Nasal packing after routine nasal surgery--is it justified?

Area of Science:

• Otolaryngology
• Surgical Innovation
• Patient Outcomes

Background:

• Nasal packing is commonly used after nasal surgery.
• The efficacy and complications of different nasal packing materials are not fully understood.
• Silastic nasal splints are also used post-operatively.

Purpose of the Study:

• To compare the efficacy and morbidity of bismuth iodoform paraffin paste (BIPP) packs, Telfa packs, and no packing after nasal surgery.
• To evaluate the impact of silastic nasal splints on post-operative outcomes.
• To assess post-operative pain, hemorrhage, vestibulitis, septal perforation, and adhesions.

Main Methods:

• A randomized, prospective trial involving 95 patients undergoing nasal surgery.
• Patients were randomized to receive BIPP, Telfa, or no nasal pack.
• Independent randomization for silastic nasal splint use was performed.

Main Results:

• Nasal packs, particularly BIPP, significantly increased post-operative pain (p < 0.001).
• Hemorrhage occurred in 2.1% of patients, both with packs in situ.
• Vestibulitis and septal perforation were unique to patients receiving BIPP packing with silastic splints (21%).
• No significant difference in adhesions was observed between packed and non-packed groups.

Conclusions:

• Routine nasal packing, especially BIPP, is difficult to justify due to increased pain and complications without demonstrable benefit.
• Packing should be reserved for persistent hemorrhage cases, with Telfa being preferable to BIPP.
• Silastic splints combined with BIPP packing are associated with increased complications.