Modified Technique of Anterior Nasal Packing: A Comparative Study Report

Abstract

Anterior nasal packing, which is a common procedure in otorhinolaryngology practice, has different complications. Pain during introduction and removal of pack, bleeding after removal due to mucosal damage and synechia formation are common among them. A continuous effort is going on worldwide to combat those by modifying the nature of pack material or inventing new materials for nasal packing. In the present study an effort was made to compare a new modification of conventional gauze pack by using aluminum foil prepared from the cover of suture materials as septal splint (to reduce the mucosal damage) with conventional gauze pack and another costly material, nasal tampon (merocel). Comparisons were done in terms of cost, efficacy and complications. Prospective hospital based interventional study. Patients were distributed into three groups according to the material used for anterior nasal packing. Comparisons were made in terms of cost of the material used, pain during introduction of pack, rise of systolic blood pressure, incidences of bleeding while pack in situ, incidences of bleeding after removal of pack that required repacking and incidences of synechia formation after pack removal. The episodes of bleeding while pack in situ, within first 48 h and forced for repacking was observed to be significantly more prevalent among nasal tampon groups (12.5%) of patients but only 2.1 and 2.4% with use of conventional gauze pack and our modification respectively. Regarding bleeding after removal of pack, 10.6% patients experienced bleeding with conventional gauze pack, whereas with our modification it was only 2.4%. Synechia formation was found to be highest among the cases with conventional gauze pack (14.9%), but with our modification it is only 2.4%. In this study it is found that use of aluminum foil prepared from the cover of suture materials can be very useful and cost effective method to reduce some of the complications of anterior nasal packing.

A comparative study between conventional nasal packing versus nasal splint with clip after septoplasty with bilateral reduction of inferior turbinates with bipolar cautery

“…6 Dutta et al conducted a study on techniques of anterior nasal packing in epistaxis., found that 93.33% patients with gauze packing for epistaxis experienced severe pain (score 8-10), whereas in our study 52% patients had a pain score over 8. 7 Schoenberg et al in their study on nasal packing after routine nasal surgery observed a mean pain score of 5.7 as compared to 1.4 in patients in whom splints were used. 8 Nunez et al did study on nasal packing against septal suturing, found worse pain scores in the nasal packing group than patients who underwent mucosal suturing and have concluded nasal packing is not absolutely necessary after septal surgery.…”

A prospective randomized trial of xylometazoline drops and epinephrine merocele nasal pack for reducing epistaxis during nasotracheal intubation

“…xylometazoline [18]. Seify et al [5] [15,24]. No study has compared the pain associated with cotton swab and merocele packing.…”

Topical Tranexamic Acid Compared With Anterior Nasal Packing for Treatment of Epistaxis in Patients Taking Antiplatelet Drugs: Randomized Controlled Trial

“…Anterior nasal packing (ANP), a frequently performed procedure in the management of epistaxis, has potential complications, including discomfort during placing and removing the pack and rebleeding following removal owing to mucosal injury and synechia formation . As such, more optimal treatment strategies are needed for the management of epistaxis, especially for patients taking antiplatelet drugs.…”