Objective: To investigate the clinical effect of nasal packing with or without Merocel after endoscopic sinus surgery (ESS) in short and long term.
Method: A total of 112 patients with chronic rhinosinusitis who received endoscopic sinus surgery were randomly divided into two groups: packed group and non-packed group. In packed group, there were 37 cases, of which 10 cases were combined with allergic rhinitis and 11 cases received correction of nasal septum at the same time. In non-packed group, there were 75 cases, of which 15 cases were combined with allergic rhinitis and 26 cases received correction of nasal septum at the same time.Visual analogue score (VAS), Nasal bleeding and sinonasal outcome Test-22 (SNOT-22) were used to evaluate the clinical effect between two groups in short and long term respectively.
Result: The VAS of nasal obstruction, rhinodynia, dysphoria, epiphora, itching, sneeze, headache and facial pain in non-packed group were significantly lower than those in packed group (P < 0.05). Within 48 hours after ESS, the amounts of nasal bleeding were 0-45 ml (median 3 ml) in packing group and 0-18 ml (median 2 ml) in non-packing group. There were significant difference between two groups (Z = -3.54, P = 0.00). The difference value of postoperative and preoperative SNOT-22 of the packed group was 38.47 ± 20.25 and the non-packed is 41.03 ± 22.73 six months after ESS (t = 0.58, P = 0.56). Each group had one case of nasal adhesion. And as for middle turbinate dislodgement, there was one case in the packed group and two cases in the unpacked group. There was no case of nasal septum hematoma in the packed group, but two cases in the un-packed group. The results showed that there was no significant difference of clinical effect between the postoperative packing and unpacking groups.
Conclusions: It is safe and practicable to manage chronic rhinosinusitis without nasal packing after ESS, which in short term not only decrease discomfort, but also reduce nasal bleeding. Also, there is no significant difference of clinical effect between the postoperative packing and unpacking groups in long the term.