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In a medical setting, such as the treatment of post-operative nosebleeds, nasal packing, including the use of nasal packs, nasal plugs or nasal tampons (NTs), is widely used to temporarily control anterior epistaxis. Although some literature has documented the use of NTs as a quick, easy and temporary solution to deal with anterior epistaxis in sports-induced nasal injuries, additional research is needed to appreciate on-field versus off-field efficacy, as well as the efficiency of different brands of NTs and packing materials.

Negative pressure pulmonary edema (NPPE) is a well-known, albeit infrequent complication caused by upper airway obstruction. It may be seen after extubation following general anesthesia due to excessive negative intrathoracic pressure exerted against an obstructed upper airway. This leads to fluid extravasation from the pulmonary capillaries into the alveolar spaces and lung parenchyma. We report a case of NPPE after endoscopic transsphenoidal resection of the nonfunctional pituitary tumor, which occurred secondary to bilateral nasal packing. Reintubation and positive pressure ventilation were used to manage the patient, who was later extubated after the resolution of features of NPPE. [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.

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 patients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmitted 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.

Aim to improve the quality of life of patients in the early postoperative period after septoplasty. Material and methods. The study involved patients who underwent septoplasty (n=51). The patients were divided into two groups: in group A (n=26) classic intranasal splints were installed at the end of the operation; in group B (n=25) we used the modified intranasal splints with an integrated rigid duct, with a pressure distributor placed mainly in the anterior nasal septum and the latches along the periphery (patent No. 191163). To assess the patients comfort before and on the first day after surgery, a quality of life assessment questionnaire (Sino-Nasal Outcome Test SNOT-20) was used. The headache intensity was evaluated in the early postoperative period using a visual analog pain scale. Statistical data processing was carried out using the STATISTICA 12 software. Results. According to the results of SNOT-20, we obtained a statistically significant (p 0.05) improvement in the quality of life of patients when using our modified splits against the traditional splits. Comparing the data of the SNOT-20 questionnaire and VAS, we found a statistically significant (p 0.05) reduction in pain in the early postoperative period when using our intranasal splints with an integrated air duct and pressure distributor. Conclusion. The use of our modified intranasal splints improves the quality of life of patients in the early postoperative period.

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]

OBJECTIVE: Nasal packing is used to stop bleeding in cases of epistaxis. Different topical drugs are preferred to these packs in the emergency department. In this study, we aimed to compare the efficacy of lidocaine, epinephrine and tranexamic acid (TXA) in stopping bleeding in patients with epistaxis. PATIENTS AND METHODS: Patients with non-traumatic epistaxis were evaluated in three treatment groups as topical lidocaine, epinephrine, and TXA. These treatments were applied prospectively in a double-blind manner and randomized manner. The bleeding stop times of the patients were recorded with bleeding time parameters. RESULTS: A total of 108 patients were included in the study. The mean age of the patients was 55.7±17.7 years. When the bleeding stop times were compared between the groups, there was no statistically significant difference (lidocaine vs. epinephrine, p=0.870; lidocaine vs. TXA, p=0.502; and epinephrine vs. TXA, p=0.242). The systolic blood pressure value statistically significantly differed between the lidocaine and epinephrine groups (p=0.034) and between the epinephrine and TXA groups (p=0.003). There was also a statistically significant difference between the diastolic blood pressure values of the epinephrine and TXA groups (p=0.020). CONCLUSIONS: We found that nasal packing with lidocaine, epinephrine and TXA was not superior to each other in terms of stopping bleeding time. [ABSTRACT FROM AUTHOR]

OBJECTIVE To compare the possibility of Post-operative hemorrhage in septoplasty with and without nasal packing among the patients operated at PNS SHIFA hospital Karachi STUDY DESIGN: Comparative Study SETTING: PNS SHIFA hospital Karachi DURATION OF STUDY: Six months, 21-04-2019 to 20-10-2019 PATIENTS AND METHODS: Ninety two patients who underwent septoplasty due to deviation of nasal septum at ENT department of PNS SHIFA were included in the analysis. Patients were randomly divided into two 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 included in the final analysis 61 were male and 31 were female. Pot operative bleeding was found in three patients in group one while thirteen patients in group two had bleeding after the procedure. With Pearson chi-square test, we found that post-operative bleeding, headache and discomfort was significantly more in the patients with nasal packing after the procedure of septoplasty due to deviated nasal septum. CONCLUSION Nasal packing emerged as a procedure linked with more complications rather than benefits among the patients undergoing septoplasty in our study. Not only post-operative hemorrhage but also 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.

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.

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 & 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.

The main objective of this study was to determine the rate of outpatient management in a population of patients undergoing bilateral ethmoidectomy. The secondary objectives were to evaluate the quality of outpatient management (rate of unscheduled overnight admission, readmission rate, complications) and to compare inpatient and outpatient groups to determine which elements of the phenotype and care pathway favored outpatient management. A single-center observational study included 204 patients operated on for bilateral ethmoidectomy. Study variables comprised: type of care pathway (outpatient/inpatient), outpatient quality indicators (unscheduled admission, readmission, complications), care pathway, and population characteristics. One hundred and twenty (58.8%) outpatients were operated on. No deaths occurred. The unscheduled admission rate was 7.5%, and the readmission rate 4.1%; at the P < 0.005 threshold, there were no significant differences between in- and out-patient groups. Outpatients had earlier surgery (P < 0.005), and nasal packing rates and pain on VAS were lower (P < 0.005). Ethmoidectomy could be carried out as an outpatient procedure in 58.8% of cases, with acceptable quality of care. Selection of patients and the organization of a dedicated care pathway seem to be elements favoring this management. [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]

Study objective: Bilateral endoscopic nasal surgery is usually associated with pain and sleep disturbance. The aim of this study was to evaluate the effects of dexmedetomidine-soaked nasal packing on analgesia and improvement of sleep quality in patients undergoing this surgery. Method: Eighty patients were enrolled and randomly allocated into 4 groups. At the end of surgery, dexmedetomidine-soaked nasal packings were applied to three groups with a dosage of 1 μg kg−1 (D1), 2μg kg−1 (D2), 4 μg kg−1 (D4) and normal saline-soaked nasal packing (NS) was applied to a fourth group. The primary outcome was postoperative pain scores using a visual analog scale (VAS) recorded at six time points: before the surgery (T1); 2 h (T2), 8 h (T3), 24 h (T4), 48 h (T5) after surgery; and at the moment of nasal packing removal (T6). Secondary outcomes were postoperative sleep status evaluated by the Pittsburgh sleep quality index (PSQI) and subjective sleep quality value (SSQV). Factors affecting sleep, hemodynamic changes, and adverse events were also recorded. Results: Compared with the NS group, dexmedetomidine-soaked nasal packing significantly relieved postoperative pain and improved sleep quality. The effect was similar between D2 and D4, which was greater than in D1. However, D2 was associated with fewer adverse events. Conclusions: Dexmedetomidine-soaked nasal packing not only offers effective analgesia but also improves postoperative sleep quality in patients undergoing bilateral endoscopic nasal surgery. Taking effect and adverse events into consideration, a dosage of 2μg kg−1 may be optimal. Trial registration: www.chictr.org.cn/index.aspx (ChiCTR1900025692) Retrospectively registered 5 September 2019 [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]

Objective: 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, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. Study Design: A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. Setting: Patients with nonabsorbable nasal packing placed. Methods: 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. Results: 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. Conclusions: 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. Level of Evidence: 3a [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: The aim of study is to find out the better option to manage post-operative septal hematoma between the nasal packing or quilting sutures. Methods: Cross sectional comparative study of 2 groups patients, group [A]; 39 patients have septoplasty with no nasal packing and suturing, while group [B]; 40 patients have septoplasty with nasal packing. The study has been carried out from July 2021 until February 2022 in Kirkuk General Hospital. From all patients take age, gender, pain, and bleeding occurrence after few moments after surgery, then after 1st day and then after seventh day after operation. Also, if patients have synechiae or not. Results: There is significant difference between group A and group B in bleeding at time of operation, group A patient more bleeding. There is significant difference between group A and group B in bleeding at 1st day after operation, group A patient less bleeding. There is significant difference between group A and group B in pain at 1st day after operation, group A patient less bleeding. There is significant difference between group A and group B in pain at 7th day after operation, group A patient less bleeding. Conclusion: Nasal pain, headache, were reduced in the trans - septal suturing group as compared to packing. However, nasal bleeding was present in both the groups. It also proves to be a cost-effective modality and gives a better post-operative quality of life to patients. Hence, we recommend trans-septal suturing as the preferred method over anterior nasal packing in patients after septoplasty. [ABSTRACT FROM AUTHOR]

Epistaxis is a common problem that can affect the whole population. The majority of cases are self-limiting and do not require any medical intervention, but epistaxis can be associated with morbidity and even death in very rare circumstances. If epistaxis does not resolve with first aid measures, or episodes are frequent, patients may require specialist assessment and treatment by ENT, either in the outpatient clinic or via an unscheduled (emergency) admission to the hospital. Here, we provide an overview of the management of epistaxis in the outpatient setting and during an emergency admission in both paediatric and adult patients. We highlight the key considerations in the history and management, covering the common and rare conditions that are associated with epistaxis. This article provides an update from our previous article published in 2018 to include the more recent literature and a useful learning resource for examinations. [ABSTRACT FROM AUTHOR]

Aim: In this study, it was aimed to make a general evaluation of patients who applied to our outpatient clinic with epistaxis. Methods: The files of approximately 300 patients who were admitted to the Otorhinolaryngology outpatient clinics of a tertiary hospital with the complaint of nasal bleeding between January 2009 and January 2019 were retrospectively evaluated. The patients were analyzed in terms of age, gender, month of epistaxis, etiological factors, concomitant diseases, whether blood transfusion was required, treatment methods applied and length of hospital stay. Results: Of the 300 evaluated patients, 128 were female (42.8%) and 172 (57.2%) were male. The mean age of the patients was determined as 34.38 ± 23.63 (min 1-max: 89). The patients applied most frequently in February (14%) and at least in July (2.6%). The number of patients detected idiopathically was 240 (80%). Among the identified reasons, the most frequent use of anticoagulants was 11% and hypertension was 4.6%. Conservative treatment was applied to 98.4% of the patients. Hospitalization periods ranged from 1 to 11 days. Only 2 patients needed blood transfusion. Conclusion: Considering the possible complications and mortality; Taking detailed anamnesis from patients and planning the necessary treatment as soon as possible constitute the basis of diagnosis and treatment management in patients with epistaxis.

AimTo describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).MethodsThis observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.ResultsA total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.ConclusionSevere epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.

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]

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.

Introduction In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient. Materials and Methods This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously. Result The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge. Conclusion The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.

Introduction: Epistaxis is a common otolaryngological emergency condition. It occurs due to local and systemic cause. Local cause lies within the nose bleeding either anterior or posterior. Commonest site of bleeding anterior epistaxis is kiesselbach’s plexus. In posterior epistaxis, it is difficult to locate bleeding site. Epistaxis is controlled by simply pinching of nose, decongested nasal drop and abgel packing. Some cases become more challenging required nasal packing and arterial ligation. Objectives: To study the epidemiological pattern and management of epistaxis. Methods: This was a retrospective study on pattern of epistaxis man­aged at Gandaki Medical College Teaching Hospital over a period from April 2015 to April 2016. Information regarding demographic profile, presentation and management of epistaxis was obtained from the Hospital records, ENT Outpatient clinic, Emergency Department, ENT ward and operation theatre. Results: A total of 78 cases were managed during study period. There was a significant male preponderance with male to female ratio 1.78:1. Patients’ age varied from eight to 80 years with mean age 40.7 years. The peak age of incidence was 21 - 30 years group. Idiopathic nasal bleeding 27 (34.6%) was commonest followed by nasal trauma 23 (29.5%) cases and hypertension 16 (20.5%) cases. Seventeen (21.8%) cases managed in day care basis with decongested nasal drop, chemi­cal cautery and abgel packing. Remaining cases required nasal packing and bipolar cautery and other specific form of treatment. Five (6.4%) cases required sphenopalatine artery ligation with no recurrence of bleeding. Conclusions: Epistaxis is common ENT emergency. Most common causes are idiopathic followed by nasal trauma and hypertension. Prompt management is instituted according to cases. Most of the cas­es are managed by non-surgical method.

Introduction In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient. Materials and Methods This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously. Result The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge. Conclusion The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.

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]

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]

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. 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. 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. The project's aims of improving epistaxis patients' outcomes and improved convenience for ED staff were achieved. [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]

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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]

Objectives To evaluate the outcome of septoplasty and the effect of bilateral anterior nasal packing (NP) on surgical outcome and postoperative (PO) arterial blood gas levels. Patients and methods A total of 90 patients underwent septoplasty: group I included patients who received PO bilateral anterior NP at the end of surgery for 48 h and group II included patients free of NP. Patients were evaluated clinically using the Nasal Obstruction and Septoplasty Effectiveness scale and underwent septoplasty using Cottle’s technique. Arterial blood samples were obtained preoperatively and before NP removal for estimation of arterial blood pH, bicarbonate (HCO3−), partial pressure of O2 (PaO2) and CO2 (PaCO2), and O2 saturation (SaO2) levels. Pain severity was assessed using numeric rating scale at 6 h, D-1, and D-2 PO, and during the first 48 h PO, nasal bleeding in group II was estimated. After NP removal, pack removal-associated pain and amount of bleeding were determined. Results Operations were conducted uneventfully with nonsignificant difference between groups. At 48 h PO, mean PaO2, PaCO2, and SaO2 levels were significantly lower in all patients than preoperative levels, with significantly lower SaO2 and PaCO2 levels in patients of group I than group II. Numeric rating scale pain scores in both groups showed progressive significant decrease till 48 h PO, with significantly lower scores in group II. Removal of NP resulted in pain scored by more than or equal to 4 in 30 patients and induced minimal bleeding, which was significantly lower than bleeding occurred in patients of group II throughout the 48 h PO. All patients enjoyed significant reduction of Nasal Obstruction and Septoplasty Effectiveness score, with nonsignificant difference between both groups. Conclusion NP after septoplasty reduced amount of PO bleeding, but pain associated with NP presence and removal-induced deleterious effect on patients’ satisfaction with deleterious effect on arterial blood O2 and CO2 levels but with nonsignificant effect on arterial blood pH or HCO3 concentration.

Abstract Background Epistaxis is the most common emergent consultation to otolaryngology-head & neck surgery (OHNS) and with 60% of the population having experienced an episode and 1.6 in 10,000 requiring hospitalization in their lifetime. In preliminary studies Floseal® (Baxter, USA) Hemostatic Matrix has shown efficacy in up to 80% of persistent anterior epistaxis. We sought to evaluate the clinical efficacy and cost-effectiveness of Floseal® (Baxter, USA) compared to traditional nasal packing for persistent epistaxis. Methods A prospective, randomized controlled trial was conducted on all adult patients consulted to the OHNS service at the tertiary referral centers of the University of Alberta Hospital and Royal Alexandra Hospital for persistent epistaxis. Patients were randomized to the Floseal® (Baxter, USA) or traditional packing study arms. Our main clinical outcome measures were: 1) Hemostasis directly following treatment and at 48 h post-treatment, and 2) self-reported patient comfort at 48 h post-treatment. Further, trial data was used for a formal cost-effectiveness analysis to determine incremental cost-effectiveness ratio (ICER). Univariate sensitivity analysis and uncertainty analysis were performed. Results There were no significant differences between groups for initial hemostasis (76.9% vs. 84.6%, p = 1.000) or, hemostasis at 48 h (76.9% vs. 69.2%, p = 1.000), requirement for admission (15.4% vs. 46.1%, p = 0.2016) or 30-day re-presentation rates (15.4% vs. 46.1%, p = 0.2016). Floseal® (Baxter, USA) was superior for decreased pain during placement (2.42 vs. 7.77, p = 0.0022), treatment (0.50 vs. 4.46, p = 0.0007) and removal (0 vs. 3.85, p = 0.0021). Floseal® (Baxter, USA) provides an average $1567.61 per patient savings from the single-payer system point of view and has an ICER of - $11,891 per re-bleed prevented (95% CI: -$37,658 to +$473). Uncertainty analysis shows that Floseal® has >90% chance of not only being cost-effective, but the dominant (preferred) treatment. Conclusions Floseal® (Baxter, USA) was demonstrated to be an effective, comfortable and cost-effective alternative treatment of persistent epistaxis when compared to traditional packing methods for patients referred to OHNS with a normal coagulation profile. Trial registration Trial registration number: NCT02488135 . Date registered: June 26, 2015.

Objectives Nasal packing after endoscopic sinus surgery is frequently used to control postoperative bleeding, enhance the wound healing process, and prevent lateralization of the middle turbinate, which causes insufficient ventilation. Many biodegradable materials have been developed to reduce pain and mucosal damage during packing removal. The purpose of this study was to compare the efficacy of Guardcel (Genewel Co.) middle meatal packing with a traditional nonabsorbable middle meatal packing, Merocel (Medtronic Xomed), on wound healing and patient satisfaction. Methods In this prospective, single-blind, randomized controlled study, we enrolled 32 consecutive patients (64 nostrils) undergoing bilateral endoscopic sinus surgery at Korea University Guro Hospital from February 2015 to August 2015. Guardcel and Merocel were inserted postoperatively into a randomly assigned side. Objective findings about bleeding, hemostasis, adhesion, and infection were evaluated with nasal endoscopy. Patients’ symptoms including pain and nasal obstruction were evaluated with a visual analog scale. Each evaluation was done at 2–3 days, 1 week, 2 weeks, and 4 weeks after surgery. Results At 2–3 days after endoscopic sinus surgery, the Guardcel side had a significantly less hemostasis time than the Merocel side (P=0.001). During this period, the pain during packing removal was significantly lower on the Guardcel-inserted side than the Merocel-inserted side (P=0.002). At two weeks after surgery, the adhesion score on the Guardcel side was significantly lower than that of the Merocel side (P=0.011). Other parameters during the study follow-up periods were not statistically significant. There were no severe adverse reactions. Conclusion Guardcel, a newly developed packing material, appeared to shorten the hemostasis time and reduce pain sensation at 2–3 days after surgery; it also prevented adhesion formation 2 weeks after surgery when compared with the control. Guardcel can be an effective and safe candidate to replace conventional packing materials after endoscopic sinus surgery.

Objective:Several types of nasal packs are used postoperatively in septoplasty. In this study, we compared two commonly used nasal packing materials, the intranasal septal splint with airway and Merocel tampon, in terms of pain, bleeding, nasal obstruction, eating difficulties, discomfort in sleep, and pain and bleeding during removal of packing in the early period.Methods:The study group included 60 patients undergoing septoplasty. Patients were divided into two groups (n=30 in each group). An intranasal splint with airway was used for the patients in the first group after septoplasty, while Merocel nasal packing was used for the second group. Patients were investigated in terms of seven different factors - pain, bleeding while the tampon was in place, nasal obstruction, eating difficulties, night sleep, pain during removal of the nasal packing, and bleeding after removal of packing.Results:There was no statistically significant difference between the groups in terms of pain 24 hours after operation (p=0.05), while visual analog scale (VAS) scores for nasal obstruction, night sleep, eating difficulties, and pain during packing removal were lower in the nasal splint group with a statistically significant difference (p

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]