Subscribe to RSS

DOI: 10.1055/s-0045-1809999
Nasal Foam Packing for Epistaxis: What are the Ideal Characteristics?
Authors
Funding The authors received no financial support for the research.

Abstract
Introduction
Epistaxis is a common otorhinolaryngological emergency, usually caused by digital trauma in children, and hypertension in the elderly. General practitioners in emergency rooms assist most of the cases without specific management.
Objectives
Describe suitable properties for efficient nasal packing in adult epistaxis.
Methods
Two cadaver heads, preserved by freezing process, were thawed for this research. When the room temperature was reached, the nasal cavities were evaluated by a nasal endoscope, which showed a length of 4.0 × 11.0 cm for the male and 4.0 × 8.5 cm for the female head. Through an orifice made in the left maxillary bone to access the maxillary sinus, a blue-dyed saline solution was applied using a sphygmomanometer (Premium) to control and mimic blood pressure. The nasal cavity was first packed with two foams with different thicknesses and densities evolved by a condom, then packed by the Merocel packing (Medtronicent Surgical Products Inc.). The pressure was administered and gradually increased until a saline leak was observed in the oropharynx. The best way to insert tampons was also evaluated to avoid extensive trauma.
Results
Despite the difficulty of the application being similar in both nasal packings made with the condom and foam, t33-densityity foam, 2.0 cm thick and 11.0 cm lon resisted to a higher pressure (250mmHg) than the commercial packing Merocel (220mmHg).
Conclusion
The most suitable foam for packaging wrapped with condoms is 2.0 cm thick, as it supported the blood pressure commonly found in epistaxis.
Publication History
Received: 24 October 2024
Accepted: 31 January 2025
Article published online:
10 September 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)
Thieme Revinter Publicações Ltda.
Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil
Flavio Serafini, Isabele Campos Araújo, Flavia Minhoto, Ana Luiza Figueira Santos. Nasal Foam Packing for Epistaxis: What are the Ideal Characteristics?. Int Arch Otorhinolaryngol 2025; 29: s00451809999.
DOI: 10.1055/s-0045-1809999
-
References
- 1 Meirelles RC, de Sá L, Almeida G. Abordagem atual das hemorragias nasais. HUPE Journal. 2014; 11 (03) 48-55
- 2 Valera FCP, Tamashiro E, Hyppolito MA, Anselmo-Lima WT. Protocolo clínico e de regulação para epistaxe. In: Protocolos clínicos e de regulação: acesso à rede de saúde. Elsevier; 2012: 1-6
- 3 Balbani APS, Formigoni GGS, Butugan O. Tratamento da epistaxe. Rev Assoc Med Bras 1999; 45 (02) 189-193
- 4 Santos RP, Leonhardt FD, Ferri RG, Gregorio LC. Ligadura endoscópica endonasal da artéria esfenopalatina para epistaxe severa. Rev Bras Otorrinolaringol 2002; 68 (04) 511-514
- 5 Pezzin LS, Belli FJ, Steffen N, Maahs GS. Epistaxe: da etiologia ao manejo. Acta Medica (Porto Alegre) 2014; 35: 1-8
- 6 Secchi MMD, Indolfo MLP, Rabesquine MM, Castro FB. Epistaxis: Prevailing Factors and Treatment. Int Arch Otorhinolaryngol 2009; 13 (04) 381-385
- 7 Rehman A, Rafiq F, Hussain B. Epistaxis – Assessment of Aetiology and Effectiveness of Treatment Modalities. Pak J Med Health Sci 2015; 9 (02) 689-692
- 8 Laranjeira FF, Müzell LP, Coelho JL, Steffen N. Epistaxe. Acta Medica (Porto Alegre) 2016; 37: 1-5
- 9 Pfaff JA, Moore GP. Otolaryngology. In: Walls RM, Hockberger RS, Gausche-Hill M. eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018. :chap 62.
- 10 Daudia A, Jaiswal V, Jones NS. Guidelines for the management of idiopathic epistaxis in adults: how we do it. Clin Otolaryngol 2008; 33 (06) 618-620
- 11 Faistauer M, Faistauer A, Grossi RS, Roithmann R. Desfecho clínico de pacientes tratados por epistaxe com tamponamento nasal após a alta hospitalar. Braz J Otorhinolaryngol 2009; 75 (06) 857-865
- 12 Nithianandan H, Thavorn K, Banaz F, Macdonald K, Lasso A, Kilty SJ. Determining the hospital cost of anterior epistaxis treatment modalities at a Canadian tertiary care centre. World J Otorhinolaryngol Head Neck Surg 2019; 5 (04) 193-199
- 13 Alshehri WM, Alwehaibi WM, Ahmed MW, Albathi A, Alqahtani B. Merocel Surgicel Wrap Technique to Manage Diffuse Epistaxis in Patients with Comorbidities. Int J Otolaryngol 2020; 2020: 8272914
- 14 Pringle MB, Beasley P, Brightwell AP. The use of Merocel nasal packs in the treatment of epistaxis. J Laryngol Otol 1996; 110 (06) 543-546
- 15 Abreu HF, Nigro CEN, Nigro JFA. Severe epistaxis: clinical treatment. Archives of the Foundation of Otolaryngology. 2000; 4 (03) 114-116