Clinical outcomes and complications of Polyvinyl Alcohol (PVA)-Based packing in otolaryngologic procedures: a systematic review

Background To manage bleeding and postoperative complications in endonasal surgeries such as septoplasty, turbinoplasty, and sinus procedures, nasal packing is commonly used. It achieves hemostasis, supports nasal tissues, reduces adhesions or stenosis, and promotes healing. This systematic review evaluates the clinical effectiveness and safety of PVA-based nasal packing compared to alternative materials in ENT procedures. Methods A comprehensive literature search was performed in PubMed, ScienceDirect, the Cochrane Library, and Google Scholar covering 12 years and 2 months (1 January 2013 to 28 February 2025) to identify studies reporting the use of PVA in surgical procedures. Risk of bias was assessed using RoB2 for randomized trials and ROBINS-I for non-randomized studies. Results A total of 31 studies met the inclusion criteria. The most commonly assessed outcomes included bleeding control, pain, patient comfort, recovery, and safety. Most studies compared PVA-based nasal packs with alternative hemostatic methods such as septal splints, Balloon Nasal Packs, bioresorbable nasal packs, silicone splints, and suturing techniques in septoplasty and endoscopic nasal surgery, focusing on hemostasis, healing, adhesion formation, and patient tolerance. Medicated Merocel was also reported to improve postoperative pain control, and its use in epistaxis management has been compared with devices such as Rapid Rhino, Posisep in terms of efficacy and complications. Most studies had some concerns or moderate risk of bias, mainly due to incomplete allocation concealment, lack of blinding for subjective outcomes, and confounding. Conclusions Favourable hemostatic outcomes were reported with PVA based nasal packaging compared with alternative materials. PVA-based materials showed effective bleeding control and reliable postoperative hemostasis in septoplasty, with more limited evidence in other procedures. Clinical trial number Not applicable.