Is Nasal Packing Essential after Functional Endoscopic Sinus Surgery? A Randomized, Controlled Trial - ORIGINAL ARTICLE
Author Raghav Mehan, Lalee Varghese, Regi Kurien, Visalakshi Jeyaseelan, Vedantam Rupa
ISSN 0974-4630
JournalTitle Clinical Rhinology An International Journal
DOI 10.5005/jp-journals-10013-1320
Volume 10
Issue 3
Publishing Year 2017
Pages 113-119
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ABSTRACT

Aim: To assess the need for nasal packing following functional endoscopic sinus surgery (FESS) for chronic rhinosinusitis (CRS).

Materials and methods: We used a prospective, singleblinded, intrapatient, randomized, controlled study design. Fifty patients undergoing bilateral FESS were randomized to have nasal packing on one side for a day and no packing on the other. Postoperative bleeding, nasal block, facial pain, and headache were monitored for 5 days. Improvement of symptoms and endoscopic and sino-nasal outcome test (SNOT)-22 scores at the 4th and 12th postoperative weeks were noted.

Results: Postoperative bleeding was significantly more in the no-packing side on the first postoperative day (p < 0.002) and, on the packed side, after pack removal on the second (p < 0.001) and third days (p = 0.003), with no difference thereafter. Three patients developed postoperative bleeding on the unpacked side necessitating packing in the recovery room. Nasal block (p < 0.001) and pain (p < 0.001) were worse on the packed side for the first 2 days. Both intention-to-treat and per-protocol analysis showed no significant difference between the two groups for all parameters.

Conclusion: Nasal packing following routine FESS is not required for most patients to prevent either postoperative bleeding or poor surgical outcome.

Clinical significance: Most ear-nose-throat (ENT) surgeons in India tend to pack the nose for at least 1 day postoperatively. The procedure of nasal packing and its removal may itself cause mucosal trauma, which may lead to delayed healing and increased risk of scarring and synechiae formation. By using hypotensive anesthesia, there is less intraoperative bleeding, and postoperative nasal packing can be avoided totally or minimized. Our study has shown that the results of packing and leaving the nose unpacked are comparable both in terms of early postoperative morbidity as well as late sequelae and quality-of-life.

Keywords: Endoscopic, Nasal pack, Randomized trial, Sinus surgery.

How to cite this article: Mehan R, Varghese L, Kurien R, Jeyaseelan V, Rupa V. Is Nasal Packing Essential after Functional Endoscopic Sinus Surgery? A Randomized, Controlled Trial. Clin Rhinol An Int J 2017;10(3):113-119.

Source of support: Nil

Conflict of interest: None

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