Elimination of nasal obstruction improves pulmonary functions and oxygenation

Background Nasal obstruction is a significant medical problem. This study aimed to examine the effect of nasal obstruction and nasal packing on arterial blood gases and pulmonary function indices, and the impact of the elimination of nasal obstruction on preoperative values. Results The mean age of the study population was 26.6 ± 10.1 years, males represented 50.8%. Spirometric indices showed statistically significant improvement (preoperative forced expiratory volume in 1st second 66.9 ± 13.9 vs 79.6 ± 14.9 postoperative and preoperative forced vital capacity 65.5 ± 12.7 vs 80.4 ± 13.8 postoperative). Oxygen saturation was significantly lower during nasal packing (95.6 ± 1.6 preoperative vs 94.7 ± 2.8 with nasal pack), and significant improvement (97.2 ± 1.4) was observed after removal of the nasal pack. Nasal obstruction scores significantly improved. Conclusion The results of this study indicate that either simple nasal obstruction or nasal packing may cause hypoxemia and abnormalities in lung function tests. Hypoxemia was more evident with nasal packing.

Comparison of Efficacy of Nasal Septal Splints with Clip versus Nasal Packing after Septoplasty

Introduction It has always been a concern of ENT surgeon to prevent post operative complications like nasal bleeding, septal hematoma and septal abscess after septoplasty. Traditionally nasal packing has been done to avoid these complications. Although the nasal pack itself has been a concern for several reasons, packing apart from causing breathing distress, has resulted in epiphora, dysphagia, sleep disturbance, post-operative pain, headache, septal infection, septal abscess and even toxic shock syndrome. Materials and Methods This study has compared the efficacy of a newly designed septal splint with clip with nasal packs. This study was done on 60 patients, nasal packing was done in 30 patients and septal splints with clip were applied in 30 patients. Results Post-operative pain, epiphora, dysphagia, dryness of mouth and sleep disturbance was found to be significantly less in patients with septal splints with clip as compared to those with nasal packing. Conclusion Septal splints with clip is more efficacious alternative to nasal packing in patients undergoing septoplasty.

Polyurethane Versus Chitosan-Based Polymers Nasal Packs After Functional Endoscopic Sinus Surgery: A Prospective Randomized Double-Blinded Study

Background Different packing materials are applied to the nose at the end of surgery to maintain drainage and sinus ventilation of the paranasal sinuses and avoid some complications such as bleeding, infection, crustations, adhesions in the middle meatus and lateralization of the middle turbinate. Objective The study aims to compare the clinical outcomes of two absorbable packing materials, the synthetic polyurethane, and the naturally occurring Chitosan-based polymers (CBP) nasal packs, after functional endoscopic sinus surgery. Methods Fifty patients with bilateral chronic rhinosinusitis with nasal polypi were operated with 100 surgical cavities. At the end of the surgery, one side was randomly packed with synthetic polyurethane and the opposite side with CBP nasal pack. Measure their outcomes at week 1, 2, 4, 8 and 12 as the presence of remnants materials in the middle meatus, crustations, adhesions, bleeding, granulations, infection, and general satisfaction of patients. Results CBP nasal pack shows a statistically significant advantage only in the first two weeks as regard remnants material, crusting and bleeding. All over the 12 weeks, there was no statistically significant difference between the two types of packs as regard granulations, adhesions and infection. In the first month, eight patients of the CBP group experienced bad smell and two patients had watery rhinorrhea as adverse reaction without a statistically significant difference. Patients were generally satisfied without a statistically significant difference between the two types of packs. Conclusion Synthetic polyurethane and Chitosan-based polymers nasal packs are safe and efficient regarding; the mucosal healing, bleeding control, and the overall satisfaction of patients. The CBP showed a higher statistically significant advantage in the first two weeks only regarding the amount of the retained material, crusting as well as bleeding. Patients packed with CBP experienced fish-like smelly odor and watery rhinorrhea but there is no statistically significant difference.

Anterior Ethmoidal Nerve Block In Prevention of Post-Operative Agitation Following Nasal Surgeries with Nasal Packs Under General Anesthesia: An Experimental Study

INTRODUCTION Postoperative agitation or emergence agitation during recovery from anesthesia is an important complication of General Anesthesia (GA) especially in otolaryngological surgeries, and nasal surgery in particular. It is potentially harmful to the patients resulting in fall from the operation table, self-extubation, self-removal of nasal pack, hemorrhage etc. Several methods and medications have been tried to reduce it. We studied the effect of anterior ethmoidal nerve block for reducing post-operative agitation for nasal surgeries with nasal packs as it falls in the same operative field. MATERIAL AND METHODS A total of 100 participants undergoing nasal surgeries with nasal pack under GA in the Department of Otolaryngology, Lumbini Medical College, Palpa, Nepal, were randomized into cases and controls by block randomization. The study was done from June 2018 till February 2020. Anterior ethmoidal nerve was blocked with lidocaine injection at the end of surgery in cases. Controls were injected with normal saline. Post-operative agitation was studied with Riker Sedation-Agitation Scale (SAS) and was compared between the two groups. RESULTS There were 50 participants in each group. Emergence agitation in cases and controls at extubation, 30 minutes post-extubation and the next morning was present in 32% and 52%, 4% and 18%, and 0 and 2% respectively. SAS score rapidly decreased in 30 minutes after extubation in controls but was still significantly higher than that of cases. CONCLUSION Anterior ethmoidal nerve block was effective in reducing post-operative agitation significantly during emergence in nasal surgeries with nasal packs.

Comparative study on the effect of various anterior nasal packing on ear compliance and ear canal volume

<p class="abstract"><strong>Background:</strong> Anterior nasal packing (ANP) is a commonly used procedure by otorhinolaryngologist for the control of post-operative bleeding post septoplasty and nasal surgery. However there remains an ambiguity regarding the effect of various nasal packings on the Eustachian tube dysfunctions. The present study intends to compare and evaluate the effects of ribbon gauge nasal packing (RNP), merocel nasal packing (MNP) and merocel with airway packing (MAP) on the eustachian dysfunction such as changes in the compliance and ear canal volume.</p><p class="abstract"><strong>Methods:</strong> Ninety patients were selected for the study, and randomly divided into 3 groups of 30 patients each where the patients were treated with RNP, MNP and MAP. The pack was kept insitu for 48 hrs and the compliance and ear canal volume was measured at before pack is applied (pre pack), with ANP insitu at 48 hrs (with pack), and after removal of the nasal pack at 5th day (post pack). </p><p class="abstract"><strong>Results:</strong> The percentage of patients with abnormal compliance level as well as ear canal volume was found to be the highest among the patients in RNP group followed by patients from the MNP group. The least number of patients with abnormal compliance and ear canal volume was observed among the patients in the MAP groups.</p><p class="abstract"><strong>Conclusions:</strong> MAPs are better than ribbon gauge and MNPs in terms of maintaining the compliance level and ear canal volume.</p><p align="center"> </p>