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 ischemia in the presence of coronary artery disease.
Urgent resuscitation and supportive care is required.
It is important to avoid cautery at the same location 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.
Topical mupirocin and oral antibiotics are suggested as a prophylactic measure though 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 authors recommend observation in the intensive care unit (ICU) of patients while posterior packing is in place.
Aspiration of blood may cause pneumonia or pneumonitis.
These serious complications are fortunately extremely uncommon.
Embolization 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 hemorrhagic telangiectasia, and coagulation disorders, are more likely to result in recurrent bleeding.
Patients require investigation to exclude these underlying conditions.
Referral to the otolaryngology department for nasal pack removal may be valuable in case any rebleeding should occur.
Application of topical vasoconstrictor and lidocaine seems to discourage mucosal trauma and rebleeding with pack removal.
Cautery (usually silver nitrate) may be indicated following pack removal for suspicious vessels or friable, hemorrhagic sites.[27]
Use of this content is subject to our disclaimer