Complications
Nasal packing impairs normal sinus mucosal clearance and may predispose to sinusitis.
May occur in the first week after packing.
Though unlikely, blood loss and stress of treatment may precipitate hypotension or cardiac ischaemia in the presence of coronary artery disease.
Resuscitate urgently and provide supportive care.
It is important to avoid cautery on both sides of the septum. This deprives the septal cartilage of its blood supply (from the mucosal covering) and may result in septal perforation if done bilaterally.
May occur in the first month after cautery.
Very rare.
May occur in the first week after nasal packing.
Prophylactic topical mupirocin and oral antibiotics have no demonstrated benefit.
May occur while posterior packing is in place.
Posterior packing may reduce respiration through either nasal obstruction or a postulated nasopulmonary reflex.
Some hospitals require observation in the intensive care unit (ICU) while patients have posterior packing in place.
Aspiration of blood may cause pneumonia or pneumonitis.
This is extremely uncommon.
Embolisation carries a low risk of CVA.
Although a serious complication, it is extremely uncommon.
Children seem more prone to require repeat cautery.
Underlying disorders, such as neoplasm, hereditary haemorrhagic telangiectasia, and coagulation disorders, are more likely to result in recurrent bleeding.
Patients require investigation to exclude these underlying conditions.
Referral to the ENT department for nasal pack removal may be valuable in case any re-bleeding should occur.
Application of topical vasoconstrictor and lidocaine seems to discourage mucosal trauma and re-bleeding with pack removal.
Cautery (usually silver nitrate) may be indicated following pack removal for suspicious vessels or friable, haemorrhagic sites.[47]
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