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Bismuth iodoform paraffin paste: a review

  • G J Crossland (a1) and A P Bath (a2)



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


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.


Corresponding author

Address for correspondence: Mr G J Crossland, Otology Fellow, Box 48, Clinic 10, Addenbrooke's Hospital, Cambridge CB2 0QQ, UK Fax: +44 (0)1223 217559 E-mail:


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1PubMed. In: [13 February 2011]
2Morison, JR. BIPP Treatment of War Wounds. London, Henry Frowde: Hodder & Stoughton, 1918
3Fleming, A. The action of chemical and physiological antiseptics in a septic wound. Br J Surg 1919;7:99129
4Gurd, FB, McKim, LH. B.I.P.P. and liquid paraffin treatment of war and civilian wounds. Ann Surg 1941;113:9871000
5Garrett Anderson, L, Chambers, H. The treatment of septic wounds with bismuth iodofrom paraffin paste. Lancet 1917;i:331–3
6Tilley, H. A series of consecutive cases in which the mastoid has been operated on for acute suppurative inflammation, B.I.P. (bismuth, iodoform, and liquid paraffin) inserted, and the external wound sutured in its entire length at the close of the operation. Proc R Soc Med 1918;11:6976
7Kampmeier, RH. Syphilis therapy: an historical perspective. J Am Vener Dis Assoc 1976;3:99108
8Chambers, S, Goldsmith, JN. The bacteriological and chemical action of bismuth iodoform paraffin paste. Lancet 1917;i:333–5
9Nordberg, G. Handbook on the Toxicology of Metals, 3rd edn.Oxford: Academic, 2007;433–43
10Wilson, AP. The dangers of BIPP. Lancet 1994;344:1313–14
11Robinson, HM. An evaluation of the bismuth blue line. J Invest Dermatol 1952;18:341–64
12Le Quesne, PM. Metal-induced diseases of the nervous system. Br J Hosp Med 1982;28:534–8
13Youngman, L, Harris, S. BIPP madness; an iatrogenic cause of acute confusion. Age Ageing 2004;33:406–7
14Bunn, HF, Forget, BG. Hemoglobin: Molecular, Genetic and Clinical Aspects. Philadelphia: WB Saunders, 1986;634–62
15Barker, SJ, Tremper, KK, Hyatt, J. Effects of methemoglobinemia on pulse oximetry and mixed venous oximetry. Anesthesiology 1989;70:112–17
16Marcus, H, Joffe, JR. Nitrate methemoglobinemia. N Engl J Med 1949;240:599602
17Nigam, A, Ruddy, J, Robin, PE. BIPP induced methaemoglobinaemia. J Laryngol Otol 1991;105:78–9
18Nigam, A, Allwood, MC. BIPP – how does it work? Clin Otolaryngol Allied Sci 1990;15:173–5
19O'Connor, AF, Freeland, AP, Heal, DJ, Rossouw, DS. Iodoform toxicity following the use of B.I.P.P.: a potential hazard. J Laryngol Otol 1977;91:903–7
20Farrell, RW. Dangers of bismuth iodoform paraffin paste. Lancet 1994;344:1637–8
21Lim, PV, Hughes, RG, Oates, J. Hypersensitive allergic reactions to bismuth-iodoform-paraffin paste following ear surgery. J Laryngol Otol 1998;112:335–7
22Bennett, AM, Bartle, J, Yung, MW. Avoidance of BIPP allergy hypersensitivity reactions following ear surgery. Clin Otolaryngol 2008;33:32–4
23Jones, PH. BIPP allergy causing facial paralysis. J Laryngol Otol 1985;99:389–90
24Loescher, AR, Robinson, PP. The effect of surgical medicaments on peripheral nerve function. Br J Oral Maxillofac Surg 1998;36:327–32
25Imison, A. BIPP aspiration. Anaesth Intensive Care 2000;28:335–6
26Flook, E, Elloy, M, Johnston, M. Meatoplasty technique which avoids using a roll of BIPP. Clin Otolaryngol 2008;33:179–80
27Chevretton, EB, McRae, RD, Booth, JB. Mastoidectomy packs: Xeroform or BIPP? J Laryngol Otol 1991;105:916–17
28Corbridge, RJ, Djazaeri, B, Hellier, WP, Hadley, J. A prospective randomized controlled trial comparing the use of merocel nasal tampons and BIPP in the control of acute epistaxis. Clin Otolaryngol Allied Sci 1995;20:305–7
29Saab, M, Randall, PE. Nasal packing for epistaxis: two methods compared. Eur J Emerg Med 1997;4:44
30McDonald, SE, Slater, J, Powell, R, Khalil, HS, Garth, RJ. A randomised controlled trial comparing Rapid Rhino Mannheim and Netcell series 5000 packs following routine nasal surgery. Rhinology 2009;47:41–4
31Badran, K, Malik, TH, Belloso, A, Timms, MS. Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis. Clin Otolaryngol 2005;30:333–7
32Moumoulidis, I, Draper, MR, Patel, H, Jani, P, Price, T. A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. Eur Arch Otorhinolaryngol 2006;263:719–22
33Bajaj, Y, Kanatas, AN, Carr, S, Sethi, N, Kelly, G. Is nasal packing really required after septoplasty? Int J Clin Pract 2009;63:757–9
34Ozcan, C, Vayisoglu, Y, Kilic, S, Gorur, K. Comparison of Rapid Rhino and Merocel nasal packs in endonasal septal surgery. J Otolaryngol Head Neck Surg 2008;37:826–31
35Lim, M, Lew-Gor, S, Sandhu, G, Howard, D, Lund, VJ. Whitehead's varnish nasal pack. J Laryngol Otol 2007;121:592–4
36McGlashan, JA, Walsh, R, Dauod, A, Vowles, A, Gleeson, MJ. A comparative study of calcium sodium alginate (Kaltostat) and bismuth tribromophenate (Xeroform) packing in the management of epistaxis. J Laryngol Otol 1992;106:1067–71
37Kamer, FM, Parkes, ML. An absorbent, non-adherent nasal pack. Laryngoscope 1975;85:384–8
38Chandra, RK, Conley, DB, Kern, RC. The effect of FloSeal on mucosal healing after endoscopic sinus surgery: a comparison with thrombin-soaked gelatin foam. Am J Rhinol 2003;17:51–5
39Cote, D, Barber, B, Diamond, C, Wright, E. FloSeal hemostatic matrix in persistent epistaxis: prospective clinical trial. J Otolaryngol Head Neck Surg 2010;39:304–8
40Mathiasen, RA, Cruz, RM. Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in patients with acute anterior epistaxis. Laryngoscope 2005;115:899902
41Cote, DW, Wright, ED. Triamcinolone-impregnated nasal dressing following endoscopic sinus surgery: a randomized, double-blind, placebo-controlled study. Laryngoscope 2010;120:1269–73
42Shoman, N, Gheriani, H, Flamer, D, Javer, A. Prospective, double-blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery. J Otolaryngol Head Neck Surg 2009;38:112–18
43Bhatnagar, RK, Berry, S. Selective Surgicel packing for the treatment of posterior epistaxis. Ear Nose Throat J 2004;83:633–4
44Amen, F, Pace-Balzan, A. Technical tutorial: how to pack a nose with bismuth iodoform paraffin paste gauze safely and effectively. Emerg Med J 2009;26:52
45Pettineo, CM, Vozenilek, JA, Kharasch, M, Wang, E, Aitchison, P. Epistaxis simulator: an innovative design. Simul Healthc 2008;3:239–41
46Thomas, S, Pringle, M. The use of airway mannequins to improve the teaching of nasal packing. Clin Otolaryngol 2006;31:563–4
47Skilbeck, CJ, Oakley, R. The fist model for nasal packing. Eur J Emerg Med 2006;13:97–8
48Bernstein, JM, Aucott, W. The BIPP introducer. Clin Otolaryngol 2009;34:402–3
49Hartley, C, Ng, KL, Jackson, A. CT and MR appearance of otolaryngologic packing materials. AJNR Am J Neuroradiol 1995;16:1697–702
50Christensen, NP, Smith, DS, Barnwell, SL, Wax, MK. Arterial embolization in the management of posterior epistaxis. Otolaryngol Head Neck Surg 2005;133:748–53
51Stanbury, JB, Ermans, AE, Bourdoux, P, Todd, C, Oken, E, Tonglet, R et al. Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid 1998;8:83100
52Wolff, J. Iodide goiter and the pharmacologic effects of excess iodide. Am J Med 1969;47:101–24
53Bachrach, LK, Burrow, GN, Gare, DJ. Maternal-fetal absorption of povidone-iodine. J Pediatr 1984;104:158–9
54Herbst, AL, Selenkow, HA. Hyperthyroidism during pregnancy. N Engl J Med 1965;273:627–33
55Braverman, LE, Ingbar, SH. Changes in thyroidal function during adaptation to large doses of iodide. J Clin Invest 1963;42:1216–31
56Melvin, GR, Aceto, T Jr, Barlow, J, Munson, D, Wierda, D. Iatrogenic congenital goiter and hypothyroidism with respiratory distress in a newborn. S D J Med 1978;31:1519
57Moosa, A, Williams, F. Congenital iodide goitre – a continuing iatrogenic problem. S Afr Med J 1977;51:490


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Bismuth iodoform paraffin paste: a review

  • G J Crossland (a1) and A P Bath (a2)


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