Aims: The aim of this pilot study is to assess whether a haemostatic gel (PuraStat) used topically as a dressing in the nose after laser ablative therapy for hereditary haemorrhagic telangiectasia (HHT) leads to better symptom control and improved health related quality of life (HR-QOL) over standard therapy. We hypothesise that PuraStat will lead to reduced bleeding and improved nasal obstruction, leading to better HR-QOL. Methodology: Prospective case-control study comparing PuraStat applied topically to laser treated areas in the nose vs topical application of chloramphenicol (Chlorsig) antibiotic ointment. Patients were recruited from a single tertiary centre in Melbourne. All patients had a diagnosis of HHT and underwent laser ablative treatment for epistaxis. Patients were excluded if they were on anticoagulant/antiplatelet medications. Severity of bleeding was measured with the Epistaxis Severity Scale (scored 0-10; low-high symptom burden) and HR-QOL was measured using the short form-36 (SF-36) questionnaire. Outcomes were measured at baseline, 2, 4 and 12 weeks. Results: Data collection of 60 patients is in progress. Preliminary analysis of 25 patients has been performed. The average age of the entire cohort was 54±17 years; 76% were female (n=19). The average age of onset of epistaxis was 19 years. The most common genetic mutation was ACVRL-1/ALK-1 (24%; n=6). The mean decrease in epistaxis severity at 12 weeks is 1.9±1.5 vs. 1.1±1.7 for the Chlorsig and PuraStat groups respectively (p=0.25). There is currently no significant differences in HR-QOL scores at 12 weeks. Conclusion: On preliminary analysis, no significant differences could be demonstrated in epistaxis severity or HR-QOL scores at 12 weeks between the two preparations and both seem to be equally effective as a dressing in the nose after laser therapy; but further data collection, analysis and results are pending.

Background: Nasal airway obstruction (NAO) is a common condition, affecting up to a third of the population and has been shown to significantly impair quality of life and negatively affect productivity. Common symptoms include nasal fullness, congestion, mouth breathing and sleep related breathing disorders. Virtual surgery and computational fluid dynamics (CFD) has been performed on computer models of patients with NAO to describe existing techniques. This review aims to systematically review the available research on virtual surgery and CFD using computational models. Methods: A systematic review of the literature of primary articles that performed virtual surgery and CFD on computer models of patients with known NAO. A search was performed on May 23nd 2023 of Medline, Scopus, Embase and IEEE databases. PRISMA guidelines were followed during all stages of the review process. Studies that used CFD to investigate the effect of real surgery for NAO as well as those that performed virtual surgery on one or more computational models of patients that had NAO were included in this review. Results: In total, 675 articles met the search criteria, with 26 studies being included in the study. Broadly, studies utilised virtual surgery to investigate the effect of surgery (including inferior turbinoplasty/turbinectomy, septoplasty, middle turbinectomy etc) on nasal airflow characteristics. Conclusions: This study demonstrates that virtual surgery and CFD is being increasingly used to investigate the efficacy of current surgical techniques in improving nasal airflow. Future studies have the potential to utilise CFD experimentally, to develop novel surgical techniques by performing virtual surgery – which has the potential to alleviate symptoms of NAO by improving nasal airflow.

Aims: Whilst a mucosa-sparing inferior turbinoplasty is effective in addressing nasal obstruction, patients may still experience other symptoms of rhinitis due to underlying allergic or non-allergic disease. This study aims to explore outcomes in a novel turbinoplasty technique, which involves the identification and cautery of the neurovascular bundles giving parasympathetic supply to the inferior turbinate. Methodology: The double flap turbinoplasty technique, involving preservation of both medial and lateral turbinate mucosa, was used in 31 patients. The neurovascular bundles were identified and cauterised with bipolar forceps in all patients. Pre- and post-operative Sino-Nasal Outcome Test (SNOT-22) and Adelaide Disease Severity Score (ADSS) questionnaires were obtained. Results: Patients showed a significant difference in pre- and post-operative total SNOT-22 (42.8+/-18.6 vs 20.4+/-13.4; p<0.001) and ADSS scores (13.2+/-4.0 vs 9.1+/-3.1; p<0.001). There was a significant reduction in all SNOT-22 rhinitis subdomains including nasal blockage (3.6+/-1.0 vs 1.2+/-1.1; p<0.001), sneezing (1.4+/-1.4 vs 0.6+/-0.9; p=0.001), runny nose (1.6+/-1.1 vs 1.1+/-1.0; p=0.03), post-nasal discharge (1.9+/-1.5 vs 0.9+/-1.0; p<0.001), nose blowing (1.9+/-1.2 vs 1.1+/-1.2; p=0.005) and thick nasal discharge (1.4+/-1.4 vs 0.6+/-0.7; p<0.001). There was a significant reduction in all ADSS rhinitis subdomains including rhinorrhoea (2.5+/-1.1 vs 2.0+/-1.0; p =0.049), postnasal drip (2.4+/-1.3 vs 1.8+/-0.9; p=0.009) and nasal obstruction (3.8+/-1.2 vs 2.0+/-1.0; p<0.001). Conclusions: Selective cautery of the neurovascular bundles using the double-flap inferior turbinoplasty technique provides a significant reduction in nasal discharge and sneezing, whilst still providing significant relief from nasal obstruction.