Introduction
Ear packing is one of the most common procedures performed by an ENT surgeon as a postsurgical procedure for tympanoplasty, stapes, and mastoid surgery.
Definition of Ear Packing
Ear packing is a simple procedure of placing cotton packs into an ear chamber to control bleeding and edema.
Purposes
- To enhance wound healing and help in keeping the surgical site moist.
- To assess the pack and drain fluid from the ear as the pack is examined.
Materials
- Bioresorbable injectable gel for ear packing.
- This is an injectable transparent, viscoelastic, bioresorbable gel composed of cross-linked polymers of hyaluronic acid. It is administered with the help of a flexible catheter after middle ear surgery.
- Small pieces of the gel are rolled into spheres, hydrated, and placed in the middle ear cavity.
- Bioabsorbable sponge.
Indications
- Middle ear surgery.
- Otological procedures.
- Canalplasty.
- Myringoplasty.
- Tympanoplasty.
- Stapes and mastoid surgery
Contraindication
- Hypersensitivity to the packing material.
Articles
| Articles | Purpose |
| Pen torch | To visualize the ear canal. |
| Flexible catheter | To visualize the middle ear. |
| Gel ear pack | To absorb bleeding. |
Ear Packing Procedure
- Explain the procedure to the patient and obtain consent.
- Position the patient comfortably with the affected ear facing upward.
- Inspect the ear canal using an otoscope to assess edema, bleeding, or obstruction.
- Apply topical anesthetic and vasoconstrictor to minimize discomfort and swelling.
- Insert the ear wick or packing gently into the canal using forceps or an applicator.
- For tight canals, moisten the wick with medication to ease insertion.
- Avoid excessive pressure to prevent trauma.
- Instill prescribed drops directly onto the wick to saturate it.
- Document the procedure, including material used, side, patient tolerance, and follow-up plan.
Post-Procedure Care
- Monitor for complications: pain, dizziness, bleeding, or signs of infection.
- Educate the patient:
- Keep the ear dry.
- Avoid inserting objects or manipulating the packing.
- Return for removal or reassessment in 48–72 hours (unless absorbable).
- Consider prophylactic antibiotics if packing is non-absorbable and left in place.
Note:
- Readymade prehydrated spherical packs are available which can be placed into the ear canal.
- Commonly bismuth, iodine, and paraffin paste (BIPP) is used to pack the ear.
Post procedure Guidelines
Activities
- Instruct the patient to avoid strenuous activity such as swimming, sports, gym, heavy exercising, or playing musical instruments that require blowing (trumpet, clarinet, trombone, saxophone, etc.) for at least 1 month after surgery.
- Instruct the patient not to sneeze with his or her mouth open for 5-7 days after surgery.
Diet
- The patient is instructed to take clear liquids at first, and if tolerated, a light food diet can be started on the same day.
- The day after surgery, the patient can resume unrestricted, normal diet as tolerated.
Fever
- A low-grade fever (101°F or less) following surgery may occur and should be treated with paracetamol.
Pain
- Patients will have mild to moderate pain for a few days after surgery and can be treated with paracetamol and ibuprofen.
Showering
- Instruct the patient to place a firm cotton ball in the ear canal and Vaseline on the outside of the cotton ball while rinsing the hair or face in the shower.
- Do not use earplugs for 6 weeks after surgery. For the first week, attempt to sleep either on the back or on the nonoperated side.
Symptoms after Insertion of Ear Pack
- Inform the patient that it is normal to experience dizziness, ringing, dark red, bloody drainage from the ear, and feel of popping and crackling after surgery.
- The patient will not be able to hear well due to gel packing placed in the ear canal and packing will be removed during follow-up visits.
Follow-Up
- The hearing test can be performed after 3 months to 1 year.
- During the visit, the internal packing will be removed.
Special Considerations
- Used in otitis externa to deliver topical antibiotics via ear wicks or ribbon gauze.
- Helps control bleeding after procedures like polypectomy or abscess drainage.
- Smaller canal size requires appropriately sized packing.
- Removal can be distressing—plan for gentle handling or anesthesia if needed.
- Increased risk of mucosal trauma or vagal response.
- Monitor for dizziness, bradycardia, or discomfort.
- Avoid excessive pressure on grafts or healing tissue.
- Use soft, non-adherent materials like silicone-coated wicks.
- Ear wicks, silicone sheets, Gelfoam, BIPP gauze, or Foley catheters (for posterior packing).
- Choose absorbable vs. non-absorbable based on follow-up availability and infection risk.
- Use topical anesthetic and vasoconstrictor (e.g., lidocaine with epinephrine).
- Insert gently to avoid canal trauma.
- Ensure correct depth and orientation.
- Otitis externa, canal stenosis, granulation tissue, or toxic shock syndrome.
- Septal or canal necrosis if packing is too tight or left too long..
- Consider prophylactic antibiotics for non-absorbable packing left >48 hours.
- Educate patients on signs of infection or complications.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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