1. Reprint from LARYNGOSCOPE, Vol. 93, No. 6, June 1983.
INTRANASAL AIRWAY/PACK: DESCRIPTION OF A NEW DEVICE.
DONALD E. DOYLE, M.D., KENNETH P. STOLLER, M.D.,
Los Angeles, CA.
ABSTRACT.
We have designed and developed a new intranasal pack which has been found to be most effective in controlling anterior and
posterior epistaxis. Its ease of introduction and patient tolerance make it ideal for treating posterior epistaxis on an outpatient basis,
and as packing for septal, sinus, or rhinoplastic surgery. The unique features of a breathing cannula and total intranasal tamponade
distinguish this device from all preceding ones.
The purpose of an intranasal pack is to be an inter-
nal splint and dressing, absorb drainage, and facili-
tate nasal hygiene. The optimal nasal packing
should fulfill certain criteria: it should be easy to in-
troduce and remove without adhering and causing
undue patient discomfort; it should contour to the
nasal fossa and produce enough pressure to help pre-
vent postoperative bleeding or epistaxis, but not
enough to macerate the mucous membranes; it
should be safe from prolapse out of the nasal cavity
or aspiration; it should promote a minimal amount
of tissue sensitivity, contamination or infection.
Gauze strips saturated with Vaseline Xeroform; )
or antibiotic ointments are most readily available
and widely used; however, they are too limber, too
porous, and often difficult to remove. Petroleum
characteristically is non-absorbent so that wounds
are not kept dry, maceration is frequent, and points
of adhesion persist. In addition to traumatizing
mucous membranes of the nose, aspiration into the
nasopharynx has not been an infrequent occurrence.
To counteract these drawbacks, tampons of fine
mesh gauze have been described.' 2 They are con-
structed out of long strips of gauze, folded, matted
or tied so as to increase their stiffness and maintain
their position without shifting or prolapsing out of
the nasal cavity; however, they are more difficult to
prepare, often difficult to remove, fail to contour
well to the nasal passages and are poorly absorbent.
Lamb's wool or cotton soaked in oil or saline often
is impossible to locate if it remains intranasally for
Editor's Note: This Manuscript was accepted for publication June 22,
1982.
Send Reprint Requests to Donald E. Doyle, M.D., 9201 Sunset Blvd.,
Suite 611, Los Angeles, CA 90069.
Fig. 1. Intranasal pack expanded by fluid.
more than a few hours, and is notoriously difficult to
remove. Surgicele or Oxycel® form gooey, friable
masses that are most difficult to remove (even if
saturated with water before insertion), especially if
left in the nose for more than 24 hours.'
Several types of nasal balloons have been de-
scribed.° 5 They are easy to insert and remove, con-
tour well to the nasal cavity, and are relatively
atraumatic to the mucous membranes while apply-
ing pressure. Their use in epistaxis has been estab-
lished; however, they are often cumbersome and
hard to apply in most elective surgical situations.
Splints made of Teflon exposed radiographic
film or materials of similar stiffness used alone with
through-and-through septal sutures or in conjunc-
tion with ribbon gauze packing can cause ulcera-
tions and ridges in the septal membranes due to
pressure necrosis at their borders. 6 Doyle, et al.' de-
veloped a splint which provided septal support and
a nasal airway at the same time. The development of
a device which could provide septal support, a tam-
ponade effect, and a nasal airway at the same time
was the next logical step.
DESCRIPTION.
The most significant vessel in a posterior
Fig. 2. Airway/Pack in place.
808

2. 809 DOYLE AND STOLLER: INTRANASAL AIRWAY/P CK.
Fig. 3. Tomographic view of Airway/Pack in pl ce, bilaterally,
with lumen open and extending through each po terior choana.
epistaxis is the sphenopalatine artery. It emerges
from the sphenopalatine foramen and se ds branches
forward on both surfaces of the turbina s as well as
the roof and floor of the nose. Adequat: pressure in
this area is a key to controlling posterior epistaxis.
We have designed a nasal pack whi h, when ex-
panded by fluid (Fig. 1) delivers not onl pressure to
the sphenopalatine artery's main bran hes, but vir-
tually all surfaces within the nasal ca ity. It has a
projecting tongue which allows it to traverse the
posterior choana, and design elements which allow
it to envelop the turbinates as well (F . . 2). Of par-
ticular interest to the patient, it has , a breathing
tube which allows for nasal respiration even though
the nose is fully packed. Figure 3 is a tomographic
view of the pack in place, bilaterally, w th the lumen
open and extending through each post for choana.
In addition to using this device for th posterior
and anterior epistaxis, we also now u it routinely
in our septal, sinus and rhinoplastic s rgery.
The intranasal pack is introduced in o the dilated
nostril (Fig. 4) after coating the notch end with an
antibiotic ointment. It is advanced alo g the floor of
the nose until it is entirely within the nasal cavity.
At this point, it may begin to expand by itself, but
we always spray it with normal sa ine or sterile
water. The material of which it is ma•, Merocel",*
expands readily when it comes in con ct with fluid.
When expanded, it is soft, yet exerts dequate pres-
sure and is comfortable for the patie . As Figure 3
*Americal Corporation, Nasal Tampon Patent No. ,098,157.
Fig. 4. Intr duction of Airway/Pack into nostril.
ere is an adequate airway at the
intranasal tamponade.
pistaxis, unless the patient has a
loss prior to treatment or there are
s for hospitalization, the fact that
k is too large to pass through the
eliminates the necessity for hospi-
eathing tube allows the patient na-
eatly reducing the chances of hy-
complication in posterior packing. 8
KNOWLEDGEMENTS.
s to Jack Anderson, M.D., New
Richard Webster, M.D., Brookline,
ouragement. Special thanks to Mr.
g, President of the Americal Cor-
viding the samples of the pack.
BIBLIOGRAPHY.
1. Call, W. H.: ontrol of Epistaxis. Surg. Clin. North Am.,
49:1235-1247, 1969
2. Scott-Brown W. G., et aL: Diseases of the Ear, Nose and
Throat. Second E ition. Butterworths, London, England, pp.
168-169, 1965.
3. Tibbels, E. .: Evaluation of a New Method of Epistaxis
Management. LAR NGOSCOPE, 73:306-314, 1963.
4. Stevens, W. S.: Nasal Packing — The Rubber Pneumatic
Pack. Arch. Otol., 4:191-194, 1951.
perience with Its
5.
Bayow, P. Use in Management of Epistaxis. E.E.N.T.
.: The Stevens Nasal Balloon: Further Ex-
965.Month., 44:74-77,
6. Kamer, F. . and Parkes, M. L.: An Absorbent, Non-
Adherent Nasal ck. LARYNGOSCOPE, 85:384-388, 1975.
7. Doyle, D. et al.: Description of a New Device: An In-
tranasal Airway/ lint. LARYNGOSCOPE, 87:608-612, 1977.
8. Kuhn, A. and Hallberg, 0. E.: Complications of Pos-
terior Nasal Pack ng for Epistaxis. Ann. Otol., 62:62, 1955.
demonstrates, t
same time as ful
In the case of
significant bloo
other justificati
the expanded p
posterior choan
talization. The
sal respiration
poxia, a commo
A
Special than
Orleans, LA an
MA for their en
George Kortew
poration, for pr