Hot nasal packing with hot saline irrigation for hemostasis after adenoidectomy: A prospective randomized controlled study

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Abstract

Objective

This study aimed to investigate the efficacy of hot posterior nasal packing and hot saline irrigation in bleeding control after adenoidectomy.

Methods

A total of 130 patients scheduled for adenoidectomy were included in the study, and randomized into two groups at the beginning of the surgical operation. After adenoidectomy, saline impregnated tampon, and saline irrigation at room temperature (22 °C) was applied to the patients in one group while 50 °C saline impregnated tampon and saline irrigation at the same temperature were applied to the patients in the other group. We recorded hemostasis for up to 3 min after tamponade for bleeding control, and the amount of bleeding into the nasopharynx.

Results

The age of the patients ranged from 1.5 to 13 years (mean ± SD: 6.07 ± 3.08 years, and 5.33 ± 2.55 years, 22 °C and 50 °C saline irrigation groups, respectively). There were 37 males and 28 females in the 22 °C saline group, while 34 males and 31 females in the 50 °C saline group. When comparing the two groups, there was no statistically significant difference in terms of duration of hemostasis (p = 0.64). However, bleeding scores at 2 nd min after the tamponade were significantly lower in the 50 °C saline group (p = 0.007). The amount of bleeding in the 50 °C saline group was also significantly lower than the 22 °C saline group (p = 0.015).

Conclusion

In this study, application of 50 °C saline impregnated tampon, and hot saline irrigation was found to be more effective in the control of bleeding after adenoidectomy by reducing the amount of bleeding compared to 22 °C saline impregnated tampon application and saline irrigation at 22 °C. However, hot nasal packing and hot saline irrigation did not affect duration of hemostasis and cauterization.

Introduction

Since Meyer first described adenoidectomy in 1868, it has been among the frequently performed surgical procedures in children by otorhinolaryngologists [[1], [2], [3]]. Even though many new high technology techniques have been developed over the years, the conventional adenoidectomy technique is still the most widely used one worldwide [4]. The conventional adenoidectomy technique [5], which was described by Guggenheim in 1957, has been currently performed with Beckman or La Force adenotomes. However, this technique is still considered as a blind technique because the surgeon evaluates the adenoid tissue through digital palpation or with the aid of a mirror [6]. Hemostasis following curettage is performed using tampons, saline irrigation, and bipolar cauterization.

Several hemostatic agents, including Ankaferd blood stopper, hemostatic sealant, adrenaline, feracrylum, QuikClot have been previously used to reduce both the time of operation and intraoperative bleeding in conventional adenoidectomy [4,[7], [8], [9]]. Apart from the use of hemostatic agents, hot saline irrigation following tampon is another technical modification, but limited studies have been available so far [10]. Hot saline irrigation has been widely used in the hemostatic control of posterior epistaxis [11]. Other uses of hot saline irrigation in otorhinolaryngology include endoscopic skull base surgery, neurosurgical procedures, and endoscopic sinus surgery [12].

Accordingly, this study aimed to investigate the efficacy of hot tampon application and hot saline irrigation (50 °C) for bleeding control after adenoidectomy at room temperature (22 °C) along with comparing its efficacy with packing and saline irrigation.

Section snippets

Methods

A prospective controlled randomized, single-blind study was designed to investigate the effect of a hot tampon with hot saline irrigation in hemostasis during adenoidectomy. After the parents signed informed consent, the patients under the age of 16 years, who underwent adenoidectomy due to the chronic nasal obstruction, were included in this study. Patients with chronic diseases, hemorrhagic diathesis, and patients who had additional procedures were excluded from the study. Among 137 patients

Results

A total number of 130 consecutive patients were included in this study. Since we used a randomized blocks approach, two balanced groups (22 °C and 50 °C groups) each including 65 patients were created. The age range of patients was between 1 and 13 years (mean ± SD: 4.5 ± 1.9 years in 22 °C saline group and 4.9 ± 1.8 years in 50 °C saline group). There were 38 male and 27 female patients in 22 °C saline group, 50 °C saline group consisted of 34 male and 31 female patients. In 22 °C saline

Discussion

Although many high-tech methods/tools for adenoidectomy have been developed over the years, adenoid curettes are still the most widely used tools [15]. Serious bleeding rates following adenoidectomy have been reported with the rate of 0.2% that rarely required an external carotid artery ligation [[16], [17], [18]]. Hemostasis in conventional adenoidectomy is traditionally achieved through the diathermy after tampon application. However, excessive electrocauterization may lead to several

Conclusion

Our cumulative results suggest that irrigation with 50 °C saline significantly reduces the amount of bleeding after adenoidectomy compared to irrigation with 22 °C saline. However, it does not influence duration of hemostasis and the rate of electrocautery usage. Also, any positive effect of hot tampon application on bleeding was not observed in this study. Nevertheless, future studies are still needed to determine precisely whether use of hot tampon shortens bleeding time.

Funding information

This work received no external funding.

Declaration of competing interest

The authors have no competing interests.

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