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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(03): 199-202
DOI: 10.1055/s-0040-1716932
Original Article

Is the Tradition of Nasal Packing Just an Illusion of Permanence or a Necessary Evil?

Arulalan Mathialagan
1   Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Suyash Singh
2   Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Awadhesh Kumar Jaiswal
2   Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Ravi Sankar Manogaran
1   Neuro-otology Unit, Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Prabhakar Mishra
3   Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
Amit Kumar Keshri
2   Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract

Background Nasal packing after an endoscopic endonasal approach (EEA) is a routine practice. There is a very urgent need for a level-I recommendation pertaining to the necessity of these packs and, if required, then the timing of its removal. However, the opponents of this practice mention its various disadvantages, among which infection is the most important. In our study, we have evaluated the bacteriological profile of the nasal packs, following endoscopic anterior skull base surgery.

Materials and Methods Thirty consecutive cases (2017–18) of anterior skull base pathologies operated by EEA were included, and preoperative nasal swab and postoperative period, the nasal packs were sent for microbiological culture. The colony of bacteria grew, and clinical condition, histopathology and demographic profile of the patients were noted.

Results Of the 30 patients, 40% (n = 12) showed an increase in nasal bacterial flora after packing, with methicillin-sensitive coagulase negative Streptococcus (MSCNS) in three patients, Escherichia fecalis (E. fecalis) in three patients, and methicillin-resistant coagulase negative Streptococcus (MRCNS) in two patients. Other rare organisms grew, including Acinetobacter baumanni with E. fecalis, Acinetobacter baumanni with MRCNS, Citrobacter koseni, and Escherichia fecium (E. fecium) with MRCNS and MRSA in one patient each.

Conclusion Packing increases the bacterial load of the nasal cavity. This bacterial flora can be a potential source of meningitis. We advocate that packing should be avoided, and if at all required, should be removed within 3 days. A routine practice of nasal swab in the preoperative period and culture of the packs may give information on the possible organism that may cause meningitis and the appropriate antibiotic sensitivity of the organism.

Keywords

anterior skull base surgery - nasal packing - bacterial culture


Publication History

Article published online:
11 March 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Wertheim HFL, Melles DC, Vos MC. et al The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005; 5 (12) 751-762
    CrossrefPubMedGoogle Scholar
  • 2 Majumdar D, Barua A, Paul B. Prevalence of nasal carriage of methicillin resistant staphylococci in healthy population of Gangtok, East Sikkim. J Int Med Sci Acad. 2008; 21 (04) 191-193
    PubMedGoogle Scholar
  • 3 Kuehnert MJ, Kruszon-Moran D, Hill HA. et al Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006; 193 (02) 172-179
    CrossrefPubMedGoogle Scholar
  • 4 Maple PAC, Hamilton-Miller JMT, Brumfitt W. World-wide antibiotic resistance in methicillin-resistant Staphylococcus aureus. Lancet 1989; 1 (8637) 537-540
    CrossrefPubMedGoogle Scholar
  • 5 Lai LT, Trooboff S, Morgan MK, Harvey RJ. The risk of meningitis following expanded endoscopic endonasal skull base surgery: a systematic review. J Neurol Surg B Skull Base 2014; 75 (01) 18-26
    PubMedGoogle Scholar
  • 6 Borg A, Kirkman MA, Choi D. Endoscopic endonasal anterior skull base surgery: a systematic review of complications during the past 65 years. World Neurosurg 2016; 95: 383-391
    CrossrefPubMedGoogle Scholar
  • 7 Arbolay OL, González JG, González RH, Gálvez YH. Extended endoscopic endonasal approach to the skull base. Minim Invasive Neurosurg 2009; 52 (03) 114-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Leong JL, Citardi MJ, Batra PS. Reconstruction of skull base defects after minimally invasive endoscopic resection of anterior skull base neoplasms. Am J Rhinol 2006; 20 (05) 476-482
    CrossrefPubMedGoogle Scholar
  • 9 Gupta A, Agrawal SR, Sivarajan K, Gupta V. A microbiological study of anterior nasal packs in epistaxis. Indian J Otolaryngol Head Neck Surg 1999; 51 (01) 42-46
    CrossrefPubMedGoogle Scholar
  • 10 Shrestha I, Pokharel M, Dhakal A, Amatya RCM, Madhup S, Sherchan JB. Study of microorganism growth pattern in nasal pack of patients visiting the Department of ENT, Head and Neck Surgery. Kathmandu Univ Med J (KUMJ) 2015; 13 (52) 303-307
    PubMedGoogle Scholar