Comparison of the Efficacy of Ivalon® Nasal Pack and Ribbon Gauze Pack Following Nasal Surgeries- A Randomised Clinical Trial

Abstract

Introduction: Nasal bleeding is one of the Ear, Nose and Throat (ENT) emergencies which are usually managed by the Hippocratic maneuver. Anterior nasal packing is unavoidable after nasal surgeries and refractory anterior nasal bleeding. There are wide variety of newer nasal packs available and easily acceptable by the patients. The most commonly used nasal packs in day to day practices are Ivalon® and vaseline soaked ribbon gauze pack. Aim: To compare the difference between Ivalon® nasal pack with a traditional ribbon gauze pack in terms of efficacy, feasibility, patient comfort, cost and need for repacking postremoval in patients undergoing nasal surgeries. Materials and Methods: This randomised clinical trial involved 144 patients who required nasal packing after nasal surgeries, like septoplasty, Functional Endoscopic Sinus Surgery (FESS) and nasal bone fracture reduction in the Department of ENT, Head and Neck surgery at a Tertiary Care Centre, Chennai, India. Patients were categorised into two groups- Ribbon gauze group and Ivalon® group. The patient’s comfort was quantified based on nasal discharge, pain on removing the pack, stuffiness of the nose, and irritability were compared. After pack removal, mucosal oedema, congestion, and synechiae formation were assessed by using a diagnostic nasal endoscopy after 1 week. Results: Out of 144 patients, in Ivalon® group, 37 (51.4%) were males and 35 (48.6%) were females. The incidence of nasal symptoms with nasal surgery i.e nasal discharge was significantly higher in the ribbon gauze packing group (68.1%) compared to Ivalon® pack (31.9%) (p-value=0.044). Pain on pack removal was also more in the former (76.4%) compared to Ivalon® group (23.6%) which were statistically significant (p-value=0.005). Pain on pack removal was significantly more in the former (76.4%) compared to Ivalon® group (23.6%). Other symptoms like anxiety, discomfort, stuffiness, local irritation, and congestion were lesser in the Ivalon® group. Mucosal oedema was higher in ribbon gauze group (59.7%) compared to Ivalon® pack (40.3%) which was statistically significant (p-value= 0.019). Conclusion: As a postnasal surgery pack, Ivalon® pack is a better option due to less pain, anxiety, stuffiness, local irritation, congestion, synechiae formation and gives better comfort when compared to the ribbon gauze packs.

Keywords

• anterior nasal packing
• pain
• repacking
• septoplasty
• synechiae