Nasal Foam Packing for Epistaxis: What are the Ideal Characteristics?

Abstract

Introduction: Epistaxis is a common otorhinolaryngological emergency, usually caused by digital trauma in children, and hypertension in the elderly. General practitioners in emergency rooms assist most of the cases without specific management.

Objectives: Describe suitable properties for efficient nasal packing in adult epistaxis.

Methods: Two cadaver heads, preserved by freezing process, were thawed for this research. When the room temperature was reached, the nasal cavities were evaluated by a nasal endoscope, which showed a length of 4.0 × 11.0 cm for the male and 4.0 × 8.5 cm for the female head. Through an orifice made in the left maxillary bone to access the maxillary sinus, a blue-dyed saline solution was applied using a sphygmomanometer (Premium) to control and mimic blood pressure. The nasal cavity was first packed with two foams with different thicknesses and densities evolved by a condom, then packed by the Merocel packing (Medtronicent Surgical Products Inc.). The pressure was administered and gradually increased until a saline leak was observed in the oropharynx. The best way to insert tampons was also evaluated to avoid extensive trauma.

Results: Despite the difficulty of the application being similar in both nasal packings made with the condom and foam, t33-densityity foam, 2.0 cm thick and 11.0 cm lon resisted to a higher pressure (250mmHg) than the commercial packing Merocel (220mmHg).

Conclusion: The most suitable foam for packaging wrapped with condoms is 2.0 cm thick, as it supported the blood pressure commonly found in epistaxis.