Question:
Would you use gentamicin ear drops in a person with a history of ear surgery?
Answer given at the time
Yes, if no perforation, and maybe if perforation but only for brief
course (eg. 1 week)
Supplementary:
Should we use Ciprofloxacin eye drops to treat ear infections until
there is a licensed preparation available OR is there a licensed
preparation available in the UK?
For Topic Review and Internet refs see below.
What do others think / do?
J
Topic review:
http://www.dizziness-and-balance.com/disorders/bilat/ototoxic_drops.htm
Potential risk if EITHER perforation or open mastoid cavity eg. post surgical
Potential risk modified by a variety of factors
Risk from aminoglycosides including gentamicin and neomycin, but also
from eg. gential violet and possibly some solvents used in ear drops
One 2011 study suggested docusate (for ear wax) was highly ototoxic.
"Summary:
While ototoxicity from intravenous aminoglycoside administration is
well documented, there is considerable controversy regarding the
significance of ototoxicity from topical preparations. The literature
reviewed here suggests that ear drops containing aminoglycosides
(such as gentamicin or neomycin), can occasionally cause hearing loss
if administered over a long period of time to a person with a
perforated ear drum."
Hain T. C. ENT Surgeon Northwestern University Chicago
http://www.australianprescriber.com/magazine/31/2/40/1
Summary
Ototoxicity is a rare but potentially serious complication of the use
of aminoglycoside and other cochleo-toxic ear drops. This risk is
increased when there is a perforation of the tympanic membrane or a
patent grommet. Until recently, no alternatives to potentially
ototoxic antibiotic ear drops were approved in Australia. The
approval of fluoroquinolone ear drops means that an alternative to
the aminoglycosides is now available for use in the open middle ear.
Guidelines from the Australian Society of Otolaryngology Head and
Neck Surgery state that non-ototoxic antibiotic ear drops are
preferable for the management of a discharging middle ear.
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