Intranasal balloon catheters: how do they work?

Despite there being a wide range of different epistaxis balloons their mode of action is unknown. Manufacturers' drawings depict balloons neatly filling the nasal cavity or precisely occluding the anterior and posterior nasal apertures. In view of the complexity of nasal internal anatomy these explanations seem unlikely. A better understanding of the configuration of these devices within the human nasal cavity may explain their mode of action and complications. This study aimed to delineate radiographically the configuration of 3 commonly used balloons within the noses of 4 human cadavers and to observe the effects of alterations in inflation volumes. The results showed that devices designed to fill the nasal cavity do not achieve this aim. Balloons do not conform to the contours of the nasal cavity but expand along pathways of least resistance and prolapse into the nasopharynx. The findings may explain the occurrence of complications such as headache and Eustachian tube obstruction. Accurate nasal tamponade is unlikely to be their true mode of action. These devices probably work by a combination of factors rather than as a result of specific design features. The possibility of rational design modifications is discussed.