Are Routine Dissolvable Nasal Dressings Necessary Following ESS?

Background

Nasal dressings have frequently been advocated to improve wound healing and prevent ongoing bleeding after endoscopic sinus surgery (ESS). Initial experience focused on removable nasal packing materials; however, their adverse effect profile, such as pain/discomfort and mucosal trauma, has driven the development of absorbable biomaterials. Despite these developments, there is still little agreement on the optimal choice of nasal dressing or whether nasal dressings are required at all.

Best Practice

The routine use of nasal packing materials to prevent postoperative bleeding events following ESS is unnecessary. A small percentage of patients will require nasal packing for ongoing bleeding after ESS. The use of bipolar cautery, topical vasoconstrictors or dissolvable packing agents that don’t adversely affect wound healing may be used to obtain hemostasis. The literature suggests that the use of dissolvable agents to improve wound healing is largely unfounded and the anticipated beneficial effect of nasal packing is wishful thinking rather than a clinical reality. In some cases the use of dissolvable agents actually has an adverse effect on the wound-healing processes. There is no commercially available product that improves wound healing when compared with no treatment at all. Research indicates that chitosan may be of benefit, but further independent research is required before recommendations can be made. Read the full article in The Laryngoscope.