In ENT practice, nasal packs are very important. Often used to control bleeding in epistaxis and after nasal surgery such as FESS, septoplasty and conchoplasty. [1] This approach is used to avoid middle turbinate movement, adhesion development, and restenosis following functional endoscopic sinus surgery (FESS). [2]

By stabilizing the internal cartilaginous septum, it also helps to prevent complications such as synechiae formation and septal hematoma after sinus surgery. It helps to reduce the likelihood of septal deviation after septoplasty as well. [3]

Nasal packs act as a protective barrier, provide pressure, fill gaps, help to preserve the nasal structure, create a suitable moist environment for healing, and serve several other purposes including promoting natural processes like hemostasis and repair. [4] It is usual in India's medical practice scene to tightly insert nasal packs post standard nasal surgeries for at least one day or sometimes up to 72 hours. Many surgeons routinely pack the nasal cavities regardless of whether the surgery itself caused major bleeding. [5]

Nasal packing, on the other hand, has some disadvantages including pain, bleeding, nasal mucosa and septum damage, allergic reactions, sleep disturbances, and lower arterial oxygen saturation during sleep. [1,6] Postoperative issues related to nasal packing encompass headaches, epiphora (excessive tearing), dry mouth which all have a significant impact on quality of life. [7] Additionally rare risks such as toxic shock syndrome can arise in patients with prolonged nasal packing.

aRemoval of the pack may lead to discomfort for patients due to pain and anxiety; studies indicate that this is often perceived by patients as the most unpleasant aspect of their perioperative experience.[8]

Nasal packing and its subsequent removal can potentially result in mucosal damage, which may delay healing and elevate the chances of scarring and synechiae formation. Despite appearing insignificant, nasal packing plays a crucial role in nasal surgical procedures as it holds the potential to influence overall healing dynamics and ultimately impact surgical results significantly. [9]

Revision procedures may be required in certain cases to address adhesions. Several methods have been developed to handle complications following surgery, such as middle turbinate removal, creating "controlled synechiae," suturing the middle turbinate, and inserting absorbable or nonabsorbable packs. [10]

The present Prospective analytical study was undertaken in Department of Otorhinolaryngology, Amaltas Medical College Hospital & Research Centre, Dewas, M.P. after valid approval of ethics committee of the institution. Study was undertaken for a period of 18 months after the approval from the ethical committee i.e.; from June 2023 to November 2024.

A total of 92 patients were selected from all patients attending ENT OPD with chief complain of obstructive nasal obstruction, nasal bleed. The patients undergoing nasal surgery or packing in a case of epistaxis from Outpatient and Inpatient Department of Otorhinolaryngology at AIMS, Dewas and satisfying the inclusion criteria were enrolled after taking a written informed consent.

INCLUSION CRITERIA

• Patients of either sex.
• Age > 18 years.
• Patient who gave written Informed consent for the study

EXCLUSION CRITERIA

• Non-Consenting patients
• Any patient that is unfit for surgery.
• Patients were divided into 2 groups by randomization, either with oxycellulose or conventional nasal packing after undergoing nasal surgery.
• Group A (N=50): Patients managed with nasal packing consisting of oxycellulose following nasal surgery.
• Group B (N=50): Patients managed with conventional nasal packing with roller gauze smeared with antibiotic ointment following nasal surgery.

Table 1: Correlation between Haemorrhage and Pack Type at POSTOP Day 0

The association between haemorrhage and pack type on Post-Operative Day 0 was evaluated using a Chi-square test, which demonstrated no statistically significant correlation between the two variables (P> 0.05). For cases utilizing Roller Gauze, 80.0% did not exhibit haemorrhage, whereas 20.0% presented with haemorrhage. A similar pattern was observed with Oxycellulose, where 90.0% of cases were free of haemorrhage and 10.0% experienced it. These findings suggest that the selection of pack type may not have a significant effect on the incidence of haemorrhage during the immediate post-operative period in the population studied. However, the number of cases of post op haemorrhage was more in Roller Gauze Packing though statistically not significant.

Table 2: Correlation between Haemorrhage and Pack Type POSTOP Day 2

The table examined the correlation between Haemorrhage and Pack Type on Post-Operative Day 2 using a Chi-square test, which indicated a significant correlation (P < 0.05) between the two variables. For Roller Gauze, the highest percentage (82.0%) was observed in cases without haemorrhage, while the lowest percentage (18.0%) occurred in cases with haemorrhage. Conversely, Oxycellulose showed 100.0% of cases without haemorrhage and 0.0% with haemorrhage on Post-Operative Day 2. These results suggest that the choice of pack type may influence the occurrence of haemorrhage on the second day post-operation, with Oxycellulose demonstrating no cases of haemorrhage compared to Roller Gauze.

Table 3: Correlation between Haemorrhage and Pack Type

The relationship between the type of surgical pack used on Post-Operative Day 5 after pack removal and the incidence of hemorrhage was investigated using a chi-square test. A statistically significant relationship between these variables was found by the analysis (P < 0.05). 18.0% of patients in the Roller Gauze group had hemorrhage, compared to 82.0% who did not. In contrast, 100.0% of patients in the Oxycellulose group remained hemorrhage-free, and no bleeding incidents were reported. Given that Oxycellulose seems to be completely effective at preventing hemorrhage when compared to Roller Gauze, these results suggest that the type of packing material may have a significant impact on bleeding outcomes.

Table 4: Correlation between Crusting and Pack Type on POSTOP Day 5

A Chi-square test was used to investigate the relationship between crusting and pack type on Post- Operative Day 5, and the results showed a statistically significant relationship (P < 0.05). 72.0% of patients with Roller Gauze showed crusting, while 28.0% did not. With 56.0% of cases exhibiting crusting and 44.0% not, the Oxycellulose group demonstrated a lower incidence of crusting. With Roller Gauze linked to a higher rate of crust formation than Oxycellulose, these results suggest that the type of nasal pack used may have an impact on crusting outcomes on the fifth post-operative day.

Table 6: Correlation between Crusting and Pack Type on POSTOP Day 15

To evaluate the association between nasal crusting and pack type on Post- Operative Day 15 a Chi-square test was employed, revealing no statistically significant relationship between the variables (P > 0.05). Among patients with Roller Gauze, 62.0% did not experience crusting, whereas 38.0% did. In the Oxycellulose group, 78.0% of individuals were free of crusting, while 22.0% exhibited this condition. These results indicate that the choice of nasal packing material may not play a significant role in influencing crusting outcomes by the fifteenth day after surgery in the studied cohort.

Table 7: Correlation between Bleeding and Pack Type on POSTOP Day 15

The association between bleeding and pack type on Post-Operative Day 15 was evaluated using a Chi- square test, which revealed no statistically significant correlation between the two variables (P > 0.05). In the Roller Gauze group, 92.0% of cases were free from bleeding, while 8.0% experienced bleeding. Similarly, within the Oxycellulose group, 94.0% of patients did not exhibit bleeding, and 6.0% did.

These results indicate that by the fifteenth post-operative day, the type of nasal pack employed does not appear to significantly affect the incidence of bleeding in the studied population.

There were notable variations in the results of postoperative hemorrhage. In particular, Roller Gauze was linked to a higher incidence of bleeding on Days 2 and 5 in comparison to Oxycellulose, even though there was no significant difference on Day 0 (p < 0.05). According to Sajjan S. et al.

[12] and Bajwa M.S. et al. [13], the higher hemorrhage rates suggest that Roller Gauze may be less successful at preserving hemostasis or may injure the nasal mucosa more. Roller Gauze's higher hemorrhage rate is in line with other research by Zhao, Z., et al. that suggests self-expanding materials, such as Oxycellulose, can better control bleeding by reducing trauma and conforming to nasal structures [14].

Although the choice of nasal packing can affect results, Kaufman et al. (1995) proposed that there might not be any appreciable differences between conventional and modern packs in terms of immediate postoperative bleeding [15]. Their results support our finding that in the two groups Day 0 hemorrhage rates were comparable. Kaufman’s research supports our finding that immediate postoperative hemorrhage is not significantly affected by the type of nasal packing used.

Smith et al. (2001) found that Oxycellulose was more effective in controlling postoperative bleeding compared to Roller Gauze [16]. This study demonstrated that Oxycellulose's expanding properties provide better hemostasis compared to traditional gauze. Smith’s study supports our finding that Oxycellulose is superior in preventing postoperative hemorrhage compared to Roller Gauze, especially evident on Day 2 and Day 5.

Schuller et al. (1998) reported similar findings, where the incidence of postoperative bleeding was lower in patients using self-expanding packs like Oxycellulose compared to traditional methods [17]. Schuller’s results align with our observation that Oxycellulose is more effective at controlling bleeding over time compared to Roller Gauze.

In our study crusting was more prevalent in the Roller gauze group on postoperative Day 5, with a significant difference between the two packing types (p = 0.005). Previous studies have documented increased crusting with advanced packing materials, though they also highlight that such materials provide superior hemostatic control.

MacDonald et al. (1993) found that while Oxycellulose effectively controlled bleeding, it was also associated with increased crusting [18]. MacDonald’s study does not aligns with our findings as Oxycellulose causes less crusting compared to Roller Gauze, in our study.

Alvi et al. (2006) noted that Oxycellulose led to more crusting but emphasized that this was a manageable side effect given its hemostatic benefits [19]. Alvi’s results does not support our observation as Oxycellulose causes less crusting in our study.

There was no significant difference in the incidence of hemorrhage between the two packing types on postoperative Day 0 (p > 0.05). This result suggests that there was no discernible difference in the immediate postoperative bleeding between Oxycellulose and Roller Gauze. On Day 2, there was a significant difference between the two packing materials; the Roller Gauze group experienced more hemorrhage than the Oxycellulose group (p < 0.05). This implies that on Day 2, Roller Gauze was linked to more bleeding. On Day 5 after pack removal, the type of packing and bleeding were significantly correlated, with Roller Gauze bleeding was more often than Oxycellulose (p < 0.05). With Roller Gauze there was bleeding on Day 5, but oxycellulose was associated with no bleeding. On Day 5 (p = 0.005) and Day 15 (p = 0.081), crusting was considerably more common in the Roller Gauze group. This implies that, in comparison to oxycellulose, roller gauze may cause more crusting problems.

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