Both My Ears are Swollen: Bismuth Iodoform Paraffin Paste (BIPP) Delayed Hypersensitivity Reaction Following Otological Surgery

Document Type : Case report

Authors

1 Department of Otorhinolaryngology Head and Neck Surgery, 1Hospital Sultan Idris Shah, Serdang, Selangor,

2 Hospital Sungai Buloh, Selangor, Malaysia

3 Department of Otorhinolaryngology Head and Neck Surgery, 1Hospital Sultan Idris Shah, Serdang, Selangor

4 3Faculty of Medicine UKM

5 HOSPITAL SULTANAH NORA ISMAIL JALAN KORMA TAMAN SOGA 83000 BATU PAHAT, JOHOR

Abstract

Introduction: Ribbon gauze impregnated with Bismuth Iodoform Paraffin Paste (BIPP) is commonly used for packing following surgical procedures in otorhinolaryngology, especially aural, nasal, and maxillofacial procedures. Unfortunately, BIPP can cause delayed hypersensitivity reactions albeit it is a rarity. To the best of our knowledge, no such cases have been reported previously in Malaysia. We present a case report regarding a delayed hypersensitivity reaction that occurred following mastoidectomy.
Case Report: A 30-year-old Chinese man with no known allergy and a history of right mastoid surgery 8 years ago for chronic suppurative otitis media with cholesteatoma. The left ear was normal on the first presentation. He was then presented again with bilateral ear discharge for the past 1 year. Upon assessment, bilateral cholesteatoma was noted and he underwent an endoscopic right ear examination with lowering of the right facial ridge and a modified radical mastoidectomy of the left ear. The surgery done for both ears went well and both ears were packed with BIPP. The patient was discharged on the third postoperative day. Unfortunately, he came back 2 days later due to painful left ear swelling which progressed to involving both ears the following day. The condition resolved completely one day after the removal of both BIPP packing.
Conclusion: Our case highlights the occurrence of a hypersensitivity reaction following BIPP packing. Although it is rare, it should be considered especially in patients with a history of exposure to BIPP.

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