The effect of different types of nasal tamponades in patients with nasal bleeding on mucociliary transport of the mucous membrane

Abstract

Introduction. The number of patients with nasal bleedings (NB) remains quite high (14.7–20.5 %) among all patients in need of emergency ENT care. When using anticoagulants and disaggregants, the risk of developing hemorrhagic complications is always higher. Otorhinolaryngologists have been improving the methods of stopping NC for many years. Objective: a comparative study of the effect of different types of nasal tamponade on mucociliary transport (MCT) of the nasal mucosa in patients with NB on the background of antithrombotic therapy. Materials and methods. The effect of different types of nasal tamponade on MCT of the nasal mucosa in 156 patients with NC who developed on the background of antithrombotic therapy was studied. All patients were divided into two groups: the main (104 patients), in which NB cessation was performed by the combined method, which includes the use of a two-chamber hydraulic tampon of our own design in combination with Nosochem gel and thermal exposure, and the control group (52 patients), where the classic gauze tamponade was used. The criterion for assessing the functional state of the nasal mucosa was the time of MCT when performing the saccharin test. Results. Immediately after removal of tampons, a significant acceleration of the MCT rate was observed in patients of both groups in comparison with the conditional norm. On day 3 after tampon removal, a significant decrease in the rate of MCT was observed in both study groups, which was more significantly (p <0.001) expressed in patients with traditional gauze tamponade. The MCT time indicator in the patients of the main group exceeded the level of the conditional norm by 36.9 %, and the similar indicator of the control group by 55.1 %. On day 7 after hydrotampon removal, time recovery was observed in patients of the main group. In patients of the control group on day 7 of gauze tampon removal there was a tendency to increase the rate of MCT. On day 14 after removal of tampons, the MCT rate in patients of the main group remained within the conditional norm, and the level of MCT rate in patients of the control group approached the conditional norm. Conclusions. Mechanical tamponade causes a violation of the functional state of the ciliated epithelium of the nasal mucosa, causing significant activation of MCT after removal of tampons, followed by a slowing of the MCT rate. Hydroballoon tamponade causes less expressed changes in MCT with a faster recovery period of the transport function of the ciliated epithelium compared to traditional gauze tamponade, what indicates a more gentle effect on the mucous membrane of the nasal cavity.

Keywords

• nasal bleeding
• mucociliary transport
• hydrotampon
• antithrombotic therapy