Background: Nasal packing is often used after functional endoscopic sinus surgery (FESS). Various non-absorbable agents are used but these packs can be uncomfortable and cause pain and bleeding on removal. Increasingly, biodegradable nasal packs are being used and have shown promising effects on post-operative bleeding and healing after FESS. Aim: We evaluate the safety and efficacy of biodegradable Nasopore®(polyurethane glycol) in FESS, particularly in the day-case setting. Methods: A retrospective chart review of 100 consecutive patients receiving Nasopore following FESS. Results: Our patients had chronic rhinosinusitis not responding to medical therapy and the extent of the surgery was determined by the extent of disease. Procedures performed in addition to FESS included septoplasty, trimming of the inferior turbinates and polypectomy. Approximately half of patients were discharged home the same day and post-operative complications were minimal. Only two patients developed post-operative bleeding, and four reported post-operative sinus infection requiring oral antibiotics. One patient developed minor intranasal adhesions of no functional significance. Conclusions: Nasopore is a safe and effective option after FESS. It is associated with minimal discomfort, no pain on removal and few post-operative complications. Nasopore is useful in achieving day-case FESS.

Background: Traditionally the posterior epistaxis is managed with nasal packing and prolonged hospital stay. However, the patient may undergo a cycle of nasal packing, repacking and eventual surgical intervention. This protocol could subject the patient to significant morbidity and may not be the cost effective strategy either. On the other hand, endoscopic sphenopalatine artery ligation (ESPAL) is increasingly employed and it has got an established role in the posterior epistaxis management. The proponents claim minimal morbidity associated with ESPAL, and regard it as an efficient, safe and cost effective treatment option compared to the traditional approach.Aim: To compare the safety, efficacy and cost effectiveness of early surgical intervention with traditional treatment (packing with or without subsequent surgical intervention) in the management of posterior epistaxis. Methods:Potentially eligible articles were identified from the following electronic databases: MEDLINE, EMBASE, The Cochrane Library including the Cochrane Central Register of Controlled Trials, Database of Abstracts and Reviews (DARE), and Google scholar. They were included if they fulfilled pre specified criteria. Data were extracted from the eligible studies according to a protocol developed for the purpose this study.Results: Two RCTs and four retrospective reviews were included. Among the included studies, both RCTs were prospective trials. Both studies have reported reduced re-bleed rates with early surgical intervention compared to the traditional management. But these differences were not statistically significant. However, there was a statistically significant reduction in cost and the total hospital stay with early surgical intervention in both RCTs. The findings from RCTs were supported by all retrospective reviews. Conclusion:Despite limited evidence, this systematic review favours early surgical intervention as opposed to traditional treatment with nasal packing. The duration of hospital stay and cost involved influence the choice of surgical intervention. However, further well designed multicentre randomised controlled clinical trials are required for a more definitive conclusion.