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.