Bismuth iodoform paraffin paste hypersensitivity reactions in mastoid cavities following isolation of mucosal lining: a series of 587 patients

A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation

PURPOSE

To compare two post-operative ear packing methods following tympanoplasty for tympanic membrane perforation.

METHODS

A prospective study of patients undergoing tympanoplasty for tympanic membrane perforation over a 2-year period was undertaken across two district general hospitals. Data, including demographics, pre-operative ear state, and graft type used for repair were recorded. Ears were packed using one of two distinct methods. Pack A: gelatin sponge, chloramphenicol ointment and an antibiotic-soaked ear wick. Pack B: antibiotic-soaked gelatin sponge, bismuth iodoform paraffin paste (BIPP) impregnated gauze dressing. The primary outcome measure was post-operative complications associated with each packing method RESULTS: One hundred and fifty-three tympanoplasties were performed during this period: 68 underwent Pack A and 85 underwent Pack B. Chi squared test showed no significant association between pack type and complication rate (p = 0.572). Univariate analysis suggested that age (p = 0.047) and concurrent bony canaloplasty (p = 0.006) significantly increased complication rates. Pre-operative ear status, indication, graft type and gender did not affect complication rate.

CONCLUSIONS

BIPP-impregnated ribbon gauze and chloramphenicol/wick are both comparable methods for packing an ear following tympanoplasty for tympanic membrane perforation. This is useful information both for surgeons who commonly use BIPP and have a patient with a known iodine allergy, or who is not known to be allergic to iodine but has been packed with BIPP previously, and for those who do not have access to BIPP and wish to use a pack with comparable success.