Nasal Tampon Research Articles

Non - traumatic Epistaxis Management Using Celox® Dressing: A Randomized Clinical Trial

Background: Epistaxis is the most common otolaryngologic emergency. Objectives: The current study aimed at evaluating the therapeutic effect of the Celox® bandage to manage non - traumatic epistaxis in the emergency department. Methods: In the current randomized, clinical trial, 150 patients with non - traumatic epistaxis admitted to the emergency department in Imam Reza and Sina hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, during years 2015-2016. The patients were randomly divided into two groups: group 1 dressing with the Celox® band and group 2 dressing with the anterior nasal tampon. The convenient sampling method was employed. Bleeding control (minute), patients’ satisfaction, and lack of rebleeding within the first 24 hours of administration were compared between the two groups. Results: There was no statistically significant difference between the two groups in terms of demographic variables, vital signs, and paraclinical testing results (P > 0.05). With respect to the control of bleeding in the first 5 minutes after management, 93.3% of the bleeding was controlled in the Celox®, and 96% of the bleeding was controlled in the anterior tampon groups (P = 0.467). The satisfaction level of the patients in the Celox® group was greater than that of the tampon group, and the difference was statistically significant (P < 0.001). Lack of rebleeding within 24 hours after management had the most significant effect on the patient satisfaction [odds ratio (OR) = 3.969]. Conclusions: Based on the results of the current study, there was no significant difference in bleeding control and the success rate between the two groups in the study. Ease of usage, however, makes Celox® a better alternative to control epistaxis. Furthermore, the treatment of epistaxis with Celox® leads to higher satisfaction levels.

Use of Hemostatic Nasal Plugs in Emergency Medical Services in the Netherlands: A Prospective Study of 33 Cases

Background: Epistaxis is a common medical emergency with possible life-threatening complications. In the prehospital setting, epistaxis can be treated with nasal tampons. HemCon® Nasal Plug is a nasal tampon impregnated with oxidized cellulose, which has hemostatic properties. Objective: The objective of this study was to determine the effectiveness and usability of HemCon Nasal Plugs in the treatment of severe epistaxis in the prehospital setting. Methods: From June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with HemCon Nasal Plugs. The plug was used according to protocol; if conventional treatment failed to control severe epistaxis or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use. Results: A total of 33 patients were treated with HemCon Nasal Plugs. Twenty-four patients were taking anticoagulants or suffered from a clotting disorder. The cause of epistaxis was idiopathic in the majority of the patients. Inserting HemCon Nasal Plugs resulted in cessation of epistaxis in 25/33 patients and resulted in reduction of epistaxis in 4/33 patients. HemCon Nasal Plugs failed to control epistaxis in 4/33 patients, possible due to an unreachable site of bleeding. Conclusion: This study demonstrated that HemCon Nasal Plug is an effective adjunct in the prehospital treatment of severe and uncontrolled epistaxis.

A Unique Case of Gossypiboma following Treatment of the Orbitozygomatic Complex Fracture

Transmaxillary approach to the orbital floor has been used successfully to treat the blowout fracture by antral packing to support the orbital floor. However, antral packs are associated with a high incidence of infection and persistent oroantral fistula. A 30-year-old man with a history of the orbitozygomatic complex fracture 8 years ago presented with a persistent facial wound on the right side of the cheek. The patient underwent an exploratory surgery under general anesthesia, and the maxillary sinus was approached through the Caldwell-Luc operation and a long 2-m nasal tampon was found in the sinus. Foreign bodies including gossypibomas are rare, hard to diagnose, and mostly asymptomatic and in chronic cases do not reveal specific radiological and clinical signs for differential diagnosis. Therefore, in the evaluation of the soft-tissue lesions in patients with a history of a prior operation, it is wise to consider foreign bodies in the differential diagnosis.

The influence of nasal packing on the quality of life in the early postoperative period following septoplastic surgery

The objective of the present study was to evaluate the influence of anterior nasal packing on the physical health condition and the quality of life of the patients in the early postoperative period following septoplastic surgery and to propose an alternative to the anterior nasal packing procedure. The study included 90 patients divided into three groups. Those of the first group underwent endoscopic septoplasty, the patients of the second group were managed by standard septoplastic surgery, and the patients of group 3 were given treatment with the use of modified septoplasty including the application of a fibrin sealant as an alternative to nasal tampons. It was shown that anterior nasal packing exerts the undesirable influence on the quality of life during the early postoperative period following septoplastic surgery whereas the use of the modified technique based on the application of a fibrin sealant as an alternative therapeutic modality significantly enhances the effectiveness of the treatment.

Effects of polymer-based, silver nanoparticle-coated silicone splints on the nasal mucosa of rats.

Infection is a serious complication after nasal packing that otolaryngologists seek to avoid. The aim of this study is to investigate the use of silver (Ag) nanoparticle, which serves as antimicrobial agents, with nasal tampons. The study design is an experimental animal model and the setting is tertiary referral center. Twenty-four rats were randomized into the following four groups: (1) control group (n=6); (2) silicone nasal splint (SNS) group (n = 6); (3) polypropylene-grafted polyethylene glycol (PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n = 6); and (4) Ag nanoparticle-embedded PP-g-PEG (Ag-PP-g-PEG) amphiphilic graft copolymer-coated SNS group (n = 6). These tampons were applied to rats for 48h, after which they were removed in a sterile manner, and the rats were sacrificed. The nasal septa of the rats were excised, and assessments of tissue changes in the nasal mucosa were compared among the groups. The removed tampons were microbiologically examined, and quantitative analyses were made. When the groups were compared microbiologically, there were no significant differences in bacterial colonization rates of coagulase-negative Staphylococcus spp. among the three groups (p=0.519), but there was a statistically significant difference among bacterial colonization rates of Heamophilus parainfluenzae and Corynebacterium spp. (p=0.018, p=0.004). We found that H. parainfluenzae grew less robustly in the Ag-PP-g-PEG than the PP-g-PEG group (p=0.017). However, we found no significant difference between the Ag-PP-g-PEG and SNS groups, or between the SNS and PP-g-PEG groups. The growth of Corynebacterium spp. did not differ significantly between the Ag-PP-g-PEG and SNS groups (p=1.000). When Group 4 was compared with Group 2, the former showed less inflammation. Compared with other tampons, Ag-PP-g-PEG amphiphilic graft copolymer-coated silicone nasal tampons caused less microbiological colonization and inflammation. Therefore, the use of these tampons may prevent secondary infections and reduce the risk of developing complications by minimizing tissue damage.

Right Zygomaticomaxillary Complex Fracture With Rupture Of Internal Maxillary Artery: A Case Report

Background: This case report gives prominence to the risk of delayed, possibly life - threatening bleeding following mid-facial fractures. Methods: A 42-year-old male was involved in an accident during which he suffered from right zygomaticomaxillary complex fractures with massive bleeding. The hemoglobin level was decreased from 11 to 5 g/dL, suspected caused by rupture of internal maxillary artery. Incidence of massive bleeding due to zygomaticomaxillary complex fracture is quite rare. Patient also felt right visual loss due to retrobulbar hematoma compression. He was given nasal tampon and transfusion in referral hospital. The patient had fracture reconstruction (reduction and fixation), ligation of right facial artery and temporary ligation of external carotid artery with Ethiloop for 5 days. Nevertheless, the bleeding still occurred. The patient then underwent Digital Subtraction Angiography (DSA) and coiling procedure from radiologic intervention. Twenty days after last procedure, we ligated the right external carotid artery due to recurrence of bleeding. Results: There are many modalities and procedure for the therapy of massive bleeding on midface fracture, ranging from conservative, minimal invasive to operative surgery. Patient that has gone through DSA procedure can still bleed. After ligation of external carotid artery, no more bleeding occurred. Conclusion: Patient suffering from extensive midfacial fracture, the internal maxillary artery and its branches are at special risk of injury due to their close anatomical relationship to bony structures. Its bleeding is possibly life threatening. Tampon and nasal packing are non-essential initial treatment, but digital pressure procedure can be performed to stop the bleeding temporarily. Ligation of external carotid artery is the best choice of treatment for permanent outcome.

The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations

IntroductionThe main reason for nasal tampon placement after septoplasty is to prevent postoperative hemorrhage, while the secondary purpose is internal stabilization after operations involving the cartilaginous-bony skeleton of the nose. Silicone intranasal splints are as successful as other materials in controlling postoperative hemorrhages of septal origin. The possibility of leaving the splints intranasally for extended periods helps stabilize the septum in the midline. However, there is nothing in the literature about how long these splints can be retained inside the nasal cavity without increasing the risk of infection, postoperative complications, and patient discomfort. ObjectiveThe current study aimed to evaluate the association between the duration of intranasal splinting and bacterial colonization, postoperative complications, and patient discomfort. MethodsPatients who had undergone septoplasty were divided into three groups according to the day of removal of the silicone splints. The splints were removed on the fifth, seventh, and tenth postoperative days. The removed splints were microbiologically cultured. Early and late complications were assessed, including local and systemic infections, tissue necrosis, granuloma formation, mucosal crusting, synechia, and septal perforation. Postoperative patient discomfort was evaluated by scoring the levels of pain and nasal obstruction. ResultsNo significant difference was found in the rate of bacterial colonization among the different groups. Decreased mucosal crusting and synechia were detected with longer usage intervals of intranasal silicone splints. Postoperative pain and nasal obstruction were also diminished by the third postoperative day. ConclusionsSilicone splints were well tolerated by the patients and any negative effects on postoperative patient comfort were limited. In fact, prolonged splint usage intervals reduced late complications. Long-term silicone nasal splint usage is a reliable, effective, and comfortable method in patients with excessive mucosal damage and in whom long-term stabilization of the bony and cartilaginous septum is essential.

Histopathological evaluation of Ankaferd blood stopper use in the rabbit septoplasty model

ObjectiveThe purpose of this study was to assess the use of Ankaferd blood stopper (ABS), an organic hemostatic agent of plant origin, in septoplasty operations, and to determine its effect on nasal septal tissues in the rabbit model. MethodThe study was performed on 30 New Zealand adult male rabbits each weighing 2500–3500g (average: 3000g). The rabbits were randomly divided into 4 groups, namely, the control group (without septoplasty), the septoplasty+tampon group, the septoplasty+ABS group, and the septoplasty+tampon+ABS group. All animals were sacrificed after two weeks, and the nasal septums were total removed using the lateral rhinotomy technique. The specimens were obtained from similar sites of cartilaginous nasal septum. The sections were stained with hematoxylin–eosin and Mason trichrome stains and studied under the light microscope by the same pathologist who evaluated the mucosal ulcerations, the severity of inflammatory cell infiltration, the mucosal thickness, and the cartilage thickness. The data obtained were statistically analyzed using the Kruskal–Wallis variance analysis and the Mann–Whitney U test. ResultsNo mucosal ulceration or inflammatory cell infiltration was detected in any of the rabbit groups. There was a statistically significant difference between the groups in terms of mucosal thickness and cartilage thickness (p<0.05). The values of mucosal thickness in the groups mentioned above were 147.7±17.6μm, 205.7±36.7μm, 139.6±14.8μm, and 190.2±17.5μm, respectively. The values of cartilage thickness were 398.2±28.9μm, 546.2±35.3μm, 363.7±24.7μm, and 447.8±28.2μm, respectively. There was no significant difference between the control group and the septoplasty+ABS group in terms of mucosal thickness and cartilage thickness (p>0.05). However, there was a significant increase in nasal mucosal and cartilage thickness in tampon-using groups when compared with the other groups (p<0.05). ConclusionAlthough nasal tampons provide the contact of mucoperichondrium with the cartilage, they are generally accepted as a discomfort for patients. Ankaferd blood stopper can be used instead of nasal tampons to increase patient comfort.

In situ green synthesis of silver nanoparticles/chitosan/poly vinyl alcohol/poly ethylene glycol hydrogel nanocomposite for novel finishing of nasal tampons

In the current study, synthesis of silver nanoparticles/chitosan/poly vinyl alcohol/poly ethylene glycol (AgNPs/Cs/PVA/PEG) hydrogel nanocomposite and finishing of cotton nasal tampons were reported via the γ-irradiation procedure. The uniform size distribution of nanoparticles and the presence of polymer nanocomposite were confirmed by energy dispersive spectroscopy (EDS) and field emission scanning electron microscope (FE-SEM), respectively. Z-average size of formed (Ag/Cs/PVA/PEG) hydrogel nanocomposite was about 96 nm. The water and simulated body fluid retention capacity of the modified tampons were assessed. The blood coagulation capability of the modified tampons was evaluated through Duke bleeding time test. The antibacterial evaluation of the modified tampons showed good antibacterial activity against Escherichia coli and Staphylococcus aureus bacteria.

The Effect of Duration of Merocel in Glove Finger With Tetracaine Solution on Septoplasty Morbidity

We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution. The study was designed as a randomized prospective study. A university hospital in Turkey. Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group. The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours. The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

The Effect of the Duration of Merocel in a Glove Finger on Postoperative Morbidity

We examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

Comparison of nasal packs with transseptal suturing after nasal septal surgery

ObjectivesTo investigate the effects of transseptal suturing against two different types of nasal packs with respect to pain, operative time and postoperative complications following nasal septal surgery. Patients and methodsOne hundred and fifty patients (aged 18–61years) scheduled for nasal septal surgery were included. Following surgery, three types of nasal packing systems were utilized: (1) transseptal suturing (Group A: 50 patients); (2) internal nasal splint (Group B: 50 patients); (3) a Merocel standard 8-cm nasal dressing without airway (Group C: 50 patients) to the patients. Postoperative pain, operation time, septal perforation and synechiae formation were evaluated. ResultsThe difference between mean operative time of groups B and C was not statistically significant (p>0.05). The difference between operative time of the two groups against group A was statistically significant (p<0.05). The mean postoperative pain scores were 2.8±1.2 (median 2) in group A, 6.1±1.3 (median 6) in group B, and 7.3±1.2 (median 7) in group C 1h to 48h post-surgery. Merocel and internal nasal splint tampons were found to be significantly more painful than transseptal suturing during 48h (p<0.05). There was no statistically significant difference in terms of infection, hematoma, synechiae formation or perforation between the groups (p>0.05). ConclusionThe use of transseptal suturing technique is a useful alternative to packing, with only minor increase in operating time.

Nasopharyngeal angiofibroma: Our experience and literature review.

Summary Introduction: Juvenile nasopharyngeal angiofibroma is a rare, highly vascular, and histologically benign tumor, generally observed in male adolescents. It shows very aggressive behavior due to local invasiveness and is associated with various symptoms. Juvenile nasopharyngeal angiofibroma originates in the sphenopalatine forame, causing epistaxes and nasal obstruction. Objective: To retrospectively describe our experience in the diagnosis and treatment of patients with juvenile nasopharyngeal angiofibroma. Scientific drawing: Retrospective, descriptive study conducted after approval from the Ethics Committee of the Federal University of Sergipe (protocol 0114.0.107.000 -11). Methods: We analyzed findings in 20 patients who underwent surgery between 2004 and 2011. Factors analyzed include patient age and gender, symptoms, stages, treatment, length of surgery, intraoperatory bleeding, postoperative need for nasal tampons, hospitalization time, complications, and tumor recurrence. Results: Patients were aged 10–29 years. All patients were treated surgically, including 17 who underwent endoscopic surgery. The mean operation time was 120 min, and the mean bleeding volume was 300 mL. Seventeen patients required clamping of the external carotids and tumor embolization. Conclusion: Endoscopic surgery alone or with other conventional techniques was safe for the treatment of angiofibromas of different stages.

Tetrahedral silicon balloon for endoscopic skull base reconstruction

INTRODUCTION Advances in transnasal endoscopic approaches and the development of instrumentation and imaging technology have turned endoscopic endonasal surgery into the mainstay for treating inflammatory diseases and neoplasms involving the paranasal sinuses and skull base. The expanded endonasal approach (EEA) and its modifications provide access to the anterior skull base, planum, sphenoid, sella, clivus, cervical spine, and infratemporal fossa via the two nostrils. This approach enables endoscopic extradural and intradural tumor resection and skull base reconstruction in a single procedure. Technical advances in reconstruction methods and the development of vascularized locoregional flaps have improved our ability to seal the cranio-basal diaphragm after tumor extirpation. Use of a nasal septal flap (NSF) has reduced the rate of complications and allowed increasing numbers of patients with skull base neoplasms to undergo curative surgical resections by means of minimally invasive techniques. One drawback of this technique is the difficulty of stabilizing the multilayered reconstruction in place after its application. Currently, a 12-French Foley catheter latex balloon is used to support the multilayered reconstruction during the 1st week after surgery. The main disadvantages of this method are: 1) the balloon surface is spherical, thus providing inadequate support to the flat surfaces of the skull base; 2) decrease in the balloon’s volume due to frequent leaks may impair the support of the flap; 3) the latex balloon is weak and frequently bursts due to exposed bone chips; 4) inability to use this balloon in patients who are allergic to latex; and 5) it is inconvenient for patients because it interferes with their nasal breathing. An alternative support for skull base reconstruction that is free of these limitations is needed. In this report we describe a novel anatomically shaped graft stabilizer for endonasal skull base reconstruction.

Modified Technique of Anterior Nasal Packing: A Comparative Study Report

Anterior nasal packing, which is a common procedure in otorhinolaryngology practice, has different complications. Pain during introduction and removal of pack, bleeding after removal due to mucosal damage and synechia formation are common among them. A continuous effort is going on worldwide to combat those by modifying the nature of pack material or inventing new materials for nasal packing. In the present study an effort was made to compare a new modification of conventional gauze pack by using aluminum foil prepared from the cover of suture materials as septal splint (to reduce the mucosal damage) with conventional gauze pack and another costly material, nasal tampon (merocel). Comparisons were done in terms of cost, efficacy and complications. Prospective hospital based interventional study. Patients were distributed into three groups according to the material used for anterior nasal packing. Comparisons were made in terms of cost of the material used, pain during introduction of pack, rise of systolic blood pressure, incidences of bleeding while pack in situ, incidences of bleeding after removal of pack that required repacking and incidences of synechia formation after pack removal. The episodes of bleeding while pack in situ, within first 48h and forced for repacking was observed to be significantly more prevalent among nasal tampon groups (12.5%) of patients but only 2.1 and 2.4% with use of conventional gauze pack and our modification respectively. Regarding bleeding after removal of pack, 10.6% patients experienced bleeding with conventional gauze pack, whereas with our modification it was only 2.4%. Synechia formation was found to be highest among the cases with conventional gauze pack (14.9%), but with our modification it is only 2.4%. In this study it is found that use of aluminum foil prepared from the cover of suture materials can be very useful and cost effective method to reduce some of the complications of anterior nasal packing.

Nasal Packing with Strips of Cured Pork as Treatment for Uncontrollable Epistaxis in a Patient with Glanzmann Thrombasthenia

Glanzmann thrombasthenia is a rare disorder of platelet function that may result in life-threatening hemorrhage, particularly from the nasal vaults. Various medical therapies (such as recombinant factor VII, antifibrinolytic agents, and blood transfusions) and surgical therapies (such as nasal packing, electrocautery, laser coagulation, septoplasty, and embolization) have been described with various degrees of success. We present a unique case report of a 4-year-old child with known Glanzmann thrombasthenia and two separate episodes of life-threatening epistaxis that were treated successfully by nasal packing with strips of cured pork because of special circumstances. Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae. In both applications, the patient had complete cessation of nasal bleeding within 24 hours, and was discharged within 72 hours after treatment. To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.

769 Is the Eosinophyl Cationic Protein a Predictive Marker of Allergic Risk in Newborns?

Aim: To evaluate Patients and Methods: 27 newborns (13 F, mean GA : 277 days, mean BW: 3890 g) were included ; FHa and IEA was evaluated, a blood sample collected from cord blood to measure serum ECP, nasal and rectal tampons executed at birth to count eosinophyls. Statist ical analysis: Anova test and t-student test. Results: 11 newborns had FHa, and 2 had IEA (group A). We attributed a score from 0 to 3 at the FHa and the IEA. Group A got 11 points, while the group without a family risk of atopy got 4 points. The mean values of ECP value was 65.5 µ/ml in group A and 7.8 µ/ml in group B (p 13,5 µg/l, FHa and IEA) with the assignment of a diagnostic score in clinical practice can be useful to apply early environmental and dietary prevention measures.

An Unusual Case of Epistaxis—Juvenile Nasopharyngeal Angiofibroma

Background: Epistaxis is a common complaint seen in the younger population. Its etiology is typically from the anterior nares, although we present a case of epistaxis from an uncommon source—juvenile nasopharyngeal angiofibroma. Juvenile nasopharyngeal angiofibroma (JNA) is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. Objectives: To illustrate a case of epistaxis from an uncommon source. Case Report: A 21-year-old man with a past medical history of allergic rhinitis presented to the Emergency Department (ED) after 6 months of intermittent yet worsening epistaxis. He described the bleeding as sudden onset that resolved after 30 min of direct compression of the external nares. He denied any history of digital manipulation, trauma, or bleeding disorders. Upon arrival in the ED, he had brisk bleeding from the right naris that was initially controlled with phenylephrine nasal spray. A small round friable mass was visualized in the right posterior nasal cavity. Further hemostasis of the epistaxis was achieved using a nasal tampon moistened with phenylephrine, and a computed tomography scan of the sinus revealed a soft tissue mass almost completely occupying the sphenoid sinus and extending into the nasopharynx and posterior ethmoids. There was also expansion and bony erosion of the right pterygopalatine fossa. A final diagnosis of JNA was made and the patient was given follow-up with an otorhinolaryngologist, who ultimately surgically resected the mass. Conclusions: JNA is a highly vascular, benign, yet locally invasive tumor that occurs in preadolescent males. This case illustrates the importance of appreciating the more uncommon cases of epistaxis, especially when conventional methods of treatment have initially failed.

Concha Bullosa

To assess the frequency and the endoscopic treatment of the middle turbinate pneumatization or concha bullosa. Forty-nine patients (26 males and 23 females) with sinusitis and headache symptoms and axial and coronal computed tomographic scans of the paranasal sinuses and who had an endoscopic examination visit in the outpatient department between January 2005 and July 2007 were included in this study. Functional endoscopic sinus surgery was performed. Nasal tampons were removed 3 days after surgery, and endoscopic examination visits were performed 7, 15, 30, and 60 days after surgical treatment. All the patients presented complaints of chronic nasal obstruction. Eleven patients (5 males and 6 females; 22.4%) presented either a unilateral or a bilateral middle turbinate pneumatization. The surgeons recorded the surgery and each examination visit. In remote controls (12 mo at least), the patients showed a total remission of symptoms. There were no important complications.

Computer‐assisted teaching of epistaxis management

To determine whether computer-assisted learning (CAL) is an effective tool for the instruction of technical skills. Prospective blinded randomized-control trial conducted on a cohort of 47 first-year medical students. Students were instructed on two techniques of nasal packing (formal nasal pack and nasal tampon) for the management of epistaxis, using either a standard text-based article or a novel computer-based learning module. Students were evaluated on proper nasal packing technique using standardized subjective and objective outcome measures by three board-certified otolaryngologists. Blind assessments took place prior to and following instruction, using the assigned learning modality. There were 47 participants enrolled in the study. Both groups demonstrated improvement in performance of both packing procedures following training. A significant post-training difference favoring CAL learners over text-based learners was observed, using the global assessment of skill for both packing techniques (P < .001). Additionally, a significant post-training difference favoring CAL learners over text-based learners was observed for all checklist items for the tampon pack and five of eight items on the formal pack checklist. The vast majority of students (94.6%) indicated that if given the choice, they would prefer to learn using CAL rather than by using text-based learning materials. CAL learners demonstrated significantly greater improvement across both subjective and objective outcome measures when compared to the text-based group. Additionally, students favored learning via the CAL modality, which further suggests that CAL is a valuable means of imparting procedural knowledge to novice medical trainees.