We employ dehydrated sponges as nasal packs (Merocel®, Xomed Surgical Products, Jacksonville, FL) and find these are much better tolerated than yards of ribbon gauze, which was previously used. The nasal packs provide a relatively gentle tamponade of the battered nasal mucosa. Ribbon inserted into the finger of a surgical glove is a good alternative and may be less unpleasant to remove. However, the extraction of any form of nasal pack is unpleasant, and the difference in discomfort is only a matter of degree.
We remove the packs as soon as we reasonably can. This is usually on the first postoperative day. Leaving them in for a longer period makes them increasingly more difficult to remove because of organized clot and may even require significant analgesia or even anesthesia at removal. We use a single tampon in the operated nostril, unless the mucosa is torn. Interestingly, a confused patient sometimes removes the packs within minutes of waking up in the recovery room. Complications from this have yet to be observed. Occasionally we have managed with no packs in patients with asthma with long-standing airway obstruction with no problem. Perhaps it is time to re-evaluate the need for packs, especially because the endoscopists do without them altogether.
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