Nasal packing involves placing material inside the nasal cavity to address a medical need, most often to stop bleeding or provide structural support. The appearance of the packing material varies widely, depending on its specific purpose and the material chosen by the healthcare provider. Materials range from simple gauze strips and expandable sponges to small inflatable balloons, all designed to exert pressure on the nasal tissues.
Reasons for Nasal Packing
Nasal packing is a procedure used when less invasive techniques have failed to control bleeding or when internal nasal structures require temporary stabilization. The most common indication is to manage epistaxis (nosebleeds). If simple methods like direct pressure or cauterization do not stop the blood flow, packing is required to apply sustained, internal pressure to the bleeding vessel.
The decision to pack depends on the bleed’s origin, classified as either anterior or posterior. Anterior packing addresses common bleeding from the front of the nose. Posterior packing targets more severe bleeds originating deeper in the nasal cavity, requiring specialized devices to apply pressure near the throat.
Beyond stopping active bleeding, packing is frequently used following nasal surgeries, such as septoplasty to correct a deviated septum or turbinate reduction. In these surgical cases, the packing acts as an internal splint to stabilize newly repositioned tissues. This support helps prevent complications like septal hematoma formation and discourages scar tissue from forming between nasal surfaces. The material maintains the correct anatomical placement until the initial healing phase is complete.
The Appearance and Types of Nasal Packing Materials
Nasal packing materials are categorized as either absorbable or non-absorbable. Absorbable materials dissolve naturally within the body, eliminating the need for removal, and promote clotting and wound healing. They often look like delicate white or tan sponges, gels, or oxidized cellulose sheets. Examples include gelatin foam, which appears as a light, porous white block, or specialized polymers that transform into a soft gel upon contact with moisture.
Non-absorbable, or removable, materials have a more defined and solid appearance. Traditional ribbon gauze looks like a long, thin strip of cotton fabric, often yellowish or off-white due to antibiotic ointment. Synthetic sponges, such as the Merocel tampon, are initially compressed rods that expand significantly upon absorbing fluid within the nose. These cylindrical sponges often have a string attached to facilitate removal.
The third type is the inflatable balloon tampon, primarily used for extensive anterior or posterior bleeds. These devices look like small, soft rubber or silicone balloons, often featuring one or two chambers and an external inflation port. The Rapid Rhino is a common example, appearing as a smooth, fabric-covered balloon that is inserted flat and then inflated with air or water to apply pressure. Once the packing is in place and has absorbed blood and fluids, the visible portion at the nostril often becomes dark red or brown.
Patient Experience and Removal
While the packing is in place, patients experience significant nasal obstruction, forcing mouth-breathing. This often leads to a dry mouth and throat, along with a temporary alteration or loss of smell and taste. Patients may also feel a constant, dull pressure sensation across the face and nose, sometimes accompanied by a mild headache.
Non-absorbable packing is typically left in place for 24 to 72 hours, depending on the clinical need. The removal process can be anxiety-inducing for the patient. To prevent sticking to the nasal lining, the healthcare provider moistens the packing with saline or water before gently and slowly pulling it out.
Although the removal process involves a sensation of pressure and pulling, it is usually quick. Minor bleeding is common immediately afterward because the material applied pressure to the healing tissue. Post-removal care typically involves gently irrigating the nasal passages with saline solution to clear discharge and promote a clean healing environment.