Nasal Packing Research Articles

Diabetes Insipidus after Endoscopic Endonasal Pituitary Macroadenoma Resection: Correlation of Patient and Surgery-Related Risk Factors.

Purpose This article aims to identify patient- and surgery-related factors that could predict the development of postoperative central diabetes insipidus (DI). Methods This is a retrospective case-control study conducted at a single-institution tertiary referral center. Patients undergoing endoscopic endonasal skull base surgery for pituitary adenoma between November 2018 and April 2023 were recruited. The main outcome measures collected include age, gender, comorbidities, tumor type, postoperative DI, intraoperative and postoperative cerebrospinal fluid (CSF) leak, flow of CSF leak, number of layers required for repair, the use of nasal packing, and hospital length of stay. Results A total of 20 patients developed DI postoperatively. Patients' demographic and comorbidity profile did not correlate with DI development. The encounter of an intraoperative CSF leak was correlated with postop DI (chi-square (1) = 18.35, p < 0.001) with a relative risk (RR) of 2.7 (confidence interval [CI] = 1.37-5.28). The use of nasal packs was also correlated with postop DI (chi-square (1) = 10.17, p = 0.001) with a RR of 1.8 (CI = 1.15-2.87). Defects requiring a two or more layers for reconstruction also correlated with postop DI compared to single layer repairs (chi-square (1) = 12.15, p < 0.001) irrelevant of the materials used. Development of DI postop correlated with an increased hospital length of stay ( t (64) = -3.35, p = 0.001). Conclusion The physician should be careful when evaluating patients with pituitary adenomas in the postoperative period, particularly those with intraoperative CSF leak, nasal packing, and those who underwent multilayer reconstruction of the surgical defect.

A comparative study of the outcomes of ribbon gauze and merocele methods of nasal packing after septal surgery

Background: Septal surgery is one of the most commonly performed procedures in Otolaryngology. Following septal surgery, nasal packing is administered to prevent potential postoperative complications, including septal hematoma, hemorrhage, and synechiae formation. Nasal packing is commonly done using either ribbon gauze or non-absorbable materials like Merocele (Medtronic Xomed Inc., Jacksonville, FL, USA). Aims and Objectives: The objective of the study is to compare the post-operative outcomes of ribbon gauze packing and merocele packing. Materials and Methods: The study was a prospective observation study, conducted in Burdwan Medical College and Hospital from August 2023 to October 2023. The study population was 40 with equal distribution between the two groups. Patients older than 18 years undergoing only septal surgery are included in the study. All the surgeries are performed by the same surgeon, both packs are removed after 48 h and followed up with diagnostic nasal endoscopy (DNE) after 1 month. Statistical analysis was done using SPSS version 22.0 (IBM Inc., US). Results: The total number of patients in our cohort was 40, out of which 20 were given ribbon gauze packs (Group A) and the rest were given merocele packs (Group B). The mean visual analog scale score for nasal pain (4.25±1.77), headache (4.30±1.63), dysphagia (2.50±1.15), sleep disturbance (3.15±1.09) in Group B was significantly lower than in Group A (6.65±1.63, 5.40±1.70, 4.00±1.84, and 5.40±2.35 respectively, p all&lt;0.05). The mean of the postnasal drip score was lower in Group B, though that did not reach statistical significance (2.75±1.070 vs. 3.25±1.650, p=0.264). There were no significant differences between the two groups with respect to the age of the patients, gender distribution, or the presence of synechiae, granulation tissue, or signs of infection on DNE. Conclusion: Although both the merocele and ribbon gauze packs can be suggested for use after septal operations, the merocele pack has the benefit of producing much less morbidity. Merocele cost is a major constraint at present so we should try to develop a similar nasal pack with less cost to benefit the maximum population.

American Rhinologic Society expert practice statement part 1: Skull base reconstruction following endoscopic skull base surgery.

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

Efficacy of adjuvant mitomycin-C and triamcinolone-impregnated nasal packing for endoscopic dacryocystorhinostomy.

To compare the success rate and complications of adjuvant use of mitomycin C and triamcinolone-impregnated biodegradable nasal packing (TABP) in endoscopic dacryocystorhinostomy (DCR). And to evaluate the efficacy of combining intraoperative mitomycin C and TABP for endoscopic DCR. A total of 198 eyes of 148 patients who underwent endoscopic DCR for acquired nasolacrimal duct obstruction were retrospectively analysed. The patients were randomly divided into three groups: Group A included patients treated without intraoperative mitomycin C but with TABP, Group B included patients treated without triamcinolone but with intraoperative mitomycin C and normal saline-impregnated nasal packing, and Group C included patients treated with intraoperative mitomycin C and TABP. The results revealed no significant difference in the overall success rates between Groups A (86.8%) and B (89.2%; P=0.377). However, Group C (97.5%) showed a significantly higher overall success rate than Groups A and B. The incidence of granulomas was significantly lower in group C (5%) than in Groups A (20.8%) and B (15.2%; P=0.009). Other complications, such as crust, synechiae, and revision surgery, did not differ significantly among the three groups. The combination of intraoperative mitomycin C and TABP effectively prevents granulomas and enhances surgical success rate. Additionally, there is no statistically significant difference observed between the use of mitomycin C or TABP alone.

Optimizing Postoperative Care in Rhinoplasty and Septoplasty: A Review of the Role of Nasal Packing and Alternatives in Complication Management.

Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000-2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Relationship between bleeding sites and clinical data: experience of 646 epistaxis cases in 8years.

This study aims to investigate the bleeding sites and their relationship with clinical characteristics in hospitalized epistaxis patients. We retrospectively reviewed the data of 646 hospitalized epistaxis patients. The bleeding sites were identified in 395 (61.1%) patients and unidentified in 251 (38.9%). We found that age > 50years (P = 0.030) and the history of cardiovascular diseases (P = 0.027) were more frequent in patients with unidentified bleeding sites. Among patients with identified sites, inferior meatus (n = 130, 32.9%) was the most common site, followed by the septal surface of the olfactory region (n = 102, 25.8%), nasal septum (n = 80, 20.3%), middle meatus (n = 60, 15.2%), and others (n = 23, 5.8%). After dividing patients into five groups by the area of the bleeding sites, we found significant differences in age (P = 0.026), history of hypertension (P = 0.001), cardiovascular diseases (P = 0.032), and nasal packing (P = 0.011). The logistic regression also revealed that these four factors were predictors for different bleeding sites. The bleeding sites can be identified in most epistaxis patients. Age > 50years and the history of cardiovascular diseases are more frequent in patients with unidentified bleeding sites. In our patients, the most common bleeding site is inferior meatus, followed by the septal surface of the olfactory region, nasal septum, and middle meatus. Age, histories of hypertension, cardiovascular diseases, and nasal packing are factors associated with the bleeding risks of different bleeding sites. According to the different clinical characteristics of patients, the order of the nasal endoscopic examination should be adjusted to develop their treatment plans.

Epistaxis and its management: A prospective study in a Teritiary Care Centre

Background: Epistaxis ( nose bleed) is one of the most common ear, nose and throat (ENT) emergencies that present to the tertiary care center. Management of Epistaxis is challenging and most are managed conservatively and some by surgical intervention. There is always a need to find the prevalence of Epistaxis and to identify the etiological factors in management of Epistaxis, by different methods such as medical treatment, anterior and posterior nasal packing, and surgical intervention that includes endoscopic cauterization, endoscopic arterial ligation, SMR and Nasal bone reduction. In our study we will determine the various etiologies of epistaxis and its management options. Methodology: A prospective study was done in the Department of ENT, for duration of 18 months, total of 70 patients of both genders in age group of 18 - 60 years with clinical features of nasal bleed were enrolled in the study, and were subjected to clinical examination and history regarding onset and predisposing factors. Patients who are willing to undergo investigations to identify the cause and treatment are enrolled for the study after obtaining the written informed consent. Results: A total of 70 patients were examined in this study. Males were affected more than females. The patients distribution across different age groups shows maximum at age of 46-60 years followed by 36-45 years. The most common cause was found to be trauma followed by hypertension, rhinosinusitis, deviated nasal septum and idiopathic. In most cases, anterior nasal bleeding was observed.Majority of the cases managed conservatively 71.5% while 28.5% patients required surgical intervention. Conclusion: The study on epistaxis and its management provides valuable insights into effective strategies for addressing this common medical condition. This study emphasizes the importance of a medical and surgical approaches based on the severity and underlying causes of epistaxis. Anterior epistaxis is more common than posterior bleeds. Majority of cases of epistaxis are manageable by conservative measures and only few require surgical intervention. Overall, this study contributes to the ongoing efforts to enhance our understanding of epistaxis and refine therapeutic approaches for better patient outcomes.

Septoplasty and Nasal Packs From Otolaryngologists' Perspectives: A Cross-Sectional Survey.

Introduction Septoplasty is a commonly performed surgery by otolaryngologists. This study examines the routine use of non-absorbable nasal packs in the postoperative period in Kuwait. Our aim is to assess the views of otolaryngologists in Kuwait regarding the routine use of non-absorbable nasal packing after septoplasty with or without turbinoplasty. Materials and methods A cross-sectional study, an anonymous survey, consisting of 10 questions, using Google Forms was conducted. It was distributed via WhatsApp and in person hard copies to otolaryngologists - head and neck surgeons in Kuwait. Data were securely stored and analyzed using Stata (StataCorp LLC, College Station, Texas) software. Results Fifty participants have completed the survey. The majority were routinely performing septoplasty for a symptomatic deviated nasal septum (n= 47, 94%). Out of those, 43% (n = 21) usually use silastic splints to prevent postoperative complications, including bleeding, hematoma formation, and adhesions. The use of quilting sutures for the same purpose was done by 21% (n = 10), and 17% (n = 8) used non-absorbable nasal packs. Only two participants believed that no specific intervention was required. More than half used postoperative nasal packs in the case of intra-operative bleeding (n=26, 52%), while 18% (n = 9) believed that it is only necessary in selected cases with predisposing factors to bleeding. Ninety-two percent (n = 46) thought that pain and discomfort were associated with the use of non-absorbable nasal packs, and 50% (n = 25) believed that it could cause hemodynamic instability. Moreover, 66% (n = 33) agreed that quilting or trans-septal sutures can safely substitute nasal packs following septoplasty. Awareness of recent updates on the complications related to nasal packing varied, with more than half of the otolaryngologists being knowledgeable (n = 29, 58%). Discussion Septoplasty, a common surgical intervention for correcting a misaligned nasal septum, addresses various symptoms, such as nasal obstruction, obstructive sleep apnea, epistaxis, and headache. While the practice of nasal packing for 24-48 hours post-septoplasty is widespread, it remains a topic of controversy. Current literature supports the continued use of nasal packing for patients at high risk of bleeding. However, potential drawbacks, including increased pain, headache, and prolonged hospital stay, raise concerns about its overall benefits. An alternative approach, utilizing quilting sutures without nasal packs, has shown promising results in comparative studies, demonstrating less pain and minimal bleeding. Additionally, trans-septal sutures emerge as a safe alternative, minimizing dead space and reducing post-operative complications. Conclusion It appears that otolaryngologists in Kuwait have diverse opinions with regard to nasal packing following septoplasty. Further research is needed to establish evidence-based guidelines for this common procedure.

Role of nasal endoscopy in evaluation and management of epistaxis

Background: Epistaxis is the most common ENT emergency. The localization of bleeding site and its control in profuse epistaxis is of major concern for the ENT surgeon. Nasal endoscope has proved to be a boon for the otolaryngologist and is an important tool in diagnosing these bleeding points and their immediate management which reduces the incidence of nasal packing either anterior or posterior. Aim was to study the importance of nasal endoscopy in diagnosing the cause and site of epistaxis and managing them appropriately. Methods: It was a prospective study conducted in 187 patients of epistaxis visiting ENT emergency at SMGSH, Jammu after getting IEC clearance. Results: 139 (73.8%) had anterior and 48 (26.2%) posterior epistaxis. Dry nasal septum and mass lesions were the common local causes followed by deviated nasal septum. Anterior part of septum (little’s area) was the common site of bleeding followed by woodruff’s area. The overall success rate of diagnosing the local cause and site of epistaxis was 99% with nasal endoscopy and only 47% with combined anterior and posterior rhinoscopy. Thus, eliciting the importance of nasal endoscopy over conventional anterior and posterior rhinoscopy. Conclusions: Nasal endoscopy helps in detecting the site and cause of epistaxis and also aids in its appropriate management. It helps in endoscopic guided direct pressure packing, bipolar electrocautery, endoscopy assisted mass excision and endoscopic guided foreign body removal. However, nasal endoscopy is not a substitute for nasal packing.

Intranasal Dexmedetomidine as Adjuvant to Local Anaesthetic in Preparation of Nasal Passage for Functional Endoscopic Sinus Surgery: Randomized Controlled Trial

Background: Intraoperative stress response and ongoing bleeding at surgical site especially in areas like head and neck can cause serious adverse reactions and affect the postoperative outcome. This study compared the effect of intranasally administered dexmedetomidine (dexmed) in combination with local anesthesia (LA) and local anesthetic alone on quality of surgical field, surgical bleeding and haemodyanamic parameters during functional endoscopic sinus surgery (FESS).&#x0D; Methods: Roller gauge strips dipped in dexmedetomidine were used for nasal packing. Sixty patients undergoing FESS were randomly allocated to receive either intranasal Dexmedetomidine with LA (D group) or intranasal LA alone (L group) via nasal packing 15 min before surgery. The primary objective was to study the quality view of surgical field through the endoscope and the blood loss that occurred while raising the nasal mucosal flap. The secondary objective was to study the intraoperative hemodynamic profile and anesthetic and analgesic requirement during surgery.&#x0D; Results: Surgical field quality, Blood loss, hemodynamic profile and satisfaction scores of patients and surgeons were significantly better (P&lt; 0.05) in dexmed group.&#x0D; Conclusion: Patients receiving intranasal dexmed with LA for FESS had better surgical field, surgeon’s satisfaction and minimal hemodynamic fluctuations with lesser blood loss as well as better postoperative comfort and analgesia.&#x0D;

Effectiveness of comprehensive rhinoplasty on secondary nasal deformity with saddle nasal deformity after cleft lip surgery

To investigate the effectiveness of comprehensive rhinoplasty with autogenous costal cartilage grafting and prosthesis augmentation rhinoplasty in the treatment of secondary nasal deformity with saddle nasal deformity after cleft lip surgery. The clinical data of 96 patients with secondary nasal deformity with saddle nasal deformity after cleft lip surgery between September 2008 and January 2019 were retrospectively analyzed. There were 17 males and 79 females with an average age of 25.6 years (range, 17-38 years). Autogenous costal cartilage grafts were used to construct stable nasal tip framework and enhance the strength of alar cartilage. Nasal dorsum prostheses (39 cases of bulge, 45 cases of silicone prosthesis) or autogenous costal cartilage (12 cases) were used for comprehensive rhinoplasty. Visual analogue scale (VAS) score was used to evaluate the postoperative satisfaction subjectively, and nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle were calculated to evaluate objectively before and after operation. All patients were followed up 6 months to 8 years, with an average of 13.4 months. Nasal septal hematoma occurred in 3 patients after operation, which was improved after local aspiration and nasal pressure packing. Two cases had mild deformation of the rib cartilage graft of the nasal dorsum, one of which had no obvious deviation of the nasal dorsum and was not given special treatment, and one case underwent the cartilage graft of the nasal dorsum removed and replaced with silicone prosthesis. The incisions of the other patients healed by first intention, and there was no complication such as postoperative infection and prosthesis displacement. The nasal alar height symmetry index, nasal alar width symmetry index, nasal dorsum central axis deviation angle, and nasal columella deviation angle significantly improved after operation when compared with preoperative ones ( P<0.05). Postoperative subjective satisfaction evaluation reached the level of basic satisfaction or above, and most of them were very satisfied. Comprehensive rhinoplasty using autologous rib cartilage grafting to construct a stable nasal tip support, combined with dorsal nasal prosthesis or autologous cartilage implantation, can achieve good effectiveness on secondary nasal deformity with saddle nasal deformity after cleft lip surgery.

Plus moist HS-W®: a new nasal packing material for the middle meatus in endoscopic sinus surgery

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

A critical appraisal of perioperative sleep apnoea management after nasal surgery: A review of up-to-date literature supplemented by findings of a retrospective observational study.

To review the current recommendations on postoperative precautions for obstructive sleep apnoea patients undergoing elective nasal surgery. Retrospective cohort study. Department of Otorhinolaryngology and Anesthesiology/Intensive Care, University Teaching Hospital, Rotterdam, the Netherlands. The medical charts of 61 patients with sleep apnoea who were admitted to the post-anaesthesia care unit between 2016 and 2020, following nasal surgery were reviewed. Number of respiratory events during post-anaesthesia care unit admission that required medical intervention. In all 61 patients, continuous positive airway pressure could not be used. In 13 patients (8%), decreased oxygen saturation levels were registered during the first postoperative night, and in five of these patients, supplemental oxygen was needed. No other respiratory incidents of medical interventions were registered. The number of clinically relevant respiratory events of obstructive sleep apnoea patients with bilateral nasal packing following nasal surgery is low. We suggest that the safety of less expensive and less scarce alternatives of postoperative observation should be explored.

RISK FACTORS, CLINICAL PROFILE, AND MANAGEMENT OF PATIENTS PRESENTING WITH EPISTAXIS: A CROSS-SECTIONAL STUDY

Objective: To analyze risk factors, clinical profile, and management strategies for patients presenting with epistaxis. Methods: This was a cross-sectional study that was undertaken in the department of otorhinolaryngology at a tertiary care medical college. 60 adult patients presenting with epistaxis were included in this study. Demographic details, such as age and gender, were noted. Patients were evaluated for the presence of risk factors such as hypertension, bleeding disorder, or clotting defects. The clinical presentation of patients was also studied. Patients were managed as per standard protocol. Statistical analysis was done using SSPS 21.0 software, and p&lt;0.05 was taken as statistically significant. Results: There were 44 males (73.33%) and 16 females (26.67%) with a M: F ratio of 1:0.36. The mean age of male and female patients was found to be 63.48±16.18 and 58.46±13.24, respectively. Assault or road traffic accidents, which were seen in 15 (25.00%) patients. The other common causes included hypertension (18.33%), nose picking (15%), and medication (such as antiplatelet or anticoagulant drugs)-induced (10%). Out of 60 patients, the majority (60.00%) were stable hemodynamically. 11 (18.33%) patients were found to have elevated blood pressure in addition to epistaxis. 5 (11.67%) patients were in hypotension, and hence fluid resuscitation was required. In 2 (3.33%) patients, the airway needed to be secured because of a compromised airway. The majority of the patients (75.00%) responded well to conservative measures. Posterior nasal packing (in addition to anterior nasal packing), cauterization, closed reduction of facial fractures, surgery for nasal mass, and functional endoscopic sinus surgery in remaining patients. Conclusion: Facial trauma, hypertension, and nose picking were the most common cases of epistaxis. Majority of the patients were hemodynamically stable and could be treated conservatively with measures such as medical management and anterior nasal packing.

Acute epistaxis management by hemostatic agents a systematic review

Background: When compared to nasal packing, the data shows that hemostatic medications are more successful in controlling acute epistaxis. A comprehensive analysis was conducted to assess the effectiveness of topical hemostats in the treatment of epistaxis. Method: Four databases were searched thoroughly for literature. Only admissible observational studies were included. Information retrieved from eight studies included the following: country, rate of short-term and 30-day hemostatic control, patient-reported outcome measures, adverse events, sample size, intervention, treating method, and length of stay in hospital. Results: Eight papers were included in the review when it reached the second stage and satisfied the qualifying requirements. A total of 268 individuals were involved in three cohort and five case series investigations; 232 of them received absorbable intranasal medications. Two investigations on oxidized cellulose compounds and 5 studies on agents that promote the common coagulation pathway were presented. While oxidized regenerated cellulose was inserted endoscopically on the bleeding site in one trial and sutured to the nasal septum in another study, the earlier medicines were applied intranasally. Successful short-term hemostasis was attained in 80% to 100% of patients in 7 out of 8 trials. Patients treated with oxidized regenerated cellulose had considerably lower pain scores than those treated with nasal packing. There were no negative effects linked to the use of intranasal agents in any of the investigations. Conclusion: When compared to nasal packing, the data shows that hemostatic medications are more successful in controlling acute epistaxis.

Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success.

In this study, we identified key discrete clinical and technical factors that may correlate with primary reconstructive success in endoscopic skull base surgery (ESBS). ESBS cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology programs were retrospectively reviewed. Logistic regression identified factors associated with surgical outcomes by defect subsite (anterior cranial fossa [ACF], suprasellar [SS], purely sellar, posterior cranial fossa [PCF]). Of 706 patients (50.4% female), 61.9% had pituitary adenomas, 73.4% had sellar or SS defects, and 20.5% had high-flow intraoperative CSF leaks. The postoperative CSF leak rate was 7.8%. Larger defect size predicted ACF postoperative leaks; use of rigid reconstruction and older age protected against sellar postoperative leaks; and use of dural sealants compared to fibrin glue protected against PCF postoperative leaks. SS postoperative leaks occurred less frequently with the use of dural onlay. Body-mass index, intraoperative CSF leak flow rate, and the use of lumbar drain were not significantly associated with postoperative CSF leak. Meningitis was associated with larger tumors in ACF defects, nondissolvable nasal packing in SS defects, and high-flow intraoperative leaks in PCF defects. Sinus infections were more common in sellar defects with synthetic grafts and nondissolvable nasal packing. Depending on defect subsite, reconstructive success following ESBS may be influenced by factors, such as age, defect size, and the use of rigid reconstruction, dural onlay, and tissue sealants.

Thrombocytopenia and Coagulopathy in Covid-19 Manifesting as Upper Gastrointestinal Bleed and Epistaxis

COVID-19 is an acute febrile illness and the common manifestations are cough, flu and fever. COVID19 infection with severe thrombocytopenia and coagulopathy is a rare life threatening presentation. We are presenting a case of a gentleman in 20&amp;apos;s with history of positive animal contact, who presented to emergency department (ED) with history of fever of more than a week and nasal bleed. Relevant examination showed unstable vitals, anterior nasal packing in place, left lower zone crackles and ongoing black stool. Laboratory workup revealed bicytopenia with platelet count of (6X109), low hemoglobin, deranged INR, low fibrinogen levels. The patient was managed for viral hemorrhagic fever leading to disseminated intravascular coagulation (DIC). He was managed with antipyretics, antibiotics. resuscitated with blood products, admitted to inpatient facility. His blood counts started improving favoring the possibility of thrombocytopenia secondary to viral illness, and later discharged in stable condition. COVID-19 is acute viral infection. Any patient with fever and bleeding should be kept on high suspicion for other viral illness as well. Treatment approach can be conservative. Thrombocytopenia and coagulopathy with 2 organ bleed is the first case reported to the best of our knowledge.

An Analysis of the VELNEZ Nasal Pack's Acceptability and Safety for Use During Nasal Surgery: A Prospective Study.

The primary function of nasal packs is to modulate the bleeding, prevent adhesions and obstruction, with least discomfort to the subjects without risking secondary infection. However, both packing and removal of the pack is an unpleasant experience, with the latter being extremely painful. Therefore the need of the hour is a dressing which prioritizes subject comfort without compromising other desired nasal pack properties.Twenty subjects were enrolled in this interventional, open label study. The subjects had 10 hospital visits, starting from baseline (Visit 1) to postoperative day 28 (Visit 10), at regular intervals. The proportion of the population with postoperative pain alleviation and bleeding control failure (within 10min) were the main objectives. Within 10min of VELNEZ administration, all 20 participants got their bleeding under control. With VELNEZ, the painful nasal pack removal method was totally avoided because it was biodegradable. No moderate/severe pain, infection and adhesions were reported in any of the subjects, but few subjects reported moderate obstruction until Visit 3 (Discharge Day). In the present study, for participants undergoing nasal surgery, VELNEZ proved to be a secure and reliable nasal pack. Trial Registration: CTRI/2021/09/036437, prospectively registered.

Gender-Specific Differences in Preoperative Concerns in Patients Undergoing Endoscopic Sinus Surgery for Chronic Rhinosinusitis.

Among patients with chronic rhinosinusitis (CRS), gender differences in epidemiology as well as quality of life have been reported. However, whether gender differences in endoscopic sinus surgery (ESS) preoperative concerns exist is unclear. CRS patients undergoing ESS at 3 tertiary care centers in Los Angeles completed the validated Western Surgical Concern Inventory - ESS assessing ESS preoperative concerns. Of the 75 patients included, female patients expressed greater concern than male patients in regard to nasal packing, undergoing anesthesia, impact of surgery on daily activities, and pain and discomfort following surgery. This study suggests there are gender differences in ESS preoperative concerns and otolaryngologists should be aware of these possible concerns during preoperative discussions.

Nasal preparation prior to nasal endoscopy: a comparison of cotton pledget packing versus topical spray

Nasal endoscopy (NE) is an office procedure done to look at the nasal and sinus passages using an endoscope which could be either rigid or flexible. It allows the clinician to characterize the intranasal anatomy better compared to the conventional techniques of headlight, speculum and mirror thus aiding the diagnosis. Therefore its popularity has increased recently and is one of the most frequently performed diagnostic procedures in Otorhinolaryngology and Head and Neck Surgery OPD. A unanimous consensus has not been reached regarding the best method for preparing the patients for NE. This study compares two methods of nasal preparation; cotton pledget packing and topical spray. A total of 100 patients were randomised into two groups of 50 each (A and B). In Group A, the nasal cavity was packed with a cotton pledget soaked in 4% lignocaine and xylometazoline nasal drops. Whereas in Group B, xylometazoline nasal drops were instilled and nasal cavity was sprayed with 10% lignocaine spray. After performing rigid nasal endoscopy, a proforma based on the patients’ and consultant’s response was filled. Patients in the cotton pledget group experienced more discomfort during packing (p=0.04), during the waiting time (p=0.001) and also during the endoscopic procedure. From the clinician’s perspective, the duration for the overall endoscopic procedure was significantly less in the spray group (p&lt;0.001). Visualisation of structures was comparable in both groups. Less bleeding was experienced in the spray group. We concluded that nasal spray is a better alternative to nasal packing for preparation of nose prior to nasal endoscopy.