COMPARATIVE STUDY BETWEEN NASAL PACKING WITH CARBOXY METHYL CELLULOSE AND LATEX GLOVED MEROCEL IN THE SAME PATIENT AFTER FUNCTIONAL ENDOSCOPIC SINONASAL SURGERY

Background: Nasal packing after functional endoscopic sinus surgery (FESS) is used as a standard procedure to control the postoperative bleeding, promote the mucosal healing and to prevent synechiae formation, but traditional non-resorbable packs have several disadvantages.The optimum solution to minimize these disadvantages may be accomplished using the new biodegradable packs.Objectives: This study was done to compare between the effect of carboxy methyl cellulose (CMC) foam nasal pack and latex gloved merocel (LGM) nasal pack in the same patient after FESS regarding the prevention of postoperative bleeding, pain and synechiae formation. Patients and Methods:A prospective, randomized, single-blinded controlled study was performed in 35 patients with bilateral chronic rhinosinusitis who were collected from ENT outpatient clinic of Al-Hussein University Hospital from Feb. 2019 to Nov. 2019.All patients underwent bilateral FESS by a single surgeon.At the end of the operation, each patient was packed with dissolvable CMC foam nasal pack in one nasal cavity and latex gloved merocel nasal pack in the other side.The hemostatic effect of the CMC foam and latex gloved merocel was assessed during the recovery period.Pain levels were recorded by the patients on a visual analogue scale 2, 6, 12 and 24 hours after surgery and at the time of packing removal.The effectiveness of prevention of synechiae formation was assessed endoscopically 4 and 8 weeks after surgery.Results: There was no statistically significant difference between CMC group and LGM group as regard their effect on control the postoperative bleeding.Only five (14.3%) of the CMC group had primary postoperative bleeding, and it occurred in three (8.6 %) of gloved merocel group.The mean level of patient pain was 0.98 (Range: 0-2) in CMC group, but was 1.65 (Range: 1-3) in latex gloved merocel group which is statistically significant.As regarding synechiae formation, the difference between both groups was statistically insignificant at the 4 weeks period] Two (5.7%) of CMC group and five (14.3 %) of LGM group developed a synechiae [and statistically significant at the 8 weeks period] three (8.6%) of CMC group and nine (25.7 %) of gloved merocel group developed synechiae]. Conclusion:Dissolvable CMC foam nasal pack was associated with very low levels of localized pain, and with low levels of postoperative bleeding and synechia formation.