RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE

BANGALORE, KARNATAKA.
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1.

Name of the candidate And

Address(In Block Letters)

Dr. SUMATHA.D
PG IN ENT
SRI VENKATESHWARA ENT INSTITUTE,
VICTORIA HOSPITAL,
BANGALORE: 560002.

2.

Name of the institution

BANGALORE MEDICAL COLLEGE,

BANGALORE.

3.

Course of study and Subject

M.S IN ENT

4.

Date of admission to the course

31-05- 2007

Title of the topic

A COMPARATIVE STUDY BETWEEN

CONVENTIONAL NASAL PACKING AND
MEROCEL PACKING IN THE MANAGEMENT
OF EPISTAXIS.

6. BRIEF RESUME OF INTENDED WORK:

6.1 NEED FOR THE STUDY:

Epistaxis is a frequent emergency condition and often causes significant anxiety
in patients. Nasal packing is commonly used to control epistaxis that has not responded to
simple measures such as external pressure or cautery. Though nasal packing is effective
modality of management of epistaxis, yet is often considered by the patient to be one of
the most unpleasant aspect of their treatment. However this treatment has been simplified
by the development of several new packing materials one of which is Merocel nasal pack.
There are very few literatures demonstrating the employment of it as haemostatic agent in
the nose.
This prospective study compares two commonly used packing materials in terms
of patients comfort, effectiveness at controlling the hemorrhage, ease of removal, and
complication associated with its use.
6.2 REVIEW OF LITERATURE:
Department of Surgery, Division of Head and Neck, University of California, did
a study on an absorbent, non adherent nasal pack and checked regarding all criterias of
ideal nasal packing like introduction and removal, contour to the nasal cavity to exert a
tamponade effect , not to prolapse or react unfavorably with mucous membrane of nose.1
In a study conducted by Donald E. Doyle, Kenneth P Stoller, Los Angeles, CA
designed and developed a new intranasal pack using merocel which has been found to be
most effective in controlling anterior and posterior epistaxis. Its ease of introduction and
patients tolerance make it ideal for treating epistaxis on an outpatient basis and as
packing for septal, sinus or rhinoplastic surgery. 2
Ear, nose, throat group of Washington did a study on complication of nasal
packing. Technical problem in packing may lead to injury to the nares, septum, mucosa
and palate to dislodgment and aspiration of packing to inadequate control of bleeding or
shock from nasal-vagal reflexes. It occasionally leads to septicemia and rarely toxic
shock syndrome. 3

In a prospective study conducted by Department of Otolaryngology (S.D.B.,

J.B.J), Medicine (A.S.L) and Microbiology (P.M.T) New York University Medical
Center, New York, comparison of the microbiological safety of merocel versus NuGauze
nasal packing in 119 surgical patients was done. Study concluded that merocel nasal
packing appears to inhibit bacterial proliferation and offer some protection against Toxic
shock syndrome associated symptomatology. 4
In a study conducted by Department of Otolaryngology, Royal Devon and Exeter
Hospital, Exeter, Devon comparison of packing material used in nasal surgery was done.
The study included 4 commonly used packing material that is telfa, paraffin gauze,
merocel and BIPP and were compared in terms of patient comfort and effectiveness at
controlling the hemorrhage. For routine packing following nasal surgery this study
suggests that paraffin gauze or Telfa are the most acceptable of the material assessed. 5
Another study conducted by Department of otolaryngology, Royal Devon and
Exeter Healthcare NHS Trust, Exeter, UK. Use of merocel nasal pack in the treatment of
epistaxis was studied. According to study merocel packs successfully controlled bleeding
in 91.5% of patients. Actual insertion takes only a couple of seconds. Discomfort during
insertion whilst in situ and on removal was minimal. The study concluded that merocel
nasal packing is an effective form of first line treatment in patients with epistaxis.6

6.3. OBJECTIVE OF THE STUDY:

To compare the efficacy of conventional nasal packing and merocel nasal packing
in terms of
1. Patients comfort
2. Effectiveness at controlling the hemorrhage
3. Ease of removal
4. Complication associated with its use.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA:
The study will be conducted on patients presenting with epistaxis in Sri
Venkateshwara ENT Institute, Victoria Hospital and Bowring and Lady Curzon Hospital
attached to Bangalore Medical College and Research Institute, Bangalore during the
study period from December 2007 to July 2009.
7.2 METHODS OF COLLECTION OF DATA.
1. History taking with the help of proforma.
2. Clinical examination.
3. Relevant investigation.
4. Management includes conventional anterior nasal packing or merocel nasal packing.
5. Collection of data regarding patients comfort, effectiveness at controlling hemorrhage,
ease of removal, and complication associated with its use.
Sample Size: Minimum of 60 cases will be taken for comparative study.
7.3 INCLUSION CRITERIA.
1. Patients of all age group and both sex.
2. Patients with anterior epistaxis.
7.4 EXCLUSION CRITERIA.
Patients with posterior epistaxis requiring postnasal packing.
7.5 Does the study require any investigation or intervention to be conducted on
patients or other humans or animals? If so, please describe briefly:
Yes
1. Clotting profile: BT, CT, PT, APTT, PLATELET COUNT.
2. Nasal endoscopy.
3. X ray nasal bones and para nasal sinus.
4. Blood culture and sensitivity.

After informing the patients and obtaining prior written consent, the patient will be
subjected to investigations as indicated and confirmed to well recognized, practiced and
established modalities of treatment.
7.6 Has the ethical clearance been obtained from your institution in case of 7.5?
Yes.
8. LIST OF REFERENCES:
1. Kamer M Frank, Parkes L Morey, An absorbent, non-adherent nasal pack.
Laryngoscope1975; 85: 384-388.
2. Doyle E Donald, Stoller P Kenneth, Intranasal airway-pack: Description of a new
device. Laryngoscope1983; 93: 808-809.
3. Fairbanks, D.N.F. complication of nasal packing. Otolaryngology - Head and Neck
Surgery 1986; 94: 412-415.
4. Breda D Stephen, Jacobs B Joseph, Lebowitz S Arthur, Tierno M Philip, Toxic shock
syndrome in nasal surgery: a physiochemical and microbiologic evaluation of merocel
and NuGauze nasal packing. Laryngoscope 1987; 97: 1388-1391.
5. Garth, R.J.N, Brightwell A.P. A comparison of packing materials used in nasal surgery.
The journal of Laryngology and Otology 1994; 108: 564-566.
6. Pringle, M.B, Beasley, P. Brightwell, A.P. The use of merocel nasal pack in the
treatment of epistaxis. The journal of Laryngology and Otolaryngology1996; 10: 543546.

9. Signature of the candidate

10. Remarks of the Guide

: Study on newer modality of treatment of

epistaxis helps its novel application on
routine basis which greatly affects
efficacy of treatment and compliance of
patients. Hence the need for the study.

11. 11.1 Name and Designation of the

Guide

: Dr. K.L.SHIVAKUMAR
MBBS, MS (ENT)
ASSISTANT PROFESSOR OF ENT
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE.
BANGALORE: 560002.

11.2. Signature

11.3. Co-guide (If Any)

11.4. Signature

11.5. Head of the Department

: Dr. SATISH.H.S
MBBS, DLO, MS (ENT)
PROFESSOR AND HOD OF ENT
SRIVENKATESHWARA INSTITUTE
BANGALORE MEDICAL COLLEGE
AND RESEARCH INSTITUTE,
BANGALORE-560002

11.6. Signature

12.1. Remarks of the Chairman and

Principal

12.2. Signature