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The primary function of nasal packs is to modulate the bleeding, prevent adhesions and obstruction, with least discomfort to the subjects without risking secondary infection. However, both packing and removal of the pack is an unpleasant experience, with the latter being extremely painful. Therefore the need of the hour is a dressing which prioritizes subject comfort without compromising other desired nasal pack properties. Twenty subjects were enrolled in this interventional, open label study. The subjects had 10 hospital visits, starting from baseline (Visit 1) to postoperative day 28 (Visit 10), at regular intervals. The proportion of the population with postoperative pain alleviation and bleeding control failure (within 10 min) were the main objectives. Within 10 min of VELNEZ administration, all 20 participants got their bleeding under control. With VELNEZ, the painful nasal pack removal method was totally avoided because it was biodegradable. No moderate/severe pain, infection and adhesions were reported in any of the subjects, but few subjects reported moderate obstruction until Visit 3 (Discharge Day). In the present study, for participants undergoing nasal surgery, VELNEZ proved to be a secure and reliable nasal pack. Trial Registration: CTRI/2021/09/036437, prospectively registered. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to assess the effectiveness of fentanyl nasal pack in managing post-operative pain following endoscopic sinus surgery (ESS). Methods: A randomized controlled trial was conducted on 100 patients undergoing ESS, with 50 patients receiving fentanyl nasal pack and 50 patients receiving standard post-operative care. Pain scores were assessed using a standardized pain scale at regular intervals post-surgery, including 1, 2, 4, 6, and 24 hours. Rescue analgesic requirements and adverse events were recorded throughout the study period. Results: The fentanyl group exhibited significantly lower pain scores compared to the control group at all time points (p < 0.05). Additionally, the fentanyl group required fewer rescue analgesics. No adverse events related to fentanyl use were observed. Conclusion: Fentanyl nasal pack demonstrates promising efficacy in post-ESS pain management without significant side effects. Its targeted delivery to the surgical site offers a valuable adjunct to standard analgesic regimens. Further research is warranted to optimize dosing strategies and evaluate long-term outcomes. [ABSTRACT FROM AUTHOR]

To evaluate levels of arterial blood gases in patients undergoing septoplasty, with conventional nasal packing versus those with nasal packing with airway. The current prospective comparative study was conducted on 68 patients undergoing septoplasty, who were divided randomly into two groups—conventional nasal packs (ANP) and nasal packs with airway (ANP-A). Arterial blood gas analysis alongwith objective symptoms of patients were recorded and evaluated. The difference between pre and post operative values of SpO2 (ANP = 6.73 ± 1.17, ANP-A = 2.84 ± 0.91) and pO2 (ANP = 15.09 ± 4.34, ANP-A = 3.46 ± 1.49) between the two groups was statistically significant (p = 0.001). Differences in post operative pH, pCO2 and HCO3 between the two groups was not statistically significant. Significant difference between the two groups was observed in patients' objective symptoms as well. Nasal packs with airway have lesser perturbing effects on septoplasty patients as compared to conventional nasal packs. [ABSTRACT FROM AUTHOR]

Numerous biomaterials have been developed over the years to enhance the outcomes of endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. These products are specifically designed to prevent postoperative bleeding, optimize wound healing, and reduce inflammation. However, there is no singular material on the market that can be deemed the optimal material for the nasal pack. We systematically reviewed the available evidence to assess the functional biomaterial efficacy after ESS in prospective studies. The search was performed using predetermined inclusion and exclusion criteria, and 31 articles were identified in PubMed, Scopus, and Web of Science. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess each study's risk of bias. The studies were critically analyzed and categorized into types of biomaterial and functional properties, according to synthesis without meta-analysis (SWiM) guidelines. Despite the heterogeneity between studies, it was observed that chitosan, gelatin, hyaluronic acid, and starch-derived materials exhibit better endoscopic scores and significant potential for use in nasal packing. The published data support the idea that applying a nasal pack after ESS improves wound healing and patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aims to find out the effect of the topical lidocaine pomade application on postoperative bleeding and pain control following a septoplasty procedure. Material and Methods: We enrolled 82 (45 male, 37 female) patients with a mean age of 31.8±8.58 (range 16-51) who underwent septoplasty. Forty five (56.88%) of them received Doyle nasal splint with a %5 lidocaine pomade, and 37 (42.12%) patients received Doyle nasal splint only. Visual analog scale (VAS) was used to measure postoperative pain intensity on the first, 2nd, and 3rd days after septoplasty before taking painkillers. Duration of postoperative bleedy nasal discharge time (hours) and hospitalization period were recorded. Complications were also recorded. Results: There was no significant difference between nasal pack groups in terms of hospitalization period (p=0.383). There was a significant difference between nasal pack groups in terms of first, 2nd, and 3rd postoperative day VAS scores. VAS scores in Doyle nasal pack group were significantly higher every 3 days. When VAS scores of postoperative first, 2nd, and 3rd days were compared, there was a significant difference between all of the groups. While the first day's VAS score was the highest, the 3rd day was the lowest. Duration of the postoperative bleedy discharge period was found significantly lower in patients with Doyle splint with lidocaine pomade (p<0.001). Conclusion: Consequently, using lidocaine pomade covered nasal silicone splints is a comfortable, reasonable and cost-effective option for patients who underwent septoplasty. It helps postoperative pain management and shortens the duration of the postoperative bleedy discharge time. [ABSTRACT FROM AUTHOR]

Introduction:Nasal packing is a common procedure used to ensure haemostasis after nasal surgery. Materials and Methods:A prospective, randomized, controlled and double-blinded study was conducted on 80 consecutive subjects to investigate whether using Nasal Dressing Sponge® (NDS) instead of simple Merocel® might improve patients’ postoperative experience of nasal packing. Results:During the stay of the tampons no differences were noticed between the two groups as regards the postoperative pain. When it comes to pain during the packing removal, patients complained of worse symptoms in the side packed with Merocel. There was no bleeding after the removal of Merocel, whereas 5,6% patients were subject to some bleeding when NDS was removed. Conclusion:Merocel and NDS gave similar results regarding haemostatic activity. Nasal Dressing Sponge could decrease pain during the removal of the nasal pack, while it could be associated to a bigger incidence of mild bleeding after removing the pack.

Background: Rapid Rhino® nasal pack was used to minimize bleeding and to relieve postoperative pain after endoscopic sinus procedures (ESS), while different nasal packs have been employed in various sinonasal surgeries throughout the last decades. The aim of the study was to compare the effectiveness of Rapid Rhino® Pack and Gloved Nasal Pack as Middle Meatal Spacers after ESS for reducing postoperative adhesion in-patient undergoing ESS and reducing the pain during pack removal. Patients and Methods: We conducted a prospective, randomized controlled clinical trial, at ENT Department, Faculty of Medicine, at Zagazig University Hospitals on 44 cases. Patients were randomized to receive Rapid Rhino® pack the in one middle meatus (right or left), and the Gloved Nasal pack in the contra-lateral middle meatus intra-operatively. Results: Sino-nasal Outcome Test (SNOT-22) chart significantly decreased from a pre-operative mean of 52.59 (SD13.17) to 34.18 (SD 8.79) at 3 months post-operatively. Visual Analogue Scale (VAS) for pain significantly decreased in the Rapid Rhino pack groups compared with gloved nasal pack. Bleeding was more in gloved nasal pack side with statistically significant difference among both groups (p=0.007). Endoscopic evaluation of our cases revealed no significant difference between both groups regarding edema, discharge and both groups were significantly improved while significant differences were found regarding while scarring and crusting. Conclusion: We concluded that whether packs are always necessary following endoscopic sinus surgery. Rapid Rhino® Pack fulfils their primary purpose of hemostasis and is well tolerated. It has also been shown to cause little pain on removal and may prevent adhesion formation. [ABSTRACT FROM AUTHOR]

Numerous biomaterials have been developed over the years to enhance the outcomes of endoscopic sinus surgery (ESS) for patients with chronic rhinosinusitis. These products are specifically designed to prevent postoperative bleeding, optimize wound healing, and reduce inflammation. However, there is no singular material on the market that can be deemed the optimal material for the nasal pack. We systematically reviewed the available evidence to assess the functional biomaterial efficacy after ESS in prospective studies. The search was performed using predetermined inclusion and exclusion criteria, and 31 articles were identified in PubMed, Scopus, and Web of Science. The Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to assess each study’s risk of bias. The studies were critically analyzed and categorized into types of biomaterial and functional properties, according to synthesis without meta-analysis (SWiM) guidelines. Despite the heterogeneity between studies, it was observed that chitosan, gelatin, hyaluronic acid, and starch-derived materials exhibit better endoscopic scores and significant potential for use in nasal packing. The published data support the idea that applying a nasal pack after ESS improves wound healing and patient-reported outcomes.

Epistaxis is one of the most common otorhinolaryngology emergencies worldwide. Although there are currently several treatments available, they present several disadvantages. This, in addition to the increasing social need of being environmentally respectful, led us to investigate whether a sponge-like scaffold (SP–CH) produced from natural by-products of the food industry — soy protein and β-chitin — can be employed as a nasal pack for the treatment of epistaxis. To evaluate the potential of our material as a nasal pack, it was compared with two of the most commonly used nasal packs in the clinic: a basic gauze and the gold standard Merocel®. Our SP-CH presented great physicochemical and mechanical properties, lost weight in aqueous medium, and could even partially degrade when incubated in blood. It was shown to be both biocompatible and hemocompatible in vitro, clearing up any doubt about its safety. It showed increased blood clotting capacity in vitro, as well as increased capacity to bind both red blood cells and platelets, compared to the standard gauze and Merocel®. Finally, a rat-tail amputation model revealed that our SP-CH could even reduce bleeding time in vivo. This work, carried out from a circular economy approach, demonstrates that a green strategy can be followed to manufacture nasal packs using valorized by-products of the food industry, with equal or even better hemostatic properties than the gold standard in the clinic.

Objectives: Nasal septal surgery is one of the most common surgical procedure performed by otolaryngologists. Nasal packs are used for bleeding control, prevention of septal hematoma, replacement of mucoperichondrial flaps, and stabilization of the septum after nasal septal surgery. The aim of this study was to investigate the effects of albumin-glutaraldehyde–based tissue adhesive (Bioglue), which can be used as an alternative to nasal pack on the nasal septum after experimental nasal septum surgery. Methods: A total of 16 female Wistar albino rats were randomly separated into the study group (n = 10) and the control group (n = 6). After raising the mucoperichondrial flap on one side of the septum, Bioglue was used to fix the mucoperichondrial flap over the septal cartilage ın the study group and nasal packs (Merocel) were used for fixation in the control group. The rats were sacrificed at 2 and 4 weeks after septoplasty. All the tissue samples were evaluated under light microscope by the same pathologist in respect of foreign-body reaction, degree of inflammation, granulation tissue, fibrosis, cartilage damage, and cilia and goblet cell damage. In the control group, the Merocel packs were removed after 2 days and the groups were compared in terms of hematoma. Results: No hematoma was observed in any group. Septal perforation was determined in all the study group participants and loss of cilia and goblet cells and foreign-body reaction were found in 8 samples of the study group participants and in none of the control group. Conclusions: The results of this study show that Bioglue caused segmental cartilage injury; therefore, it may not suitable for use following septal surgery. [ABSTRACT FROM AUTHOR]

Background: Nasal packing is commonly done after septal surgeries. Nonabsorbable nasal pack is used to minimize bleeding from surgery site, support the mucoperichondrial flaps, and minimize the risk of formation of septal hematomas and adhesions. However, these materials cause pain and discomfort in-situ as well as during removal. This study was done to evaluate the effect of 2% lignocaine rehydration of nasal pack on pain during pack removal. Methods: This prospective study was conducted on 60 patients who had undergone septoplasty. The patients were divided into 2 groups: Lignocaine and Normal saline group, with 30 patients each. In the Lignocaine group, 2.5 ml of 2% of lignocaine was diluted with 2.5 ml of distilled water and was injected into the nasal pack; and in Normal saline group, 5 ml of normal saline was injected into the nasal pack. Nothing was injected to the left nostril, which acted as a control, in both groups. All patients were asked severity of pain during removal of nasal packing by VAS. Results: In lignocaine group, mean pain score was 3.73 ± 1.63 on lignocaine side and 6.23 ± 1.69 on control side (U=109.5, p

ABSTRACT Objective: To determine the efficacy of carragelose® nasal spray versus mupirocin ointment impregnated nasal packs on postoperative mucosal healing among chronic rhinosinusitis with nasal polyposis (CRSwNP) patients after endoscopic sinus surgery (ESS). Methods: Design: Double-Blind, Non-Randomized, Right-Left Side Comparison Setting: Tertiary Government Training Hospital Participants: Fifteen (15) patients diagnosed with chronic rhinosinusitis with nasal polyposis (CRSwNP) who had ESS were included in the study. Nasal packs (Netcell®) impregnated with carragelose® nasal spray or mupirocin ointment were respectively applied in right and left nostrils. Postoperative mucosal healing was graded by a blinded consultant using the Lund-Kennedy Endoscopic Scoring System and Perioperative Sinus Endoscopy (POSE) scoring system. Results: Six patients (12 nasal sides) completed the study. Comparing nasal packs impregnated with carragelose® nasal spray mupirocin ointment, the carragelose® group had lower Lund- Kennedy median scores than the mupirocin group on the 7th post-operative day; and this was statistically significant (p = .027). There were no significant differences in Lund-Kennedy postoperative scores on days 4 (p = .217), 14 (p = .171) and 28 (p = .151). Conclusion: Carragelose® nasal spray impregnated nasal packs may be comparable with, and may be an alternative to mupirocin ointment impregnated nasal packs in terms of postoperative mucosal healing among ESS patients with CRSwNP.

Objective:To compare silicone nasal septal splints with integral airway and a polyvinyl alcohol (PVA) sponge after septoplasty in terms of patient comfort (both with the pack in place and during removal) and postoperative complications.Methods:This study involved 169 patients who underwent septoplasty without additional nasal procedures due to nasal septal deviation. They were allocated into two groups. Group A comprised 90 patients who underwent septoplasty and who were packed with silicone nasal septal splints. Group B comprised 76 patients who underwent septoplasty and who were packed with a PVA sponge. They were removed on the second postoperative day. Patients were asked to record pain levels using a visual analog scale (VAS).Results:The patients in the groups had similar mean ages: 29.77 years (range, 19-74 years) and 23.77 years (range, 21–37 years) in Group A and Group B, respectively (p>0.05). VAS scores were significantly lower in Group A than in Group B at the 1st, 2nd, 4th, 8th, 12th, 24th, 48th, and 72nd postoperative hours (p

Objectives: To investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED). Design: Prospective cohort study. Setting: A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period. Participants: Patients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs. Main outcome measures: The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology. Results: A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2P =.028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2). Conclusions: The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis. [ABSTRACT FROM AUTHOR]

Nasal injury following nasal surgery is an adverse consequence, and prompt treatment should be initiated. Nasal packing, either non-absorbable or absorbable, are commonly used after nasal surgery to prevent bleeding and promote wound healing. In the current study, a novel gelatine sponge crosslinked with genipin was evaluated for suitability to be used as nasal packing and compared to one of the frequently used commercial nasal packing made up of polyurethane. Gelatine at 7% and 10% (w/v) concentration were crosslinked with varying concentrations of genipin, 0.5%, 0.25%, and 0.2% (v/v). The gelatine sponges were further characterised by its water uptake ability, biodegradation, water vapour transmission rate, porosity, contact angle, chemical composition, crosslinking degree, and mechanical properties. The gelatine sponges absorbed five times more water than their dry weight and were degraded within five days. The water vapour transmission rate of the gelatine sponges was 1187.7 ± 430.2 g/(m−2 day) for 7% gelatine and 779.4 ± 375.5 g/(m−2 day) for 10% gelatine. Crosslinking of gelatine with genipin resulted in lower porosity and did not affect the wettability of gelatine sponge (contact angle: 95.3 ± 12.1° for 7% gelatine and 88.4 ± 7.2° for 10% gelatine). In terms of biodegradability, the gelatine sponges took 24–48 h to degrade completely. Genipin crosslinking improved the degradation resistance and mechanical strength of gelatine sponge. The physical and chemical properties of the gelatine sponge, i.e. biodegradability and mechanical durability, support its potential as nasal packing. [ABSTRACT FROM AUTHOR]

INTRODUCTION Postoperative agitation or emergence agitation during recovery from anesthesia is an important complication of General Anesthesia (GA) especially in otolaryngological surgeries, and nasal surgery in particular. It is potentially harmful to the patients resulting in fall from the operation table, self-extubation, self-removal of nasal pack, hemorrhage etc. Several methods and medications have been tried to reduce it. We studied the effect of anterior ethmoidal nerve block for reducing post-operative agitation for nasal surgeries with nasal packs as it falls in the same operative field. MATERIAL AND METHODS A total of 100 participants undergoing nasal surgeries with nasal pack under GA in the Department of Otolaryngology, Lumbini Medical College, Palpa, Nepal, were randomized into cases and controls by block randomization. The study was done from June 2018 till February 2020. Anterior ethmoidal nerve was blocked with bupivacaine injection at the end of surgery in cases. Controls were injected with normal saline. Post-operative agitation was studied with Riker Sedation-Agitation Scale (SAS) and was compared between the two groups. RESULTS There were 50 participants in each group. Emergence agitation in cases and controls at extubation, 30 minutes post- extubation and the next morning was present in 32% and 52%, 4% and 18%, and 0 and 2% respectively. SAS score rapidly decreased in 30 minutes after extubation in controls but was still significantly higher than that of cases. CONCLUSION Anterior ethmoidal nerve block was effective in reducing post-operative agitation significantly during emergence in nasal surgeries with nasal packs. [ABSTRACT FROM AUTHOR]

Objective: We purposed to compare the effects of certain local anesthetics soaked Merocel nasal packs on hemorrhage and pain after septoplasty.Materials and methods: This study is a prospective double-blind study that was done in patients undergoing septoplasty. The study was created with 90 patients. All patients were divided into four groups. The each group was applied 2% lidocaine plus adrenaline, 2% tetracaine, 4% articaine plus adrenaline as study groups or 0.9% sodium chloride (NaCl) as control group in their Merocel packs after septoplasty. Verbal analog scale (VAS) was applied to all patients and the amount of postoperative hemorrhage was noted during postoperative period. The statistical analysis was performed using Student’s t test and Chi-square test on each patient group at each time point.Results: The study groups (2% lidocaine plus adrenaline, 2% tetracaine and 4% articaine plus adrenaline groups) had significantly better pain scores versus control group in the 1st, 4th, 8th, 16th and 24th postoperative hours (p < 0.05). The articaine plus adrenaline group had better pain scores than the lidocaine plus adrenaline group, and the lidocaine plus adrenaline group had better pain scores than the tetracaine group in the postoperative first day. Also articaine plus adrenaline group had less postoperative bleeding rate than the lidocaine plus adrenaline, tetracaine and control groups (p < 0.05). There was no statistically significant difference between the lidocaine plus adrenaline, tetracaine and control groups in terms of postoperative hemorrhage (p > 0.05).Conclusion: Topical articaine plus adrenaline application in the nasal packs can be safely used for less pain and bleeding following septoplasty. [ABSTRACT FROM AUTHOR]

There is little evidence to suggest that bilateral nasal packing increases intra-nasal pressures compared to a single pack (or is well tolerated) for uncontrolled unilateral epistaxis, but it is often performed and justified on those grounds. 15 volunteers were recruited according to strict criteria. Rapid Rhino 5.5 cm anterior packs were inserted bilaterally following topical nasal preparation with co-phenylcaine. The first pack was inflated to a pre-determined pressure. The contralateral pack was inflated to match, and any intra-nasal pressure change on the first side was measured. The subject's level of discomfort was scored on a visual analogue scale. This procedure was repeated at incremental pressures. Higher ipsilateral intra-nasal pressures are achieved when additional contralateral nasal packs are inflated. This change in ipsilateral intra-nasal pressure is greater at higher total inflation pressures. At higher pressures, the subjects reported lower mean pain scores when bilateral packs were used compared to unilateral. This effect was only statistically significant at intra-nasal pressures of 140 mmHg and above (Wilcoxon Signed-Rank test, p < 0.02). It is possible to increase the ipsilateral nasal cavity pressure by inserting a contralateral nasal pack. Although this extra pressure may be enough to tamponade further venous bleeding without significantly increasing a subject's discomfort, the high levels of pack pressure required, make this unlikely to be of significant use in the clinical setting. [ABSTRACT FROM AUTHOR]

Objective. This study aims to compare the effects of Merocel nasal packs and silicone nasal septal splints with integral airway on the ventilation and pressure of the middle ear when applied intranasally after septoplasty for isolated septal deviation.Study Design. A prospective, randomized trial.Setting. A tertiary referral center.Subjects and Methods. Fifty-one patients who underwent septoplasty for nasal respiratory impairment caused by septal deviation were randomized into 2 groups. After septoplasty, bilateral anterior Merocel nasal packs were applied in one group, while silicone nasal septal splints with integral airway were applied in the other group. Middle ear pressures were compared using preoperative and post-operative tympanometry.Results. Pathological decrease in the middle ear pressure in at least 1 ear was determined in 17 patients (73.9%) in the Merocel group compared with only 6 patients (21.4%) in the silicone nasal septal splint group at the 48th postoperative hour. In the first 24 hours following surgery, decreases in tympanometric pressures were seen in both groups, but more in the Merocel group. After 24 hours, middle ear pressures continued to decrease in the Merocel group but started to increase in the silicone nasal septal splint group.Conclusion. Because they allow inhalation through the nose and cause less Eustachian tube dysfunction than Merocel, using silicone nasal septal splints with integral airway instead of packing after septoplasty seems a more reasonable option. [ABSTRACT FROM PUBLISHER]

Objective: Our study compared Rapid Rhino (RR; Applied Therapeutic Ltd, Leicestershire, UK) and Merocel (Medtronic Xomed, Jacksonville, FL) nasal packing materials in endonasal septoplasty surgery in terms of postoperative patient comfort and reactionary bleeding. Patients and Methods: Fifty-one patients underwent endonasal septoplasty. One nasal cavity was packed with Merocel packs and the RR pack was used for the other side. The pain and nasal fullness levels on each side were studied at 1 and 6 hours postoperatively. Pain level was also studied during the removal of the nasal packs on the second day. These levels were scored on the basis of a visual analogue scale (VAS) between 0 and 10. Reactionary bleeding after nasal pack removal was also recorded. The Wilcoxon test was used for statistical analysis of the VAS scores, and the McNemar test was used for comparison of bleeding levels after pack removal. A p value < .05 was considered to be statistically significant. Results: Minimal bleeding was noted in 15 patients following Merocel pack removal; however, no bleeding was seen following RR pack removal. Comparison of the VAS scores of pain and nasal fullness of each nasal pack at 1 and 6 hours postoperatively showed a statistically significant difference (p < .05). Similarly, comparison of the pain level for pack removal and bleeding after removal on the second postoperative day demonstrated a statistically significant difference (p < .05 and p = .001, respectively). Conclusion: RR is more tolerable by patients than Merocel after septoplasty surgery. RR also has some advantages, namely, easy pack removal and less reactionary bleeding. [ABSTRACT FROM AUTHOR]

Epistaxis is one of the most common otorhinolaryngology emergencies worldwide. Although there are currently several treatments available, they present several disadvantages. This, in addition to the increasing social need of being environmentally respectful, led us to investigate whether a sponge-like scaffold (SP-CH) produced from natural by-products of the food industry - soy protein and β-chitin - can be employed as a nasal pack for the treatment of epistaxis. To evaluate the potential of our material as a nasal pack, it was compared with two of the most commonly used nasal packs in the clinic: a basic gauze and the gold standard Merocel®. Our SP-CH presented great physicochemical and mechanical properties, lost weight in aqueous medium, and could even partially degrade when incubated in blood. It was shown to be both biocompatible and hemocompatible in vitro , clearing up any doubt about its safety. It showed increased blood clotting capacity in vitro , as well as increased capacity to bind both red blood cells and platelets, compared to the standard gauze and Merocel®. Finally, a rat-tail amputation model revealed that our SP-CH could even reduce bleeding time in vivo . This work, carried out from a circular economy approach, demonstrates that a green strategy can be followed to manufacture nasal packs using valorized by-products of the food industry, with equal or even better hemostatic properties than the gold standard in the clinic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors.)