title: Bismuth iodoform paraffin paste hypersensitivity reactions in mastoid cavities following isolation of mucosal lining: a series of 587 patients.
abstract: OBJECTIVE
  (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).
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Otolaryngology, Division of Otology/Neurotology, Toronto General Hospital, Ontario, Canada. chriscoulson1@gmail.com
authors.forename: C J
authors.initials: CJ
authors.lastname: Coulson
authors.forename: D D
authors.initials: DD
authors.lastname: Pothier
authors.forename: P
authors.initials: P
authors.lastname: Lai
authors.forename: J A
authors.initials: JA
authors.lastname: Rutka
mesh_terms: D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D001458:Bandages; D001729:Bismuth / Q000009:adverse effects / Q000627:therapeutic use*; D004338:Drug Combinations; D004342:Drug Hypersensitivity / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006847:Hydrocarbons, Iodinated / Q000009:adverse effects / Q000627:therapeutic use*; D006854:Hydrocortisone / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods; D008416:Mastoid / Q000276:immunology / Q000601:surgery; D009092:Mucous Membrane; D009355:Neomycin / Q000627:therapeutic use; D010032:Otitis Externa / Q000276:immunology; D010035:Otitis Media, Suppurative / Q000601:surgery* / Q000628:therapy; D013506:Otologic Surgical Procedures; D011112:Polymyxin B / Q000627:therapeutic use; D011182:Postoperative Care / Q000379:methods; D012086:Reoperation; D017747:Seafood / Q000009:adverse effects
chemical_list: D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D006847:Hydrocarbons, Iodinated; C045757:bismuth iodoform paraffin paste; C033225:hydrocortisone, neomycin, polymyxin B drug combination; D009355:Neomycin; D011112:Polymyxin B; D001729:Bismuth; D006854:Hydrocortisone