Chronic Rhino-sinusitis, Rhinosinusitis, Sinusitis
Conditions
Keywords
VELNEZ, NASOPORE, Nasal Packing, Biodegradable Nasal Pack, Functional Endoscopic Sinus Surgery, Septoplasty, Rhino Sinusitis
Brief summary
This clinical trial evaluated two absorbable nasal packing materials - VELNEZ and NASOPORE - in adult patients (18-70 years) who underwent nasal surgery, including septoplasty, FESS, or turbinoplasty. The study addressed two core questions: whether VELNEZ offered superior haemorrhage control and faster biodegradation, and whether it reduced postoperative pain, fibrosis, adhesion, and discomfort compared to NASOPORE. Participants were randomised to receive either packing material following surgery. They were monitored on the day of surgery for haemostasis and device performance, then followed up with clinical and endoscopic assessments - including pain scoring and adverse event tracking - through Day 90.
Detailed description
This study was a prospective, randomised, open-label, single-centre, two-arm parallel clinical investigation conducted in a post-market setting. It was designed to evaluate and compare the clinical performance of two biodegradable nasal packing materials - VELNEZ and NASOPORE - following routine nasal surgical procedures under real-world conditions. Rationale and background Nasal packing is routinely employed after septoplasty, FESS, and turbinoplasty to achieve haemostasis, support mucosal healing, and prevent postoperative complications including adhesions and septal haematoma. Conventional non-absorbable packing materials, while effective for haemostasis, are associated with significant patient discomfort, pain at removal, mucosal trauma, and risk of delayed healing. Biodegradable alternatives were developed to address these limitations by obviating the need for mechanical removal and providing a more favourable postoperative environment. Investigational devices VELNEZ is a biodegradable composite nasal packing material comprising gelatin, chitosan, polyvinyl alcohol, and psyllium husk. Following placement, it was designed to fragment and gradually dissolve within the nasal cavity over several days. Its composition was intended to deliver effective haemostasis, physically separate mucosal surfaces to reduce adhesion formation, and support tissue regeneration - all without requiring removal, thereby minimising procedure-related trauma and improving patient tolerability. NASOPORE is a biosynthetic, biodegradable polyurethane foam with established clinical use. Its hydrophilic properties allowed it to absorb fluids and conform to the contours of the nasal cavity, providing mechanical support and haemostatic function. Degradation occurred through fragmentation over time, though the rate and completeness of dissolution varied across patients. Study design and randomisation Participants were assigned in a 1:1 ratio to receive either VELNEZ or NASOPORE as postoperative nasal packing immediately following surgery. Randomisation was performed to minimise selection bias. Given the physical and visual differences between the two materials, blinding of investigators and participants was not feasible; the study was therefore conducted in an open-label manner. Clinical assessments and follow-up Assessments were conducted perioperatively and at scheduled postoperative visits through the final follow-up at Day 90. The evaluation framework covered the following domains: Device performance: Ease of placement, conformability to nasal anatomy, and haemostatic effectiveness were assessed perioperatively. Degradation profile was monitored clinically at each follow-up; irrigation or manual intervention was performed where incomplete dissolution was observed. Mucosal and structural healing: Endoscopic examination of the surgical site was performed at applicable visits to evaluate mucosal condition, presence of oedema, secretions, fibrosis, scar formation, and adhesion development. Any pressure-related discomfort or structural changes were documented. Patient-reported outcomes: Symptom burden and quality of life were assessed using the Sino-Nasal Outcome Test (SNOT-22), a validated instrument for sinonasal conditions. Pain and tolerability were evaluated using standardised pain assessment scales at defined time points. Safety monitoring: Adverse events and serious adverse events were recorded throughout the study. Device-related complications - including infection, hypersensitivity reactions, and signs of delayed healing - were specifically monitored. Vital signs, physical examinations, and laboratory evaluations were conducted per routine clinical practice. Statistical approach Continuous variables were summarised using descriptive statistics and compared between groups using parametric or non-parametric tests, selected based on data distribution. Categorical variables were analysed using Chi-square or Fisher's exact test, as appropriate. All analyses were conducted at a two-sided significance level. Ethical and regulatory conduct The study was conducted in accordance with Good Clinical Practice (GCP) and the ethical principles of the Declaration of Helsinki. Institutional Ethics Committee approval was obtained prior to initiation. All participants provided written informed consent before enrolment.
Interventions
VELNEZ is a biodegradable composite nasal packing material composed of gelatin, chitosan, polyvinyl alcohol, and psyllium husk. It is designed to fragment and degrade within the nasal cavity after app
NASOPORE is a biosynthetic biodegradable polyurethane foam nasal packing material. It absorbs fluids, conforms to the nasal cavity, and gradually fragments over time. The device is used for postoperative bleeding control, support of nasal structures, and facilitation of healing following nasal surgery.
Sponsors
Study design
Intervention model description
The study followed a parallel assignment model in which participants were randomised in a 1:1 ratio to receive either VELNEZ or NASOPORE as postoperative nasal packing. Each participant was assigned to a single treatment arm and remained in that arm throughout the study; no crossover occurred. The allocation sequence was determined using a predefined randomisation schedule to minimise selection bias and ensure balanced distribution across treatment groups. Given the physical differences between the two devices, blinding was not feasible; the study was therefore conducted in an open-label manner, with both investigators and participants aware of the assigned intervention. Both devices were applied intraoperatively or immediately postoperatively as part of routine surgical care. All participants received standard perioperative and postoperative management, with clinical assessments conducted at predefined follow-up time points to evaluate device performance, outcomes, and safety.
Eligibility
Inclusion criteria
* Participants eligible for the use of a nasal pack (either VELNEZ or Nasopore) in routine clinical practice after a planned nasal surgery. * Male and female in the age group of 18 to 70 years. (Both Included) * Participants or their LAR who can provide informed consent form in writing. * Participants who allow their study data to be collected at pre-defined follow-up period.
Exclusion criteria
Participants who are unable to be treated with VELNEZ, or Nasopore nasal pack in routine clinical practice after a planned surgery. * Participant's/ legal guardian (LAR) who cannot provide informed Consent written. * Participant unwilling or unable to comply with the postoperative visits necessary for data collection. * Participant with an active infection at the surgery site. * Participant with a history of asthma. * Pregnant or lactating Females * Participant who are on aspirin or anti-platelet drugs therapy. * Participant positive for HIV, HCV, VDRL, HBs Ag. * Participant who is allergic (Hypersensitive) to any of the ingredients of the nasal packs. * Participant with bleeding disorders. * Any medical condition that, in the opinion of the investigator, would make the subject unsuitable for inclusion (e.g., a chronic, relapsing or hereditary disease that may interfere with the outcome of the study).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Clinical Success of Nasal Pack | Up to Day 90 post-surgery | Proportion of participants achieved successful clinical outcome defined as complete degradation of the nasal pack within 7 days without device-related adverse events, along with acceptable levels of fibrosis and scar formation, absence of moderate to severe postoperative pain, and no significant breathing discomfort due to pressure effect |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative Pain Assessment using Visual Analogue Scale (VAS) | From Day 0 to Day 14 post-nasal surgery | Patient-reported pain levels will be assessed using the Visual Analogue Scale (VAS), a 10 cm horizontal line anchored by "no pain" (score = 0) and "worst imaginable pain" (score = 10). The total score ranges from 0 to 10. Higher scores indicate greater pain intensity and worse outcome (lower tolerability of the nasal pack). |
| Time to Haemorrhage Control | Day 0 (Intraoperative) | Time (in minutes) from application of the nasal pack at completion of surgery to achievement of complete haemostasis, as assessed by the operating surgeon |
| Adhesion Formation (Endoscopic Assessment) | Up to Day 90 post-surgery on post surgery follow up visits | Incidence and severity of nasal adhesions assessed using endoscopic examination during follow-up visits. |
| Endoscopic Healing Assessment | From Day 7 to Day 90 post-surgery | Assessment of nasal mucosal healing based on endoscopic findings including mucosal oedema, nasal secretions, and presence of polyps during follow-up visits |
| Incidence of Adverse Events (AEs) and Serious Adverse Events (SAEs) | From Day 0 to Day 90 post-surgery | Number and proportion of participants experiencing adverse events, serious adverse events, or device-related complications during the study period. |
Countries
Malaysia
Contacts
Universiti Teknologi MARA (UiTM), Selangor, Malaysia
UCSI University, Kuala Lumpur, Malaysia