A Study into the Benefits of Bilateral Packing for Epistaxis

Objective: Theoretically there is a safety benefit in using bilateral nasal packs in managing epistaxis. Our study aims to show an additional benefit in this practice: the reduction to the deformity caused across the nasal septum with bilateral packing, therefore creating a safer and more pleasant patient experience.

Method: We created a simple nasal model to illustrate the nasal septal cartilage as a structure that is anchored inferiorly, superiorly, and posteriorly, but with a free anterior edge. Using 7.5 cm Arthrocare RapidRhino packs and a manometer, we measured the septal deflection created using different pack pressures, unilaterally and bilaterally.

Results: By measuring the anterior deflection of the cartilage analogue (3 mm wide silicone sheeting) at 3 different fixed points along the anterior edge, we were able to demonstrate significantly less septal deflection when using bilateral packing with the same pressures, compared with unilateral packing. The dynamic nature of the model meant that the maximum deflection points varied between repetitions of the study, yet less septal deflection was seen with bilateral packing, particularly with higher inflation pressures, regardless of the starting deformity.

Conclusion: Our simple model shows that the nasal septal deformity with bilateral packing is reduced, compared with unilateral packing. We theorize that the reduced deformity shown with bilateral packing will make for greater patient comfort. We have commissioned a model with pressure sensors across the nasal septum to analyze this theory.