Keywords
Ear packing; surgery; otology; professional practices
IntroductionPacking of the external auditory canal (EAC) after middle ear surgery is an established practice in many ENT centers. Since the first packing technique was introduced in 1973 using Gelfoam1, various types of external ear packing materials have been described2-4. While packing material varies among surgeons, the material of choice tends to be based more on tradition than evidence. The theoretical advantages of packing of the EAC are to promote healing of the tympanic eardrum, to support a tympanic graft, and to reposition the tympanomeatal flap in the correct position to avoid EAC stenosis. Packing also aids local hemostasis, helps to avoid lateralization blunting, and improves efficacy of local treatments4.
Packing agents are classified in non-absorbable or absorbable3. Non-absorbable packs include hydroxylated polyvinyl acetate (ear wick), silicone sheet, ribbon gauze (with antibiotics, antiseptic ointments, cream or bismuth, iodoform, paraffin paste). Non-absorbable packs need to be removed 7 to 21 days postoperatively, depending on the surgical procedure and the surgeon habits. Removal is usually performed during a clinical visit without anesthesia, except in pediatric and/or anxious patients, in whom inhalation sedation (e.g., nitrous oxide/oxygen premix) can be used5. The disadvantages for non-absorbable packs are uncomfortable removal, bleeding, and graft or skin flap displacement following removal4. Absorbable packs include short time resorption (8-14 days) for porcine gelatin sponge (Gelita®) or long-time resorption (8 weeks) for hemostatic collagen compress from veal dermis (Pangen®). While there is none of the pain and discomfort associated with removal of non-absorbable packs, hearing loss and ear fullness can persist for several weeks with absorbable packs6.
Most previous otological studies have focused on auditory performance or surgical complications involved with ear packing, but none have reported postoperative surgical habits among physicians. There is currently no consensus regarding ear packing and/or the preferred packing material. As such, there is a need to better understand postoperative practices among surgeons. The aim of this study was to describe practices among French otologists regarding packing of the EAC after otologic surgery procedures. A second objective was to assess physicians’ preferences for packing the EAC or not.