A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation
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OTOLOGY
A safe and comparable alternative to BIPP packing following tympanoplasty for tympanic membrane perforation Sheneen Meghji1 · Wahidah Wahid1 · Eyal Schechter2 · Codruta Neumann3 · Aaron Trinidade1 Received: 2 September 2020 / Accepted: 7 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Ear packing · Tympanoplasty · Tympanic membrane perforation
Introduction Packing of the external auditory canal (EAC) following ear surgery is thought to have several benefits, including holding the tympanomeatal flap in place, reducing the risk of post-operative infection and preventing circumferential canal cicatrisation during healing. There are many different ways of packing the EAC and the choice of packing material used varies depending on surgeons’ experience, availability of material, cost, and patient sensitivities. * Aaron Trinidade [email protected] 1
Department of Otolaryngology, Southend University Hospital NHS Foundation Trust, Prittlewell Chase, Westcliff‑on‑Sea, Southend‑on‑Sea SS0 0RY, UK
2
Luton and Dunstable Hospital NHS Trust, Luton, UK
3
East Kent University Hospitals NHS Foundation Trust, Canterbury, UK
The traditional packing used in the UK is ribbon gauze impregnated with bismuth iodoform paraffin paste (BIPP; Aurum Pharmaceuticals Ltd, Romford, UK), but with a 1% iodine hypersensiti
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