Nasal Packing Research Articles

Clinical outcome of no nasal packing in patients undergoing endoscopic sinus surgery

Clinical outcome of no nasal packing in patients undergoing endoscopic sinus surgery

Uncontrolled systemic hypertension and haemolacria.

Haemolacria is a condition caused by a group of disorders resulting in production of tears that are partly composed of blood. It can be unilateral or bilateral. The etiology includes ocular, systemic, psychological, pharmacological, and idiopathic.[123] We present an unusual case scenario of unilateral hemolacria in a 62-year-old previously fit and well gentleman who presented to ER (emergency consultation room) with sudden onset epistaxis from the right nostril. Immediate evaluation included local examination by an ENT (Ear Nose and Throat department) colleague and systemic evaluation by the physician. The Physician diagnosed severe hypertension (BP recorded was 190/110 mm hg) and antihypertensive therapy was initiated. The source of the nasal bleed was identified as the Little's area (Kiesselbach's plexus). An attempt to cauterize the bleed under local anesthesia was made by the ENT colleague, following which anterior nasal packing was done. Within a few minutes of packing the nose, patient started shedding blood mixed tears from the right eye (Haemolacria) [Fig. 1]. The BP continued to stay high at 160/100 mm of Hg. Following this the antihypertensive measures were intensified resulting in complete resolution of the symptoms within the next 6 hours.Figure 1: Shows blood mixed tears coming out of right eye of the patient. It shows right haemolacria and the free end/thread of the anterior nasal pack in the right nostrilPreliminary ophthalmic evaluation revealed no local ocular causes of haemolacria, no previous trauma or lacrimal surgeries. We suspect retrograde blood flow through the Nasolacrimal duct to the conjunctival cul de sac following mechanical attempts at stopping the epistaxis, which alone was apparently ineffective as the underlying primary pathology was uncontrolled systemic hypertension. The authors also suspect a possible congenital absence of the valve of Hasner[4] or iatrogenic damage to the valve of Hasner at the inferior meatus at the time of primary mechanical attempts at haemostasis[5] that resulted in the above presentation. The patient was lost to further follow up thus preventing a further lacrimal outflow reassessment and a formal nasal endoscopic re-assessment. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgement Dr. Sujay Siddharthan, TMS Eye hospital.

Burun Tamponunun Hasta Konforuna Etkisi ile İlgili Sonuçların Karşılaştırılması

Burun Tamponunun Hasta Konforuna Etkisi ile İlgili Sonuçların Karşılaştırılması

Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis

Introduction: Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis. Methods: Retrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Results: A total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31). Conclusion: Endoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis.

Outcome of Endoscopic Sphenopalatine Artery Cauterization for Posterior Epistaxis

Introduction Epistaxis is a common otorhinolaryngology emergency condition. Majority of it is anterior epistaxis which usually improves with conservative management. However, for posterior epistaxis, apart from posterior nasal packing, endoscopic sphenopalatine artery cauterization (ESPAC) is considered an effective measure for its control. Hence, this study was conducted to evaluate the outcome of endoscopic sphenopalatine artery cauterization for posterior epistaxis.
 MethodsRetrospective medical chart review of patients who underwent endoscopic sphenopalatine artery cauterization for posterior epistaxis from January to December 2018 at Ganesh Man Singh Memorial Academy of ENT-Head & Neck Surgery, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
 ResultsA total of 31 patients (21 males and 10 females) underwent ESPAC during the one-year period. Twenty-seven of them were unilateral whilst four were bilateral. Four of them rebled, of which two bled within 48 hours and the remaining two after two months. The overall success rate of ESPAC was 87.1% (27/31).
 ConclusionEndoscopic sphenopalatine artery cauterization is an effective measure to control posterior epistaxis.

Simulation-based ENT induction: validation of a novel mannequin training model.

To ascertain whether simulation-based teaching is superior to lecture-based teaching for an induction programme using a home-made induction model. A simulation-based induction programme was designed and separate lecture-based teaching covering the same content was organised for junior doctors. The junior doctors were asked to complete pre- and post-induction surveys regarding confidence and anxiety levels. The skills taught included microsuction, flexible nasendoscopy, and anterior and posterior nasal packing. Structured interviews were conducted after the programme to gain qualitative data for analysis. The trainees' knowledge retention was compared using a standardised written assessment one month after the session. Simulation-based teaching using the induction model was associated with a statistically significant increase in confidence levels and reduction in anxiety levels, and was associated with greater knowledge retention. A regular simulation induction programme should be introduced using the induction model, as it leads to better knowledge retention and increased confidence levels.

Comparison the Effect of trans-septal suture technique versus the intranasal Merocel packing regarding local nasal pain and sleep disturbances after septoplasty

Background and objectives: Nasal septal deviation is corrected by septoplasty which is a common surgical procedure performed by otolaryngologists. Septal surgery may be associated with numerous complications mainly pain. Otolaryngologists frequently pack both nasal cavities with different types of nasal packing to minimize these complications. Nasal packing is associated with some burden on the patient in post-operative days like local pain. To avoid these issues, many surgeons use transseptal [through and through] suturing techniques to overcome the need for packing after surgery. The aim of this study was to compare the effect of the transseptal suture technique versus the intranasal packing regarding local nasal pain and sleep disturbances after septoplasty. Methods: Prospective comparative study conducted on 120 patients. These patients underwent septoplasty, without additional nasal procedure, for nasal septal deviation. Patients were randomly divided into two equal groups before the operation. Group (A) with trans-septal su- ture technique was compared with group (B) in which intra-nasal packing with Merocel was done which were removed on the second postoperative day. Pain level using visual analog scale postoperatively was recorded over a follow-up period of 1st and 2nd postoperative day. Results: Out of 120 patients who had classical septoplasty, 74 patients were males (61.7%) and 46 patients were females (38.3%). Patients who had intra-nasal packing got significantly more postoperative pain (P<0.05), Visual analog scale score was significantly higher in group B than those who had trans-septal suture [group A]. Conclusions: Trans-septal suturing technique without nasal packing for septoplasty postoperatively can be safely performed and with minimal local pain and sleep disturbances compared with the intra-nasal packing technique.

내시경적 아데노이드 등급과 소아 폐쇄성 수면무호흡증 중증도의 상관관계

Background and Objectives: Hypertrophy of adenoids was recognized as one of the main causes of snoring and obstructive sleep apnea (OSA) in pediatric patients. Recently, two endoscopic adenoid grading system was proposed, Parikh grade (P-G) and ACE grade (ACE-G). The aim of this study is to evaluate the correlation between obstructive sleep apnea severity and these two endoscopic adenoid grading systems. Materials and Methods: We retrospectively reviewed the medical records of 52 patients who underwent a polysomnography and endoscopic nasal endoscopy in the secondary referral hospital from 2008 to 2017. Adenoid exam was performed with nasal endoscopy after nasal packing soaked with lidocaine and xylometazoline in out-patient clinic. It was evaluated the correlation between each adenoid grading system and apnea-hypopnea index, adjusted by sex, age, tonsil grade, body mass index, and presence of allergic rhinitis. Results: Mean age was 7.6 year (range : 2-15, SD : 2.57) and 75% of the patient had obstructive sleep apnea (AHI≥1). P-G was statistically correlated with OSA severity. (OR=11.8, 95% CI : 1.5-92.2, p=0.02) Only subgrade E of ACE-G has meaningful correlation with OSA severity (OR=2.07, 95% CI : 0.91-4.81 p=0.03). Conclusion: P-G and subgrade E of ACE-G were statistically related to sleep apnea severity in pediatric patients. Endoscopic adenoid grading system can be useful tool to evaluate adenoid hypertrophy and upper airway in pediatric OSA patients. (J Clinical Otolaryngol 2019;30:204-208)

Management of Palatal Fracture and Airway Challenge in A Child — A Red Flag

Airway managements in maxillofacial fracture patients are complex and crucial. Trauma to the maxillofacial region may cause hemorrhage, swelling which may lead to pulmonary aspiration and airway obstruction. Airway managements in maxillofacial fracture patients are complex and crucial. Besides being uncooperative, presence of fractures and soft tissue injuries posed challenges in managing pediatric patient who already have smaller airway opening. This condition is an important red flag which required extra caution from the treating clinicians. A 6-year-old boy was involved in a road traffic accident and presented with profuse bleeding from the oral cavity and nostrils. Physical examination showed oozing of blood with step deformity of the midpalate. Multiple attempts in intubation resulted in failure before succeeding with the aid of suction devices. After intubation was done, intraoral bleeding was successfully managed with transpalatal wiring and nasal packing. The patient was ventilated in the intensive care unit and was extubated two days later. He was discharged well from hospital after one week of admission. Airway management is a rush against time, particularly in a pediatric patient suffering from a palatal fracture. The need for helping hands for suction and child control must be emphasized to ensure the patient’s survival.

Hot nasal packing with hot saline irrigation for hemostasis after adenoidectomy: A prospective randomized controlled study

ObjectiveThis study aimed to investigate the efficacy of hot posterior nasal packing and hot saline irrigation in bleeding control after adenoidectomy. MethodsA total of 130 patients scheduled for adenoidectomy were included in the study, and randomized into two groups at the beginning of the surgical operation. After adenoidectomy, saline impregnated tampon, and saline irrigation at room temperature (22 °C) was applied to the patients in one group while 50 °C saline impregnated tampon and saline irrigation at the same temperature were applied to the patients in the other group. We recorded hemostasis for up to 3 min after tamponade for bleeding control, and the amount of bleeding into the nasopharynx. ResultsThe age of the patients ranged from 1.5 to 13 years (mean ± SD: 6.07 ± 3.08 years, and 5.33 ± 2.55 years, 22 °C and 50 °C saline irrigation groups, respectively). There were 37 males and 28 females in the 22 °C saline group, while 34 males and 31 females in the 50 °C saline group. When comparing the two groups, there was no statistically significant difference in terms of duration of hemostasis (p = 0.64). However, bleeding scores at 2 nd min after the tamponade were significantly lower in the 50 °C saline group (p = 0.007). The amount of bleeding in the 50 °C saline group was also significantly lower than the 22 °C saline group (p = 0.015). ConclusionIn this study, application of 50 °C saline impregnated tampon, and hot saline irrigation was found to be more effective in the control of bleeding after adenoidectomy by reducing the amount of bleeding compared to 22 °C saline impregnated tampon application and saline irrigation at 22 °C. However, hot nasal packing and hot saline irrigation did not affect duration of hemostasis and cauterization.

Conservative management, a preferred first line method for treatment of epistaxis.

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

"In-Office Balloon Sinus Ostial Dilation with Concurrent Antiplatelet and Anticoagulant Therapy for Chronic Rhinosinusitis without Nasal Polyps".

Functional endoscopic sinus surgery (FESS) and balloon sinus ostial dilation (BSD) are well-recognized minimally invasive surgical treatments for chronic rhinosinusitis without nasal polyps (CRSsNP) refractory symptoms to medical therapy. Patients on antiplatelet and anticoagulant therapies (AAT) usually are recommended to discontinue their medications around the period of endoscopic sinus surgery. The goal of this study is to assess the clinical experience of BSD in CRSsNP patients with concurrent anticoagulant or antiplatelet therapy. A review of prospectively-collected clinical data from October 2012 to March 2017 were used to perform a cohort study of subjects with CRSsNP who met criteria for surgical intervention while on antiplatelet and anticoagulant therapy. Data were collected on demographics, details of the procedures, type of AAT used, pre- and postoperative 22-item Sino-Nasal Outcome Test (SNOT-22) scores, and complications. Thirty-five patients underwent in-office BSD while on antiplatelet and/or anticoagulant therapy. The mean difference in pre- and postoperative SNOT-22 scores of 9.9 (SD 14.4, P < .001) was both statistically significant and exceeded the minimal clinically important difference of 8.9. Absorbable nasal packing was used for persistent bleeding immediately post-procedure in two patients. Intraoperative bleeding was associated with aspirin 325 mg and warfarin. FESS was required for further management of chronic sinusitis in four patients after anticoagulant/antiplatelet therapy could be discontinued. There were no systemic complications. None of the patients experienced significant bleeding events postoperatively after leaving the office. In-office BSD appears to be a safe alternative to endoscopic sinus surgery in select patients who cannot discontinue antiplatelet and anticoagulant therapy. IV.

The clinical study of modified transseptal suturing after septoplasty

Objective:To study whether modified transseptal suturing could be an alternative to packing after septoplasty. Method:We conducted a prospective randomized controlled trial. The study involved 40 patients who underwent septoplasty. Patients were randomly divided into two groups, one with anterior nasal packing and the other with modified transseptal suturing. Patients were asked to record their subjective discomfort levels on a visual analogue scale（VAS） during 48 h postoperatively. Both groups were compared for VAS, postoperative complications 2 weeks after septoplasty through nasal endoscope, the datum of rhinomanometry before surgery and 2 weeks after surgery. Result:The differences of mean postoperative VAS score between two groups were statistically significant（P<0.05）. The patients of nasal packing group experienced more discomforts than the other group. No statistically significant between two groups in terms of the datum of rhinomanometry before surgery and 2 weeks after surgery（P>0.05）. There were no bleeding, septal hematoma, nasal septum perforation and local infection in all patients 2 weeks after septoplasty. During follow-up 1 case was found with postoperative nasal adhesion, nasal vestibular swelling and fester were seen in two patients and nasal peculiar smell was found in 1 case in nasal packing group. We can find that there were a lot of blood crust in silicone ventilation tube about in 14 patients in packing group. However, the suturing group could see none of the above questions. Conclusion:Modified transseptal suturing is more simple and convenient than nasal packing. In a word, the use of modified transseptal suturing could be an alternative topacking after septoplasty.

A Comparison of Conventional Nasal Pack with Merocel Nasal Pack in the Management of Epistaxis

A Comparison of Conventional Nasal Pack with Merocel Nasal Pack in the Management of Epistaxis

Hot Nasal Packing With Hot Saline Irrigation for Hemostasis After Adenoidectomy

Hot Nasal Packing With Hot Saline Irrigation for Hemostasis After Adenoidectomy

TXA plus compression and nasal packing did not differ for epistaxis, and both were better than compression alone.

Source Citation Akkan S, Corbacioglu SK, Aytar H, et al. Evaluating effectiveness of nasal compression with tranexamic acid compared with simple nasal compression and Merocel packing: a randomized ...

THE EFFICACY OF MAGNESIUM SULPHATE ON EMERGENCE AGITATION IN ADULTS FOLLOWING NASAL SURGERIES

Background: Emergence agitation (EA), although short-lived, is potentially harmful to the patient and the recovery staff. In the postoperative care unit, an agitated patient requires more nurses to control his abnormal movement and apply restrains that could result in bruises of his extremities. Objectives: The objective of the study was to investigate efficacy of intraoperative magnesium sulphate on prevention of EA in adults undergoing nasal surgeries under sevoflurane anesthesia. Primary outcome of the study was to compare incidence of EA between magnesium and control group. The secondary outcome was to assess pre-operative hemodynamic parameters, sedation scores, emergence time and quality of recovery in both study groups. Patients and Methods: The present study was conducted in the Al-Hussein University Hospital, following approval from the Ethics Committee of the hospital. This study included 70 adult patients of American Society of Anesthesiologists physical status I and II between 20 and 40 years of age of both sexes, non-smokers, with BMI less than or equal to 30, posted for nasal surgery under general anesthesia in which nasal packing on each side was used postoperatively. Thorough pre-anesthetic evaluation was done. Results: In patients undergoing nasal surgeries, intraoperative administration of magnesium decreased the incidence and severity of postoperative agitation, ameliorated postoperative pain and shortened stay in the PACU Conclusion: The intraoperative administration of magnesium sulphate in patients undergoing nasal surgeries decreased postoperative agitation, pain intensity and pethidine consumption in the early postoperative period. Intraoperative administration of saline did not decrease post operative agitation, pain intensity and pethidine consumption in the early postoperative period.

Incidence of Bleeding Complications With Flexible Bronchoscopy in Cancer Patients With Thrombocytopenia.

Bronchoscopy is a safe procedure, but current guidelines recommend transfusion for platelets <20 K/μL. Studies of bronchoscopy in thrombocytopenia are limited. Our objective was to evaluate the incidence of bleeding with flexible bronchoscopy in those with thrombocytopenia especially those <20 K/μL. We performed a retrospective review of all flexible bronchoscopies between June 1, 2008 and December 31, 2010. Biopsies and therapeutic procedures were excluded. The χ, Fisher exact, and Rank-sum test were conducted to evaluate associations of clinically significant bleeding. There were 1711 patients who underwent 2053 flexible bronchoscopies. Cancer diagnosis included hematologic (61.3%) and solid organ malignancy (34.9%). Half of the bronchoscopies had moderate to severe thrombocytopenia (<100 K/μL) with the following ranges: 14.7% with 50 to <100 K/μL, 20.6% with 20 to <50 K/μL, 10.6% with 10 to <20 K/μL, 4.1% with <10 K/μL. Platelet transfusion was given in 90.6% of those with platelets <10 K/μL and 55.5% of those with platelets 10 to <20 K/μL. The nasal route for bronchoscopy was used in 92.4%. Bleeding complication rate however was 1.1% (0.2% major) and not affected by platelets. Bronchoscopy with lavage can be safely performed without platelet transfusion in those with platelets of ≥10 K/μL. In the absence of nasal bleeding, trauma, or deformity, the nasal route can be used for bronchoscopy.

P996Early experience of transnasal micro-transesophageal echocardiography to guide left atrium appendage closure under conscious sedation

Abstract Introduction Percutaneous left atrial appendage closure (LAAC) is typically performed utilizing transesophageal echocardiography (TEE) and fluoroscopy under general anesthesia (GA) or intracardiac echocardiography (ICE) under conscious sedation. Transnasal microtransesophageal echocardiography (micro-TEE) is a recently described technique to guide structural heart interventions eliminating the need for GA, which is beneficial for all, especially older patients. In this series, we report our initial experience with this novel technique to guide LAAC. Methods and results Between June 2018 and January 2019, we performed 30 consecutives LAAC (mean age 80,2 years old) with the Amplatzer AMULET in whom we considered using transnasal micro-TEE under conscious sedation instead of TEE under GA. All patients had a CT prior to the procedure to assess anatomy suitability and to rule out thrombus as well as a follow-up CT performed at 3 months post-LAAC to confirm complete sealing. Three patients had TEE instead of micro-TEE for various reasons (patient preference, cognitive impairment, INR &gt;2). We observed one cross-over to TEE+GA because of a failed esophageal intubation under conscious sedation. Device implantation success rate was 100%. Imaging quality was quoted either good or excellent in 25 of the 26 patients with the remaining being quoted as suboptimal. Patient tolerance was either good or excellent in 24 of the 26 cases. There were five epistaxis noticed, one requiring nasal packing. No device embolization, no significant peri-device leak, no tamponade occurred in any patient during this period. At 3 months, there was no prosthesis thrombosis observed and 23% (6/26) had partial opacification of the LAA behind the prosthesis. Conclusion In this series, transnasal micro-TEE was feasible, safe, well tolerated and provided sufficient imaging quality to guide LAAC with the Amplatzer AMULET under conscious sedation. The cheaper cost and the wider field of view of micro-TEE over ICE are potential advantages that could impact the organization of LAAC programs especially when these interventions are planned in the elderly in whom GA carries a significant risk.

Endonasal Arteriovenous Fistula Following Transsphenoidal Resection of Pituitary Adenoma Treated with N-Butyl-2-Cyanoacrylate

AbstractVascular lesions of the external carotid artery after transsphenoidal pituitary surgery are rare. Immediate diagnosis must be done and endovascular embolization is the treatment of choice.We report the case of a 53-year-old woman with visual complaints who underwent transsphenoidal surgery of a pituitary adenoma with good clinical and radiological evolution. Five days after surgery nasal tampons were removed and suddenly the patient started to bleed: nasal packing and air way protection were required. Digital subtraction angiography revealed an endonasal arteriovenous fistula with a feeder from the sphenopalatine artery and drainage to sphenopalatine veins. Embolization with N-butyl-2-cyanoacrylate was performed with total obliteration of the arteriovenous fistula. We suggest that endovascular treatment of external carotid artery lesions after transsphenoidal surgery is the best alternative in cases of active bleeding.