Nasal packing is a medical material placed inside the nasal cavity, most often after surgery like a septoplasty or rhinoplasty, or following a severe nosebleed. Its purpose is to manage bleeding, absorb drainage, and structurally support the internal tissues. The packing acts as an internal splint to prevent blood clots (septal hematomas) and stabilize repositioned structures. Patients often focus their anxiety on the moment of removal, so this article explains what to expect during this brief procedure.
Addressing the Discomfort: Sensation Versus Pain
The process of having nasal packing removed is generally described by patients as deeply uncomfortable and strange, rather than acutely painful. The discomfort stems from the intense feeling of pressure and pulling as the material slides through the highly sensitive nasal passages. This sensation often feels like an intense tickle or a deep, vacuum-like tugging.
The physical sensation is amplified because the packing material has been in place for 24 to 72 hours, absorbing blood and mucus and conforming tightly to the nasal anatomy. This discomfort relates to mechanoreception (the sense of physical pressure) rather than nociception (the signaling of tissue damage or sharp pain). Anxiety and fear can significantly increase the perceived discomfort, but studies indicate that anticipation of pain is often greater than the actual physical experience.
Types of Nasal Packing Materials
The specific material used heavily influences the removal experience, based on how much it adheres to the internal nasal lining. Traditional gauze or Vaseline gauze packing is often the most challenging to remove because it becomes saturated with clotted blood and sticks firmly to the mucosal surface. This adherence increases friction and tugging upon extraction, potentially resulting in more bleeding.
Modern non-absorbable options, such as polyvinyl alcohol sponges like Merocel or Doyle splints, are designed to be less adhesive. Merocel is a compressed sponge that expands when wet. Some surgeons use “gloved” Merocel,” which is covered to reduce surface friction, leading to less pain and bleeding upon removal.
The least invasive option is absorbable packing, made from materials like collagen or carboxymethyl cellulose. These materials dissolve naturally over time and do not require a separate removal procedure, eliminating discomfort entirely. Non-absorbable packs require manual removal and are used when extended structural support is needed.
The Removal Process: What to Expect During the Procedure
The removal of nasal packing is performed by a medical professional in a clinical setting, allowing for precise technique and immediate management of any reaction. The process begins with the patient sitting upright. The provider will often spray the packing with a saline solution or a topical anesthetic/decongestant combination to lubricate the material and shrink the surrounding nasal tissue.
This lubrication step re-moistens the packing and helps loosen any sections adhered to dried blood or mucosal lining. The practitioner then uses specialized tools, such as forceps or a small suction instrument, to grasp the packing firmly. They use a slow, steady, and continuous pull to extract the material, instructing the patient to breathe through their mouth to help manage the sensation.
The entire procedure is remarkably brief, typically lasting less than 30 seconds per side. Although the sensation can be intense while the material is actively being removed, its short duration aids patient tolerance.
Preparing for Removal and Immediate Aftercare
Patients should discuss any anxiety with their surgical team, who may approve taking a prescribed pain reliever or anti-anxiety medication about an hour before the appointment. Focusing on deep, slow breathing techniques during the removal helps keep the body relaxed. It is also beneficial to keep the head elevated in the hours leading up to the appointment to reduce blood flow and pressure.
Immediately after the packing is removed, patients often experience an instant sense of relief as internal pressure is released and nasal breathing is restored. A brief episode of minor bleeding or lightheadedness is common. The provider will typically hold pressure on the fleshy part of the nose for a few minutes to ensure any bleeding subsides.
Initial aftercare focuses on gentle hygiene to aid the healing process. Patients are instructed to avoid blowing their nose forcefully for at least a week to prevent dislodging clots. Saline nasal washes or sprays are often recommended to keep the nasal passages moist and gently clear out any remaining crusts or discharge.