Nasal Tampon Research Articles

The pain of nasal tampon removal after nasal surgery: A randomized control trial

The purpose of this study was to compare the pain and discomfort associated with the removal of two commercially available nasal tampons after nasal surgery. Prospective, paired, randomized clinical trial. Consecutive, consenting, adult patients undergoing nasal surgery. The nose was packed with a Rapid Rhino tampon (Applied Therapeutics, Tampa, FL) on one side and a Rhino Rocket tampon (Shippert Medical Technologies Corporation, Centennial, CO) on the other. The pain of packing removal was assessed with a validated 100-mm visual analog scale. Patient satisfaction was measured on a Likert scale from 1 to 5. In all 13 patients, the pain of removal was greater with the Rhino Rocket Tampon (82.7 +/- 20.9 mm) than with the Rapid Rhino tampon (12.0 +/- 11.9 mm); the mean difference was 70.7 mm (95% confidence interval [CI], 47.1-78.2 mm; P < 0.0001). Patient satisfaction was significantly higher with the Rapid Rhino nasal tampon (4.6 +/- 1.1 vs 1.5 +/- 0.7; mean difference 3.1 [95% CI, 2.6-3.6]; P < 0.001). Removal of the Rapid Rhino nasal tampon was significantly less painful and was associated with higher patient satisfaction than the removal of the Rhino Rocket nasal tampon.

Nasal Tampon Packing Using Anesthetic Lidocaine and Chlorhexidine Urinary Lubricant Gel

Since Hippocrates first defined nasal tampon packing in the fifth century BC, nasal tampons have been considered the primary treatment for epistaxis [1]. Nasal tampon use is very common after surgery involving the nasal cavity and paranasal sinuses. Many kinds of materials such as gauzes, expanding sponges, ready-made or inflatable tampons, and Foley catheters can be used for nasal tamponing. However, whatever is used, the primary purposes of nasal tamponing are to provide an adequate pressure over the nasal mucosa to prevent bleeding and hematoma, to support unstable gentle nasal structures after nasal surgery, and to protect against infection. It is important to prepare the nasal tampon in a sterile way to prevent infection [2]. However, both the placement and the removal of nasal tampons can be distressing and painful for patients. Because the tampon adheres to the mucosa over the course of time, patients can become distressed and there can be bleeding, particularly when the tampon is removed. Because of these unwanted circumstances, the gauzes are greased and softened with lubricants or pomades. Antibiotic ointments have advantages against infections. However, additional methods can be required to reduce pain. For providing adequate greasiness and softness to facilitate application, for maintaining analgesia, and for preventing infections, the use of sterile urinary lubricant anesthetic gel that includes lidocaine and chlorhexidine (lidocaine HCl 2%, chlorhexidine 2HCl 0.05%) is a practical, useful, and cheap method for preparing the nasal tampon. Chlorhexidine helps prevent infections, while lidocaine reduces the pain after the application by distributing local anesthesia over the nasal mucosa. Thus, the patient can be more comfortable after the application. Also, the gel keeps the tampon from adhering to the nasal mucosa, so the pain and bleeding seen with removal is reduced. To prepare the nasal tampon, long, slim gauzes are greased with urinary lubricant (Figs. 1 and 2). Being in a sterile container is an additional advantage of the lubricant. Although the use of commercial tampons is easier than making them, they are more difficult to obtain. Also, they are more expensive than classical tampon packing. It is easy to obtain sterile lidocaine and chlorhexidine urinary

A change in UK epistaxis management

Ear nose and throat oral and maxillofacial surgery service provision is undergoing major changes within the United Kingdom Healthcare System (NHS) with devolution of many treatments to primary care. Epistaxis, active bleeding from the nose, is a common ear nose and throat/oral and maxillofacial surgery emergency, and can be severe or even fatal. The causes can be from local or systemic illnesses. We aimed to apply a revised clinical protocol to epistaxis patients presenting to an Accident and Emergency (A&E) department of a District General Hospital (DGH) and to compare the results to the routine management protocol in same hospital. Sixty consecutive patients suffering epistaxis of local origin in an Accident and Emergency department in a District General Hospital were included in this study which was conducted over a 7-month-period (September-March). A revised management protocol was developed using nasal tampons (Netcel Polyvinyl alcohol sponge) and a proforma was created for the A&E department. Retrospective recorded data of all cases who presented with epistaxis of local origin to the A&E department in the same DGH in the past 4 years, (September-March), were analysed. Data collected included: patient's demographics, cause of epistaxis, management plan, admission, in-patient stay and complications. Previously, all patients requiring nasal packing were admitted. Over the previous 4-year-period (September-March) a mean of 28 patients were admitted per month, with a mean duration of in-patient stay of 2.7 days. In the patients' group treated under the revised protocol, the total number of admissions was significantly reduced, by 73%, (P < 0.0001), despite no significant change in the number of monthly epistaxis referrals (P < 0.0001). There was also a significant increase in the mean age of admitted patients with epistaxis (P < 0.0001), the admitted patients had a mean length of stay of 2.5 days. This revised management protocol saved 201 bed days per annum. After careful assessment and provided that nasal packing properly performed and advice sheet is given and understood, we believe it is safe to manage patients with routine epistaxis at home. This is a change to the current standard UK management. We discuss the case for and against the adoption of this policy by the main healthcare components (primary and secondary) of the NHS. We present an economic argument.

The role of surgical audit in improving patient management; nasal haemorrhage: an audit study

BackgroundNasal bleeding remains one of the most common Head & Neck Surgical (Ear Nose and Throat [ENT]/Oral & Maxillofacial Surgery [OMFS]) emergencies resulting in hospital admission. In the majority of cases, no other intervention is required other than nasal packing, and it was felt many cases could ideally be managed at home, without further medical interference. A limited but national telephone survey of accident and emergency departments revealed that early discharge practice was identified in some rural areas and urban departments (where adverse socio-demographic factors resulted in poor patient compliance to admission or follow up), with little adverse patient sequelae. A simple nasal packing protocol was also identified.The aim of this audit was to determine if routine nasal haemorrhage (epistaxis) can be managed at home with simple nasal packing; a retrospective and prospective audit.Ethical committee approval was obtained. Similar practice was identified in other UK accident and emergency centres. Literature was reviewed and best practice identified. Regional consultation and feedback with regard to prospective changes and local applicability of areas of improved practice mutually agreed upon with involved providers of care.MethodsRetrospective: The Epistaxis admissions for the previous four years during the same seven months (September to March).Prospective: 60consecutive patients referred with a diagnosis of Nasal bleeding over a seven month time course (September to March). All patients were over 16, not pregnant and gave fully informed counselled consent.New Guidelines for the management of nosebleeds, nasal packing protocols (with Netcel®) and discharge policy were developed at the Hospital. Training of accident and emergency and emergency ENT staff was provided together with access to adequate examination and treatment resources. Detailed patient information leaflets were piloted and developed for use.ResultsPreviously all patients requiring nasal packing were admitted. The type of nasal packing included Gauge impregnated Bismuth Iodoform Paraffin Paste, Nasal Tampon, and Vaseline gauge. Over the previous four year period (September to March) a mean of 28 patients were admitted per month, with a mean duration of in patient stay of 2.67 days.In the prospective audit the total number of admissions was significantly reduced, by over 70%, (χ2 = 25.05, df = 6, P < 0.0001), despite no significant change in the number of monthly epistaxis referrals (χ2 = 4.99, df = 6, P < 0.0001). There was also a significant increase in the mean age of admitted patients with epistaxis (χ2 = 22.71, df = 5, P < 0.0001), the admitted patients had a mean length of stay of 2.53 days. This policy results is an estimated saved 201.39 bed days per annum resulting in an estimated annual speciality saving of over £50,000, allowing resource re-allocation to other areas of need. Furthermore, bed usage could be optimised for other emergency or elective work.ConclusionExclusion criteria have now been expanded to exclude traumatic nasal haemorrhage. New adjunctive therapies now include direct endoscopic bipolar diathermy of bleeding points, and the judicious use of topical pro-coagulant agents applied via the nasal tampon. Expansion of the audit protocols for use in general practice.This original audit informed clinical practice and had potential benefits for patients, clinicians, and provision of service. Systematic replication of this project, possibly on a regional and general practice basis, could result in further financial savings, which would allow development of improved patient services and delivery of care.

Epistaxis packing

PREVIEWPrimary care physicians often encounter epistaxis. Its treatment may involve nasal sponge tampons, double-balloon nasal catheters, and anterior gauze with posterior Foley catheters, depending on the location of the bleed. Topical anesthetic and decongestant agents are essential, and intravenous analgesia, which enhances comfort, should be considered in all cases. Here, Dr Randall investigates the practical aspects of epistaxis therapy and provides a simplified approach to treatment using three types of packs that work in virtually every situation.

A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis

A prospective study was performed to compare the efficacy and patient tolerance of Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. A total of 42 patients were studied. There was no significant difference between the two types of pack in efficacy or patient discomfort with pack in situ. Rapid Rhino produced significantly lower scores for subjective patient discomfort during insertion and removal of pack.

An Alternative to a Postnasal Pack for the Arrest of Perioperative Hemorrhage following Curettage Adenoidectomy

Controlling bleeding with standard postnasal packing following curettage adenoidectomy is only occasionally warranted. Children find the packing experience unpleasant, and removal of the packing usually requires general anesthesia. We describe a simple technique for packing the nasopharynx with bilateral nasal tampons via an anterior approach. The tampons are much easier to insert than standard packing, they are well tolerated while in place, and they can be easily removed with perhaps only some light sedation rather than general anesthesia.

Comparison of nasal tampons for the treatment of epistaxis in the emergency department: A randomized controlled trial

Nasal tampons are commonly used to stop bleeding, yet their insertion is painful. We compare the pain of insertion and removal of 2 commonly used nasal tampons. This was a prospective randomized controlled trial in 1 urban and 1 suburban emergency department (ED). Subjects were a convenience sample of adult ED patients with active epistaxis requiring insertion of a nasal tampon, regardless of coagulation status. Pretreatment of the nasal mucosa was performed using an aerosolized lidocaine-Neo-Synephrine combination. Patients were randomized to tamponade with a single Rapid Rhino or Rhino Rocket nasal tampon. The pain and ease of insertion and success of tamponade were recorded. Tampon removal was performed after 1 to 3 days, and the pain and ease of removal, as well as the presence of any bleeding, were noted. Patients rated pain of insertion and removal on a previously validated 100-mm visual analogue pain scale (100=worst pain). Physician ease of insertion and removal was recorded on a 5-point Likert scale. Continuous data are presented as means and 95% confidence intervals (CIs). We evaluated 40 patients evenly distributed between study groups and sites. Median patient age was 61 years (interquartile range 48 to 79 years), and 33% were female patients. Coagulopathy was present in 10 (25%) patients. Baseline characteristics were similar in both treatment groups. The mean pain of insertion of the Rapid Rhino (30 mm, 95% CI 18 to 41 mm) was significantly less than with the Rhino Rocket (48 mm, 95% CI 34 to 61 mm; mean difference 18 mm, 95% CI 1 to 35 mm). The mean pain of removal of the Rapid Rhino (11 mm, 95% CI 1 to 21 mm) was also lower than with the Rhino Rocket (23 mm, 95% CI 13 to 33 mm; mean difference 12 mm, 95% CI -1 to 25 mm). The Rapid Rhino was also easier to insert and remove and had a lower incidence of recurrent bleeding after removal than the Rhino Rocket. Rates of successful tamponade were similar in the 2 groups. The Rapid Rhino nasal tampon is less painful to insert and easier to remove than the Rhino Rocket, whereas both are similarly effective at stopping nosebleeds.

A preoperative sleep study with nasal airway occlusion in pharyngeal flap surgery

Purpose Obstructive sleep apnea is a major complication of pharyngeal flap surgery. The purpose of the present study is to predict preoperatively the risk of upper airway obstruction after surgery. Material and methods We performed an overnight sleep study preoperatively and postoperatively in 16 pediatric patients considered for pharyngeal flap surgery. Preoperative sleep study was done for two nights, once in normal breathing condition and once with complete nasal occlusion by packing of nostril with tampon gauze. Results In preoperative sleep recordings in normal breathing condition, all subjects had a normal apnea hypopnea index (AHI) less than 5/h. In preoperative recording with complete nasal occlusion, five patients exceeded 5/h in AHI. In particular, for two patients who had AHI higher than 15/h, we gave up a surgery in one case and performed pharyngeal flap operation for the other following a tracheotomy for severe disturbance of oral breathing. The remaining 14 subjects underwent surgery without airway obstructive complications. There was strong correlation between preoperative AHI with nasal tampon gauze and AHI at two weeks postoperatively (r = 0.88 P < .0001). There was no significant correlation between preoperative AHI in normal breathing condition and postoperative AHI (P > .05). Conclusions These results exhibit preoperative sleep study with complete nasal airway occlusion represent postoperative breathing condition well during early postoperative period. Preoperative sleep study with complete nasal airway occlusion with nasal tampons could be useful for predicting the risk of upper airway obstruction secondary to pharyngeal flap surgery.

Anestesia para septoplastia e turbinectomia em paciente portador de doença de von Willebrand: relato de caso

Although von Willebrands disease is the most common hereditary hemorrhagic disorder, there are few reports in Brazilian literature relating this disease to anesthesia. This report aimed at describing a case of general anesthesia for septoplasty and turbinectomy in a von Willebrands disease type I patient, prophylactically treated with desmopressin (1-deamine-8-D- arginine vasopressin, DDAVP) in the pre and postoperative period. A female patient, 19 years old, 58 kg, with hypothyroidism controlled with L-tiroxine (75 mg) had her von Willebrands disease manifested three years before after a wisdom tooth extraction with persistent bleeding in the postoperative period. To prevent new per and postoperative hemorrhagic episodes, patient was prophylactically treated with desmopressin (0.3 microg.kg-1). Anesthesia was induced with midazolam (2.5 mg), fentanyl (150 microg), droperidol (2.5 mg), lidocaine (60 mg), atracurium (30 mg) and metoprolol (4 mg), followed by tracheal intubation and ventilation under intermittent positive pressure. Anesthesia was maintained with 2% sevoflurane in a mixture of 50% oxygen and nitrous oxide. This technique provided a good heart rate and blood pressure control during surgery. Patient remained with a nasal tampon for 24 hours and no bleeding was observed at its removal. Patient was discharged the day after surgery uneventfully. There were no immediate or late postoperative bleeding. The prophylactic treatment with DDAVP associated to the anesthetic technique used in this case was effective in controlling peri and postoperative bleeding.

Endoscopic control of posterior epistaxis.

Control of bleeding vessels by suction cautery under endoscopic vision was used on 38 patients suffering from posterior epistaxis. Twelve patients also required the insertion of nasal tampons at the end of the cautery procedure. Eight patients, six of them hypertensive, had recurrent epistaxis post-operatively. Five patients needed further cautery in order to control the bleeding. Three patients required temporary balloon tamponade, and a single patient had internal maxillary ligation. Temporary palatal numbness in three patients was the only post-operative complication. Otherwise, the technique has the potential advantages of simplicity, safety, effectiveness and simplified post-operative care.

A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis

A prospective study was undertaken to compare the efficacy of Merocel nasal tampons to BIPP (Bismuth Subnitrate and Iodoform Paste) impregnated ribbon gauze in the control of acute epistaxis requiring hospital admission. A total of 50 patients presenting with severe epistaxis was treated with either merocel nasal tampons, or BIPP. The groups did not differ significantly in terms of age, sex distribution, aetiology or severity of the bleed. There was no significant difference in efficacy or patient tolerance of either treatment. It was concluded that Merocel nasal tampons should be considered effective in the first line treatment of severe epistaxis uncontrolled by simple measures. Their ease of insertion makes them suitable for use in the accident and emergency department or in general practice.

Controlling intraoperative and postoperative nasal bleeding.

An indwelling nasal suction tampon is described that effectively controls both intraoperative and postoperative nasal hemorrhage. The significant benefits of this device are better intraoperative control for the surgeon and less complicated postoperative recovery. I do not have any financial involvement in this device, but I would like other nasal surgeons to benefit from its particular advantages. The device is available under the trade name Instant and may be obtained from Innovations by Westmed, 3351 E. Hemisphere Loop, Tucson, Ariz. 85706; (602) 294-7987.

Nasal tampon packing in rhinoplasty: a simple and safe method of hemostasis.

To absorb bleeding and pack the nasal cavities after rhinoplasty, a sterile commercial vaginal tampon was used. It has the following advantages: high absorbency, round configuration, and safety removal cord included to preclude gliding into the nasopharynx.

Toxic shock syndrome associated with use of a nasal tampon

Toxic shock syndrome has been noted to occur with nasal surgery, both with and without packing. A new synthetic sponge, described as a nasal tampon, has become available for use as packing after surgery. Herein is reported the first case of toxic shock syndrome associated with the use of this nasal tampon.

Anterior epistaxis: a new nasal tampon for fast, effective control.

Epistaxis is the second most common cause of spontaneous bleeding. Of the two categories of epistaxis, mundane and severe, the mundane, usually anterior epistaxis, is the more common. It has been reported that 60% of individuals report at least one episode of epistaxis during their lifetime. Eighty percent of epistaxis occurs in Kiesselbach's plexus, a vascular network in the anterior portion of the nasal septum. We have designed a nasal tampon to control this common variety of epistaxis which is a fast, efficient, and cost-effective method of anterior epistaxis control. The material used in the manufacture of the device (MerocelTM) has been used for over 5 years by the author, both in treatment of severe epistaxis and as a postoperative nasal packing. The design presented here has been used for anterior epistaxis for 18 months without untoward sequelae and with universal success.

ヒビテン消毒液によるきゅう上皮障害 Ｈａｒｄｙ手術後のきゅう覚障害とその実験的考察

The transsphenoidal approach to pituitary adenoma (Hardy's operation) is a safe method which does not cause nasal dysfunction. Some patients, however, have suffered from olfactory disturbances after Hardy's operation. Three groups of patients were studied.Group 1 patients had hyposmia which soon improved after removal of the nasal tampon. The patients of group 2 had prolonged olfactory disturbance. Group 3 patients had hyposmia which improved three to seven weeks, it was assumed that the hyposmia of this group was caused by treatment with Chlorhexidine digluconate (Hibitane®) solution which was used for preoperative disinfection of the nasal cavity.To test the posibility of olfactory impairment by Hibitane, the nasal cavities of guinea pigs were irrigated three times with 5ml of 0.5% Hibitane solution. Saline solution was used as a control. Under Nembutal® anesthesia, olfactory epithelium from the superior-posterior part of the nasal septum was examined 3, 7-10, 14-17 and 30-35 days after Hibitane treatment. The samples were examined by light microscopy and scanning electron microscopy. Degeneration of the olfactory epithelium was evident over extensive areas three to seven days after treatment. Regeneration of the epithelium started at 14-17 days, and the surface appeared nearly normal at 30-35 days. These results suggest that olfactory epithelium is injured by Hibitane solution and recovers within about one month.Povidone iodine (Isodine®) solution (100mg/ml) was applied by the same method, but there was no change in olfactory epithelium.

Changes in serum electrolytes and cardiovascular function: a possible cause of shock during nasal operation using local anesthetics

The cause of the shock induced by local anesthetics remains to be unexplained. The measurements of serum electrolytes, blood sugar and serum catecholamine, the recording of electrocardiogram and blood gas analyses were performed in 46 patients during surgical intervention under local anesthesia. The results showed that the administration of epinephrine mixed with local anesthetics caused severe degree of hypopotasium. Especially in the case of nasal operation using nasal tampon immersed with epinephrine, the condition of hypopotasium stayed well over sixty minutes. Hypopotasium brought, about by the application of epinephrine is suspected to be one of the causes of the shock during operation, The authors emphasized that special attention to the level of serum electrolytes should be paid when local anesthetics are used with epinephrine.

A Simplified Technique for Quantitative Collection of Salivary Secretions of Man

Several methods have been devised for the collection of the salivary secretions of man, but most of them are either troublesome or inaccurate. The method presented here is applicable to the collection of the secretions of the parotid, sublingual, and submaxillary glands separately and simultaneously on both sides.The method consists of applying pieces of tared absorbent material to the various duct openings, absorbing the secretions for the desired length of time, and then reweighing to nearest .05 gm. The quantity collected is given by difference. It is simpler to collect the secretions from the 3 pairs of glands separately, and the nasal tampons marketed by Johnson and Johnson are found to be the most satisfactory absorbent material.To collect the secretions of the parotid glands, the floor of the mouth is packed off with dental rolls, and strips of tared nasal tampons about 4 cm. long are placed over the openings of Stenson's ducts. The strips will remain in place without support. They may be left in p...

Nasal tampon treatment of sinus diseases

The LaryngoscopeVolume 35, Issue 6 p. 453-468 Article Nasal tampon treatment of sinus diseases† Dr. J.'Ivimey Dowling, Dr. J.'Ivimey Dowling Albany, N. Y.Search for more papers by this author Dr. J.'Ivimey Dowling, Dr. J.'Ivimey Dowling Albany, N. Y.Search for more papers by this author First published: June 1925 https://doi.org/10.1288/00005537-192506000-00006Citations: 2 † Read before the New York .Academy of Medicine, Section on Laryngology and Rhinology, Jan. 28, 1925. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume35, Issue6June 1925Pages 453-468 RelatedInformation