Relative contraindications Severe nasal septal deviation toward the bleeding side (makes it difficult to insert balloon device) Complications Injury (eg, pressure necrosis) Migration of the nasal packing and aspiration into the airway or airway compromise Infections such as sinusitis, otitis media, or rarely toxic shock syndrome Penetration of the catheter through the skull base and into the brain parenchyma, though this is unlikely in the absence of preexisting skull base trauma Dysphagia Otitis media secondary to eustachian tube obstruction Necrosis of the nasal ala Sometimes hypoxemia, particularly if patients are also sedated Activation of the trigemino-cardiac reflex leading to cardiac arrhythmia and even cardiac arrest * * Such cardiac complications have been reported in the literature, although this remains controversial.