direct stabilizing and reconstructive maneuver; nasal packing and external splinting done at the end of surgery are ineffective if compared with multiple bone and cartilage direct sutures.

Epistaxis is a rare complication following the endonasal approach of skull base surgery. Conservative methods like anterior and posterior nasal packing can be useful, but when these fail, a neuro-interventional technique can be used as a last-resort measure in cases of severe bleeding. The authors identify a 22-year-old female patient with recurrent epistaxis following resection of skull-base chordoma through an endonasal approach. An endovascular catheter digital subtraction angiogram identified the cause of epistaxis as a rupture of the left sphenopalatine artery branch of the left external carotid artery. A large dissecting aneurysm in the right intracerebral artery was also incidentally found. The unique co-occurrence of vascular problems was successfully managed by neuro-interventional techniques.

Background: Nasal septal suturing is a commonly used alternative treatment to nasal packing after septoplasty. Besides alleviating postoperative discomfort, extensive studies have shown that nasal septal suturing is more effective than nasal packing. However, its clinical benefits remain controversial. Methods: We will perform a systematic review of nasal packings effect-related outcome in comparison to nasal septum suture among septoplasty patients by searching 8 databases, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All eligible studies will be screened against the inclusion and exclusion criteria. Two independent reviewers will extract the data. Moreover, Review Manage 5.3 will be used for quality assessment and data analysis. Then, the random effects model or fixed effects model will be applied according to the heterogeneity. In conformity with the GRADE criteria, the merits of the evidence and recommended strength will be assessed. Results: This protocol will guide subsequent systematic reviews and meta-analyses. The differences in efficacy between nasal septal suturing and nasal packing after septoplasty will be evaluated in terms of efficiency, adverse reaction, comfort degree, and other factors. Conclusion: This proposed study will explore the possibility of adopting nasal septal suturing as an alternative to nasal packing after septoplasty. OSF registration number: doi: 10.17605/OSF.IO/WF3GX.

Objective: The endoscopic transsphenoidal pituitary surgery has gained popularity and has shown excellent results with a more comfortable postoperative course. However, the quality of the early postoperative course is not well-established in endoscopic transsphenoidal pituitary surgery. We hypothesized that the quality of the early postoperative course would be improved when an enhanced recovery after surgery (ERAS) protocol and minimally invasive endoscopic transsphenoidal pituitary surgery is implemented.Methods: We implemented a perioperative management ERAS protocol for endoscopic transsphenoidal pituitary surgery by an experienced surgeon (Yuehui Ma) in our department from January 2018. From then the endoscopic transsphenoidal pituitary surgery was implemented with a minimally invasive technique, such as bony sella reconstruction and partial nasal packing. We compared the results of 78 endoscopic transsphenoidal pituitary surgery cases during the initiation of the ERAS protocol and minimally invasive technique implementation: 37 cases in the control group and 41 cases in the ERAS group. Outcomes assessed included the effectiveness and security of surgery, postoperative hospital length of stay (LOS), and postoperative status on postoperative day 1 (POD1).Results: Postoperative status on POD1, such as nasal ventilation, out of bed, headache score, and liquid supplement, had significant improvement (P < 0.05). The median postoperative LOS decreased from 8 days in the control group to 3 days in the ERAS group (P < 0.05). The ERAS group had better economic benefit with fewer hospital charges (P < 0.05). There was no difference in the early postoperative diabetes insipidus and 30-day readmission for epistaxis, hyponatremia, or other complications between the two groups.Conclusion: The quality of the early postoperative course was improved when a neurosurgical ERAS protocol and minimally invasive endoscopic transsphenoidal pituitary surgery with partially nasal packing were implemented. Endoscopic transsphenoidal pituitary day surgery could be recommended in some classes of patients though further evaluation in large case studies is warranted.

Nasal packing is an essential component of ENT surgery. Following many different surgical procedures on the nose, e.g. rhinoplasty, septoplasty, turbinate minimization or cautery, nasal packing plays a key role in preventing haemorrhage or crust formation and, on occasion, helps secure flaps or grafts in the correct alignment. The range of products composed of various materials and marketed for use as packing has been steadily growing. Nasal packing materials need to (1) promote haemostasis following nosebleeds or an operation; (2) offer structural support to cartilage or bone, the conchae or other soft tissues (such as to an advancement flap); and (3) stop adhesions forming or stenosis developing, particularly after sinus procedures. This kind of pack needs to remain in place for a more extensive period. Struts and some materials offer particular benefit in these uses. In this chapter, ideal packing and ointment after nasal surgery are presented.

Rationale: Negative pressure pulmonary edema (NPPE) is associated with serious postoperative complications. Compact nasal packing is always done after an open rhinoplasty procedure which makes it difficult to achieve positive pressure ventilation via a mask if NPPE arises. Patient concerns: A 21-year-old healthy man got an open rhinoplasty, septal perforation repair, and revisional septal reconstruction. After surgery, he became so agitated that it was difficult to calm him. We decided to remove the endotracheal tube. On arrival at the post-anesthesia care unit, he was cyanotic and his SpO2 had decreased to about 2%. We attempted positive pressure ventilation using mask bagging; however, it was ineffective due to the nasal packing. Diagnoses: Negative pressure pulmonary edema Interventions: Emergent reintubation was immediately done and Ambu bagging was commenced. A considerable pinkish secretion came out of the tube. A T-piece was applied to him using 15 L/min of oxygen supply. The patient was eventually transferred to the intensive care unit of our hospital. Outcomes: On postoperative day (POD) 1, a decision was made to extubate, and the oxygen supply was shifted to 3L/min using a venturi-mask. On POD 2, a chest posteroanterior radiograph was taken and indicated no active lung lesion. The patient was subsequently discharged without any complications. He had no symptoms on POD 6, 11, and 18 at follow-up visits to our outpatient clinic. Lessons: Anesthesiologists should be alert to the possibility of NPPE and its treatment because of its rapid onset but positive clinical outcome if there is a proper intervention. In nasal surgery cases in particular, early re-intubation should be conducted and extubation should be done to fully awaken the patients.

Introduction Epistaxis represents a massive burden upon NHS resources. Despite being an extremely common reason for emergency ENT admissions, there remains significant variation in its management. Although the evidence base is continually growing, there appears to be a lack of guidance towards managing anti-coagulants and anti-platelet medications and identifying patient-specific outcomes in this setting. Epistaxis has long been associated with a multitude of risk factors but none have shown consistent, direct correlation. Materials and methods We aimed to identify if the use of anti-thrombotic medication was associated with a longer length of hospital admission or conferred a higher requirement for nasal packing, re-packing, surgery or re-admission. We conducted a retrospective analysis of 100 consecutive adult patients admitted over a 6-month period. Statistical analysis was conducted using SPSS software. Results Sixty-five percent of patients were taking anti-thrombotic medication. The variability of admission INR values in those taking warfarin did not relate with any outcome measure. There was no statistical difference between patients taking anti-thrombotic medication and those who do not, with regards to our primary outcome measures. Re-admission rates within 28 days were found to be 13%, with anti-thrombotic medication use and pre-existing cardiovascular disease recognised as commonly encountered risk factors. Three percent of patients required surgical intervention. Eight percent of patients required re-packing, with a Rapid Rhino chosen in all instances. Conclusion The use of anti-thrombotic medication is not associated with increased morbidity or increased rate of complications. Anti-thrombotic usage and more than one medical co-morbidity increase the risk of re-admission within 28 days.

Background: Epistaxis is a common cause of otorhinolaryngological clinic visits and admissions into accident and emergency. Severe epistaxis could remarkably alter the hemodynamic milieu of individuals and results into significant morbidity and occasional mortality. Aims:To review the clinical pattern and laboratory test results of individuals treated for epistaxis in a tertiary health care center in northern Nigeria.Methods:This study was a 10-year retrospective review of patients managed for epistaxis in the department of otorhinolaryngology, Aminu Kano teaching hospital, Kano, Nigeria. Case files of patients were retrieved, reviewed, and clinical and laboratory data were extracted. The data were analyzed using Statistical Product and Service Solution version 23.Results: A total of 256 were reviewed with 149 (58.2%) male and 107 (41.8%) female with M: F of 1.4:1. A mean age ± SD of 33.86 ± 20.06 years. Anterior epistaxis was the most prevalent, 126 (49.2%), and majority of the patients presented with severe epistaxis, 75 (29.3%). Most were treated with nasal packing, 93 (36.3%). Majority had abnormal full blood counts and clotting profile results, 158 (61.75) and 104 (40.6%), respectively. There was a significant association between patient's genotype and outcome. Anterior epistaxis and AA genotype were significant positive predictors of outcome. Conclusion: Coagulopathies, anaemia, and hemoglobinopathies are common findings among our patients with epistaxis.