The experience cited below is based on 150 cases in which the airway was employed. A clinical study evaluating all
aspects of the anatomy, physiology, physics of airflow through a closed space, and clinical performance of the device
Q: Is the Kotler Nasal Airway (KNA) a splint or a stent? Watch video
A: Neither. The KNA is an airway only. Its exclusive mission is to provide every nasal/sinus surgery patient
a reliable, functioning nasal airway in the immediate post-operative period.
Q: Are there any contraindications to using the KNA? Watch video
A: No. Appropriate after rhinoplasty, septoplasty, turbinate and sinus surgery. For open rhinoplasty cases,
in deference to the external transcolumellar incision, the bridge connecting the two tubes can be divided and
each tube secured by suture technique of the surgeon's choice.
Q: How long can the airway stay in place? Watch video
A: In our 150 cases, the tubes sat in place for up to six days, without any adverse consequences.
Q: Can one use septal splints concomitant with the nasal airway? Watch video
A: Yes. Every technique of intranasal splinting, stenting, or packing is incompatible with the indwelling airway.
It was designed that way. The key to internal harmony is that the device is so designed that it nests in the
"surgically-quiet", always un-operated portion of the nasal fossa, the floor.
Q: "I don't routinely pack the nose. Why should I insert an airway?" Watch video
A: Packing, or no packing, the nasal cavities will fill with blood and mucus. Guaranteed. And there will always be
some nasal mucosal edema. This will cause the non-packed patient to be dissatisfied. Since nose-blowing is unwise and generally
forbidden in the immediate postoperative period, without a guaranteed airway, the patient will unhappily resort to mouth breathing.
As in "When do you do a trach? When you think about it", if you are wondering about an airway, put in the KNA.
Q: Any packing material or technique of packing that is incompatible with the airway?
A: No. Absorbable and non-absorbable packing was used in every clinical study case. Packing a separate issue.
Q: If the nose is packed tightly, can the airway device be compressed and rendered inoperative?
A: No. A specific durometer (measure of stiffness) silicone plastic material was selected to rule out such a possibility.
Never happened in the clinical study.
Q: Is it possible for the tubes to be blocked by blood or mucus? Watch video
A: Yes, possible, but correctable. A home irrigation syringe and tip are included in the KNA kit. Patients and
caregivers, who assiduously follow the Instructions for Home Care card, will be able to prevent blockage. However,
if home care is somehow inadequate, using a suction catheter at an office visit will solve the problem. Our experience
was that fewer than 5% of patients required an office visit to clear the airway.
Q: Can the airway dislodge anteriorly? Posteriorly? Watch video
A: The "bridge" prevents any posterior migration. In our experience, no airway ever self-extruded, anteriorly, for two reasons:
1. The airway is designed to fit snuggly onto the floor of the nose.
2. The act of swallowing tends to create a posteriorly-directed, negative intranasal pressure that mitigates against any anterior movement
Q: Is removal painful?
A: No. However, if you want to allay any patient anxiety, topically anesthetize the nose five minutes prior to removal.
Here's what works for us: a 1:1 mixture of oxymetazoline 0.05 %, or phenylephrine 1%, with pontocaine 2%. This renders
the nose anesthetic and shrinks the mucosa to help facilitate removal. Drip into nasal cavity and wait five minutes.
Repeat if you like. Then remove KNA and, as indicated, the packing.
Here is another tip: For those patients raised on tales of the horrors of nasal pack removal, plan a pre-medication sedative routine.
A dose of a tranquilizer and pain pill, of surgeon choice, taken one hour prior to pack removal and secretion suctioning will bring a
less anxious patient to the office.
Q: Does the surgicenter or hospital purchase the KNA kit? Watch video
A: Yes; analogous to it supplying the anesthesiologist with endotracheal tubes. The facility is responsible for supplying
the surgeon with all supplies, materials, and devices used in the OR. All consumables should be line-item billed by the facility to
the insurer. Your medical biller or coder will know how to submit the charge.
Q: Will insurers compensate the surgeon for the additional service of inserting, positioning, and later removal of the airway? Watch video
A: Yes. In over 50 cases where the patient had indemnity insurance, 75% of a variety of insurers honored the charge. Payments up to
$375 were allowed. Allowances and actual payments, of course, vary depending on policy benefits, deductibles, co-pays, etc. Consult your insurance
billing/coding specialist. Two consultants suggested using CPT Code "30999, by report". This code requires explanation of the service be included
in the operative report. Each surgeon will, of course, create a custom operative report for the surgical case. In any event, the above-mentioned
procedure code should be accompanied by a descriptive title such as "insertion intranasal airway" or "prosthesis" or "air tubes".
Q: Can these tubes be reused?
A: No. As noted on the KNA box, Federal law prohibits more than one use of such a device.
Q: Any worries about the tubes "sticking" to intranasal tissue and causing problems in removal? Watch video
A: There is never a problem with removal because medical-grade silicone is the classic non-stick material. Artificial
heart valves and artificial joints are made of the same material. Even SuperGlue® will not stick to it.