Hypersensitive allergic reactions to bismuth-iodoform-paraffin paste following ear surgery

Myoclonus From Intoxication by Bismuth Iodoform Paraffin Paste (BIPP) Nasopharyngeal Packing

Bismuth iodoform paraffin paste (BIPP) gauze is widely used as an antiseptic wound packing in otolaryngology, head, and neck surgery. Uncommonly, BIPP can cause intoxication. Our report highlights an elderly patient who developed encephalopathy and overt myoclonus after nasopharyngectomy secondary to intoxication by the components of the BIPP gauze. The patient’s impaired renal function, the amount of BIPP packing and the extensive nature of his wound likely predisposed him to BIPP toxicity. The myoclonus and delirium resolved promptly after removal of the BIPP packs. Clinicians should be aware of the clinical features of BIPP intoxication because of its common usage.

A pilot randomized controlled trial comparing bismuth iodine paraffin paste external ear pack and no ear pack after middle ear surgery

To pilot a substantive randomized control trial comparing post-operative external ear canal pack with no ear pack after middle ear surgery, 32 adults undergoing primary posterior bony canal wall preserving middle ear surgery were randomized to have either a bismuth iodoform paraffin paste pack or no ear pack post-operatively. Outcome measures included clinician- and patient-recorded visual analogue scale scores for ear signs and symptoms at 3 weeks and 3 months and audiometric findings at 3 months post-operatively. There was no statistically significant inter-group difference in 3-week clinician and patient cumulative scores for ear signs and symptoms. There was also no significant difference in graft take rate, appearance of ear canals and audiometric results in either group at 3 months. No difference in ear symptoms, clinician findings or hearing was demonstrated between patients with a post-operative pack compared to those without a pack following middle ear surgery in this pilot study.

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

AIM

(1) To assess hypersensitivity to bismuth iodoform paraffin paste impregnated ribbon gauze following its use in packing canal wall down mastoidectomy cavities; (2) to determine if isolation of the skin and mucosa from the pack, using thin Silastic sheeting and Cortisporin ointment, reduces hypersensitivity reactions, compared with a previous series; and (3) to review the literature and to determine if bismuth iodoform paraffin paste hypersensitivity precludes the consumption of seafood (due to its high iodine content).

MATERIALS AND METHODS

All patients undergoing canal wall down mastoidectomy with intra-operative bismuth iodoform paraffin paste packing between 1985 and 2009 were identified and reviewed.

RESULTS

Of 587 patients identified, the overall bismuth iodoform paraffin paste reaction rate was 1 per cent. All reactions were in patients undergoing revision mastoidectomy procedures, giving a reaction rate for revision procedures of 2.4 per cent.

CONCLUSION

Reactions are an uncommon event following post-operative mastoid cavity packing using bismuth iodoform paraffin paste. Reaction rates may be lowered by preparing the cavity with Silastic sheeting and Cortisporin ointment prior to packing, thus isolating the skin and mucosal surfaces. Development of such a reaction does not preclude the consumption of seafood.

Bismuth iodoform paraffin paste: a review

Introduction:

This article reviews the literature pertaining to bismuth iodoform paraffin paste.

Overview:

Bismuth iodoform paraffin paste is used in most otolaryngology departments on a daily basis. Questions about its properties are common in postgraduate otolaryngology examinations. This article reviews bismuth iodoform paraffin paste's current and historical usage, constituents, properties, side effects, and radiographic properties, and its alternatives in otological and rhinological practice.

Allergic Reaction to Bismuth-lodoform-Paraffin Paste (BIPP) Following Ear Surgery

Bismuth Iodoform Paraffin Paste (BIPP) impregnated ribbon gauze is one of the most commonly used packs after external and middle ear surgery. Allergic reaction to BIPP is rare. We report two cases of hypersensitive BIPP reaction following tympanoplasty surgery. To our knowledge no such cases have been reported previously in Qatar. We reviewed the literature and discuss the management and its prevention.

Nasal septal cyst: a rare phenomenon

INTRODUCTION

Well-recognized complications of nasal septal surgery i.e. septoplasty or submucous resection (SMR), include septal haematoma, infection, septal perforation and external nasal deformity. Nasal septal cysts are extremely rare in rhinology.

OBJECTIVES

To discuss the underlying aetiological theories, management and strategies for prevention of this very rare complication of a commonly performed rhinological procedure such as SMR.

CASE REPORT

We describe a case of a nasal septal cyst several years after an SMR had been performed, which was excised using an open rhinoplasty approach that has not previously been described for this purpose.

CONCLUSION

Entrapment of free nasal mucosal remnants or inward folding of incised septal mucosa in the submucosal space is postulated as the cause of this phenomenon, leading to the development of this type of "inclusion" cyst. Postoperative nasal packing, especially if traumatic, may exacerbate this. We recommend that anterior nasal packing should be used only if necessary, and packs inserted with care, possibly under endoscopic guidance.

Ear packing after ear surgery: is it really necessary?

OBJECTIVE

We question the need for packing of the ear canal after ear surgery. For several years, it had not been the first author's standard practice to use post-operative ear packing. During this period, few problems or complications had been encountered.

SETTING

Tertiary referral, academic, paediatric hospital.

MATERIALS AND METHODS

A retrospective review of all children who had undergone major ear surgery in our unit over the last year was carried out. These cases represented a full range of otological procedures. Post-operative complications and infections in the first six post-operative weeks were recorded.

RESULTS

A total of 135 ears were operated upon in 107 patients ranging in age from 11 months to 19 years (mean 9.5 years). During this time period, eight children (7.5 per cent) developed a post-operative ear infection. No cases of tympanic or meatal granulations, problems with the tympanomeatal flap, or meatal stenosis were encountered. All infections were successfully managed with topical antibiotics.

DISCUSSION

We conclude that packing after ear surgery may be safely abandoned. This would not only save valuable operating time, but would also obviate the need for pack removal, always a source of discomfort and anxiety. This is especially important in children, who may subsequently require a further general anaesthesia in order to remove the pack.

Facial nerve paralysis: A three year retrospective study

Of all the cranial nerves, the facial nerve is the one which is most commonly involved in disease. Facial paralysis leaves the patient severely disfigured. Timely diagnosis and treatment can lead to considerable recovery. 16 consecutive patients of facial paralysis of all age groups and due to different causes diagnosed and treated in a tertiary referral hospital have been studied retrospectively. The frequency of aetiological factors, the various factors governing the management of these cases and their actual outcomes after a minimum period of one year are discussed. The causes of facial nerve palsy included cholesteatomas, Bell's Palsy, iatrogenic, traumatic, neuroma and others. In general, early reporting, diagnosis and surgical intervention wherever indicated have resulted in better recovery. Surgical decompression of the facial nerve traditionally advocated have been questioned. Rare causes of facial nerve paralysis like postoperative BIPP pack allergy and bilateral congenital agenesis of facial nerve are also included.

Early complications of surgery for chronic otitis media

This audit report details early post-operative complications following surgery for chronic otitis media. One hundred and forty-five cases were assessed. There were no facial nerve palsies, a bone conduction threshold elevation occurred in 4.6 per cent of cases. A wound infection occurred in six per cent of cases as did BIPP allergy. Twenty-six per cent of patients reported symptoms consistent with chorda tympani trauma. Short-lived symptoms of jaw discomfort were reported by 46 per cent of patients and imbalance or vertigo by 10 per cent of patients. The findings are compared with other published reports of complications following ear surgery.