Nasal Septum Perforation and Inferior Turbinate Avulsion/Unilateral Empty Nose Syndrome Resulting from Management of Recurrent Epistaxis

Abstract

The patient is a 68-year-old male who reported a history of excellent health until 10 years ago, when he developed a cardiac/thromboembolic condition that required use of aspirin and clopidogrel for anticoagulation. In his first year of treatment, he unfortunately developed recurrent right-sided epistaxis. He recalled presenting to his local emergency department (ED) on multiple occasions to manage the nosebleeds, which led to multiple right-sided nasal cautery procedures. On his last ED visit, given profuse recurrent epistaxis, additional cautery of the nasal septum and right-sided nasal packing were pursued. Upon aggressive placement and advancement of the nasal packing into his right nasal cavity by the ED treatment team, the patient recalls experiencing an “unbearable, tearing sensation” and “excruciating, blistering pain” to his right face. Because of this traumatic experience, the patient was admitted and taken to the OR the following day by an otolaryngologist for additional surgical control of epistaxis. After this procedure, he learned that a large nasal septum perforation was found, and that “there was damage to his nasal turbinate” but that nothing further could be offered.