Nasal Packing Using Merocel Pack and Merocel Pack with Tube to Study its Effects on Middle Ear Pressure and Hearing Threshold

Jump To References Section

Authors

  • Prajakta Jivba Keluskar
     PG Resident, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra ,IN
  • Kiran Burse
     Professor and Head, Department of Otorhinolaryngology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra ,IN

DOI:

https://doi.org/10.18311/mvpjms/2019/v6i2/22913

Keywords:

Eustachian Tube Dysfunction, Merocel Nasal Pack, Middle Ear Pressure, Sialistic Tube
Hearing threshold middle ear pressure

Abstract

Background: Nasal packs are frequently used after nasal surgery for hemostasis and internal stabilization of bony and cartilaginous structures. Nasal packing causes lymphatic stasis in nasopharynx and around the opening of Eustachian Tube, which ultimately results in middle ear dysfunction. Objectives: The aim of this study is to compare the effect on Middle Ear Pressure and Hearing Threshold of Anterior Nasal Packing using Merocel Pack and Merocel Pack with Sialistic Tube. Methods: This is a non–randomised comparative interventional study which was carried out in the Department of Otorhinolaryngology – Head & Neck surgery, Dr. Vasantrao Pawar Medical College for the period of two years from February 2017 to October 2018. 66 patients were selected. Results: 66 patients were studied. Out of 66 patients two groups were compared one with Merocel Pack with Tube and Merocel Pack without Tube. Statistically significant difference observed between pre and post operative middle ear pressure of patients of Merocel Pack with and without Tube. Out of 33 post operative patients of Merocel Pack without tube had mean middle ear pressure –61.12±23.56daPa and –58.4±29.23daPa for Right and Left Ear respectively. Whereas out of 33 post operative patients of Merocel Pack with Tube had –49.72±27.2daPa and –43.48±26.26daPa for Right and Left ear. Statistically significant difference observed between them for post operative patients of Merocel Pack with or without Tube for both Right and Left ear. Conclusion: There is post operatively increase in middle ear pressure transiently for few days with nasal pack in situ which returns to normal after pack removal. In this comparative study, middle ear pressure was found to be more negative in patients using Merocel Pack without tube as there was complete blockage of the nostrils of the patients. However, in Merocel Pack with Tube patients patient was able to breathe by nose through ventilating tube so middle ear pressure did not increase as that of without Tube patients. Also, patient felt symptomatically better with the Tube packing because of no mouth breathing post operatively.

Downloads

Published

2020-05-07

Issue

Volume 6, Issue 2, July-December 2019

Section

Original Research Article

 

References

Browning GG. Aetiopathology of inflammatory conditions of the external and middle ear. In: Booth JB, editor. ScottBrown's Otolaryngology, 6th ed. Vol. 3: Otology, Oxford: Butterworth –Heinemann; 1997. p. 3/3/8−3/3/9.

Sade J, Amos AR. The Eustachian tube. In: ludman H, Wright T, Editors. Diseases of ear. 6th ed. London: Arnold; 1998; 348−49.

Richard G. Lymphatics in middle ear effusion. Laryngoscope. 1973; 83:1713−20. https://doi.org/10.1288/00005537197310000-00011. PMid: 4758767.

Sood VP. Septoplasty in children. Indian Journal of Otolaryngology. 1985; 3:87−89.

Thompson AC, Crowther JA. Effect of nasal packing on eustachian tube function. J Laryngol Otol. 1991; 105(7):539−40. https://doi.org/10.1017/S0022215100116548. PMid: 1875135.

Mohan G, Saxena RK, Chauhan PG. Effect of anterior nasal packing on middle ear pressure. Indian Journal of Otolaryngology. 1990; 42(3):130−31.

Laszig R. Development of pressure in the middle ear after nasal operation.1: HNO. 1985; 33(4):187−89.

Mc Curdy MC, John Jr. Effects of Anterior nasal packing on eustachian tube function. Arch Otolaryngol. 1977; 103:521−23. https://doi.org/10.1001/archotol.1977.00780260051004. PMid: 901277.

Hamilton WJ, et al. Human Embryology. 4th ed. Baltimore; William and Wilkins; 1972. p. 300.

Jasser H, Abbas H, Sachdeva A, David B. Effect of anterior nasal packing on middle ear pressure and hearing threshold. Kuwait Medical J. 2009 Mar; 41(1):37−38.

Egelund E, Jeppesen F. Respiratory tube with nasal packing following septorhinoplasty. Rhinology. 1992; 30:193−204.

Mohan C, Shrivastav A, Shukla P. Effect of nasal packing on middle ear pressure. Int J Adv Int Med Sci. 2016; 1(2):52−56. https://doi.org/10.5005/jp-journals-10050-10019.

Huang XK, Zhan YS, Xu G, Wang SF. Influence of chronic sinusitis on middle ear function. Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2000 Apr; 14(4):166−67.

Hüseyin Dere, ć°brahim Ercan, Serdar Celikkanat, Cafer í–zdem. A Comparison of the effect of nasal packing with and without airway on eustachian tube dysfunction. Marmara Medical Journal. 2002; 15(2):108−10.

Gupta M, Singh S, Chauhan B. Comparative study of complete nasal packing with and without airways. B-ENT. 2011; 7(2):91−96.

Thompson AC, Crowther JA. Effect of nasal packing on eustachian tube function. J Laryngol Otol. 1991 Jul; 105(7):539−40. https://doi.org/10.1017/S0022215100116548. PMid: 1875135.

Bonding P, Tos M. Middle ear pressure during brief pathological conditions of the nose and throat. Acta Otolarynglogy. 1984; 82:63−69. https://doi.org/10.3109/00016488109133238. PMid: 7315256.