Eliminating the Toynbee phenomenon in patients with nasal packs

Nasal Septal Suture Technique versus Nasal Packing after Septoplasty

Background

The aim of this study was to compare eustachian function and blood gas changes with nasal packing (NP) and nasal septal suturing (NSS) after septoplasty.

Methods

Eighty patients who have nasal septal deviation and who otherwise are healthy were studied. Forty of these patients had finger glove NPs in their nasal cavities for 48 hours after septoplasty. Another 40 patients had NSS performed after septoplasty. Acoustic tympanometry and pH, PCO2, and PO2 analyses of arterial blood were performed preoperatively and 48 hours postoperatively.

Results

We observed a statistically significant increase in middle ear pressure (p < 0.001) and a significant reduction of PO2 (p < 0.001) and increase of PCO2 (p = 0.041) in the NP group but no difference in the NSS group, postoperatively.

Conclusion

NSS should be preferred as an alternative to intranasal packing.

Packing in endonasal surgery

Nasal packing is used to control bleeding in epistaxis and after endonasal surgery, for internal stabilization, and to prevent synechiae or restenosis, particularly after surgery. Generally accepted standards regarding the materials that should be used for packing, how long the packing should be left in place, or the indications for nasal packing are lacking. In view of the present lack of standardization and the many different packing materials used, we review the currently available materials and outline their respective properties, indications, and risks.

Nasopharyngeal pressure gradients during non-phonetic activities of the velopharyngeal valve. Part I

The phonetic activity of the velopharyngeal valve has been the subject of electromyographic, radiological, ultrasonic, endoscopic, and of various acoustic and aeromechanical investigations. The subject of the present study was the non-phonetic activities of the velopharyngeal valve. Ten patients were assessed by nasendoscopic examinations of the velopharyngeal valve. The pressure gradients in the nasopharynx during these activities were recorded. Typical individual nasopharyngeal pressure patterns were revealed inducing a development of a special technique and tests for a further study of the non-phonetic activities of the velopharyngeal valve in correlation with its abnormality and pathological speech activities.

Study of Toynbee phenomenon by combined intranasopharyngeal and tympanometric measurements

The Toynbee maneuver, swallowing when the nose is obstructed, leads in most cases to pressure changes in one or both middle ears, resulting in a sensation of fullness. Since first described, many varying and contradictory comments have been reported in the literature concerning the type and amount of pressure changes both in the nasopharynx and in the middle ear. In our study, the pressure changes were determined by catheters placed into the nasopharynx and repeated tympanometric measurements. New information concerning the rapid pressure variations in the nasopharynx and middle ear during deglutition with an obstructed nose was obtained. Typical individual nasopharyngeal pressure change patterns were recorded, ranging from a maximal positive pressure of +450 to a negative pressure as low as -320 mm H2O.