Carboxymethyl cellulose and chitosan-based tampon for effective epistaxis management

Epistaxis, commonly known as nosebleeds, is a frequent occurrence that places significant strain on public health systems worldwide. Traditional methods for managing epistaxis, such as nasal packing, can be uncomfortable and may result in complications, such as adhesions and mucosal trauma. In response to this, the use of carboxymethylcellulose (CMC), chitosan (CS), and citric acid (CA) as green crosslinkers for nasal packing in epistaxis management was studied. These biomaterials were chosen for their hemostatic properties and biocompatibility. This study aimed to assess the effectiveness of these natural materials in improving patient comfort and treatment outcomes compared with conventional packing materials when used as nasal packs for epistaxis. This study compared CA-crosslinked and freeze-dried sponges with two nasal packs commonly used in clinical practice: cotton gauze and a commercial hemostatic sponge. The goal was to optimize the crosslinking process using CA to refine the formulation parameters of the nasal packing materials and enhance their hemostatic efficacy, biocompatibility, antibacterial properties, and mechanical properties. The CS-CMC2 sponge exhibited exceptional morphological, hydrophilic, and mechanical properties, including the ability to partially degrade in an incubated aqueous medium. It has hemocompatible properties in vitro, confirming its safety in the blood contact material. In comparison to cotton gauze and the commercial sponge, it exhibited increased blood clotting capacity and the ability to adhere to red blood cells and platelets owing to its CS content. CS-CMC2 demonstrated potent antibacterial properties against Staphylococcus aureus, which could be prescribed to the presence of CS. These antibacterial properties may facilitate nasal mucosal repair. In summary, CS-CMC2 exhibits outstanding blood clotting, balanced swelling, and mechanical properties, which can support nasal hemostasis and mucosal repair, making it a promising therapy for epistaxis and valuable instrument for monitoring bleeding.