How to perform adequate nasal packing in posterior epistaxis with difficult access

Inadequate nasal packing in the treatment of posterior epistaxis can result in an increase in patient morbidity and mortality, and also hospital expenditure. The presence of a septal spur or septal deviation anterior to the bleeding may prevent sufficient local pressure over the bleeding point with a ribbon gauze pack. A modified Jobson-Horne probe can be used to ensure a tight ribbon gauze application over the bleeding point behind the septal spur or deviation.