Tualang Honey-impregnated Nasal Pack in Endoscopic Sinus Surgery Reduces Post-operative Inflammation and Bacterial Growth

Background: To compare the efficacy of nasal packing using nasopore impregnated with tualang honey (THP) in middle meatal packing to contralateral saline-impregnated nasal packing (SP) in endoscopic sinus surgery (ESS). Methods: Twenty-three patients undergo ESS and are randomly selected in each nostril either THP or SP packing. Symptoms including pain and nasal obstruction were evaluated using a visual analogue scale (VAS) score by the patient and surgeon during weekly nasal toilette for 4 weeks. Post-operative endoscopic evaluation on hemostasis score, infection and mucosal changes including recurrent polyps and adhesion done by 2 independent surgeons weekly via video endoscopic recording. Bacteria swab culture and sensitivity were taken 1 week postoperatively and mucosal biopsy from the designated middle meatus area was taken preoperatively and at 3rd-week post surgery. Results: Patients VAS score showed a significant reduction in the symptoms of pain and nasal obstruction in the THP nasal cavity compared to the SP nostril. The surgeon also found that it is easier to perform nasal toilette in the THP nostril compared to SP. Endoscopic examination by 2 independent surgeons revealed a significant reduction in inflammation and bleeding in THP compared to SP in weekly follow-ups. Interestingly, there was evidence of recurrent polyps in SP nasal mucosa and none in THP mucosa. Swab culture and sensitivity of the nasal mucosa showed significantly lower bacterial growth in THP. Histologically, pre- and post-operative biopsy of the middle turbinate shows no significant difference in both groups. Conclusion: Tualang honey has the advantage of reducing the symptoms of pain and obstruction in the patient, easing the nasal toilette postESS and providing better wound healing, with less inflammation and lower bacterial growth, thus reducing recurrent polyps’ formation. Cite this article as: Faiz Bin Zulkifli M, Putra Bin Sabir Husin Athar P, Ridzo Bin Mahmud M, Binti Hj Idrus R, Bin Mohamad Rose I, Bin Saim A. Tualang honey-impregnated nasal pack in endoscopic sinus surgery reduces post-operative inflammation and bacterial growth. B-ENT 2024;20(3):153-159.