Toxic shock syndrome related to nasal packing

While toxic shock syndrome (TSS) is generally considered to be a tampon-related illness, an increasing number of reported cases have been related to surgical wounds. At least one case has been reported following nasal surgery with nasal packing. We report two additional cases of TSS associated with nasal packing. Because nasal packing is in some ways analogous to the use of tampons for menstrual hygiene, and nasal carriage of Staphylococcus aureus is frequent, the scarcity of TSS cases reported to occur following nasal packing is surprising. Otorhinolaryngologists are urged to report TSS cases associated with nasal packing to their state and local health departments or the Centers for Disease Control to aid in the understanding of the pathogenesis of this disease.