Risk of nasal septal perforation following nasal packing for epistaxis in the emergency department

Abstract

Introduction

Nasal packing is commonly employed in the emergency department (ED) to manage epistaxis that does not respond to conservative treatments. However, this intervention may increase the risk of nasal septal perforation (NSP) due to reduced blood flow to the nasal septum. No prior study has explored the relationship between nasal packing and risk of NSP.

Methods

We examined all patients who received non-absorbable nasal packing in the ED at our institution, identifying 19 patients diagnosed with NSP post-treatment and 50 randomly selected patients without NSP for comparison. t-Tests and Chi square tests were utilized to compare numeric and categoric variables respectively and a multivariable logistic regression model was developed to assess risk factors.

Results

Baseline characteristics of individuals who developed NSP were similar to those of the comparison group, with the exception of tobacco use. Interestingly, individuals with NSP had a lower rate of tobacco use (21 % vs 64 % current/former users, p = 0.004). Univariable analysis revealed that patients with NSP had a longer mean duration of nasal packing (5 vs 3 days, p = 0.001). Multivariable analysis showed that each additional day of packing increased odds of NSP by 77 %, and bilateral packing, compared to unilateral, was associated with four times the odds of NSP.

Conclusions

Our findings indicate that prolonged nasal packing increases the risk of NSP. Prospective, large-scale studies are needed to identify patients at risk for NSP after nasal packing in the ED and to inform guidelines on the removal of nasal packing.