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Objectives: To determine the best Foley catheter and inflation fluid for post-nasal packing. Design: Experimental study. Setting: District General Hospital (Wexham Park Hospital). Materials: 108 latex and 108 silicone catheters were directly compared. Outcome measures: Catheters were analysed according to the inflation fluid instilled and the use of an umbilical clamp. Analysis occurred at 24, 36, 48 and 72 h periods after being placed in humidified incubator at 37°C. The main outcome measure was whether deflation was possible at specified times. The secondary outcome measure was an attempt to identify the failure point in those catheters that failed to deflate. Results: Air was found to be an unsuitable inflation fluid for either silicone or latex catheters due to a 100% spontaneous deflation rate within a 24-h period. Silicone catheters were found to be 100% reliable when inflated with water or saline, irrespective of the use of a clamp. Latex catheters were unreliable with an overall failure rate of 30%. This high failure rate was related both to the use of an umbilical clamp to secure the catheter and to the use of saline as the inflation medium. Conclusions and recommendations: Firstly, air should not be used for inflation of catheters unless specified in manufacturer's instructions. Secondly, when Foley catheters are used for post-nasal packing, silicone should be considered the first choice of catheter type. If not available, latex ones may be used but should be inflated with water and secured with a non-crushing clamp at the alar rim.

A prospective study to compare 3 different types of nasal pack after septoplasty with or without a supplementary turbinectomy has been performed with respect to discomfort and complications caused by the packing and the short-term results evaluated 3 months after operation. Fingerstall packings gave less problems than either Merocel or hydrocortisone-terramycine gauze packs with ventilation tubes. They were easier to remove and were associated with less persistent secretion in the post-operative period. No definite advantage from the patient's point of view has been demonstrated by the use of tubes and nasal packing. An analysis of the nasal patency 3 months post-operatively by peak-flow index and acoustic rhinometry revealed no differences between groups.

A prospective randomized study was undertaken to compare the qualities of calcium sodium alginate (Kaltostat), trousered paraffin gauze, and glove finger packs as nasal packing material following the operation of partial inferior turbinectomy. All three types of packing material were found to be similarly effective in preventing bleeding whilst the packs were in situ. Calcium sodium alginate (Kaltostat) was associated with significantly less bleeding on pack removal than the other two packing materials. Further, irrespective of the material used, leaving the packs in situ for 48 hours produced significantly less bleeding than when they were removed after 24 hours.

Nasal packing is associated with post-operative Eustachian tube dysfunction in patients undergoing nasal surgical procedures. The effect of cannulated nasal packs which may improve nasopharyngeal ventilation was investigated in a prospective randomized controlled trial. Adult elective patients without tympanometric evidence of pre-operative Eustachian tube dysfunction were recruited. All subjects underwent single or combined intranasal surgical procedures and were randomized to receive either bilateral cannulated or non-cannulated Merocel nasal packs. Middle ear pressures (MEP) were recorded pre-operatively and post-operatively before nasal pack removal. Left and right ear results were amalgamated for analysis and 40 adults, 20 in each group were analysed. There was no difference in preoperative MEP, - 15 dPa (median value) in both groups. Post-operatively the MEP changed in both groups P < 0.0001. There was no significant inter group difference in the post-operative median MEP, - 85 dPa in the cannulated and - 70 dPa in the control groups, (95% c.i. for the difference in the medians - 25-55 dPa). Nasal surgery with post-operative packing leads to an objective reduction in MEP which is not altered by venting the packs.