The use of topical ototoxic drugs in chronic otitis media.

The supplement to the January 2003 EAR, NOSE & THROAT JOURNAL (Volume 82, Suppl 1) should be of great value to any physician who treats otitis media. John Rutka, MD, and David S. Haynes, MD, with Supplement Editor Peter S. Roland, MD, provide a well-documented and reasoned discussion of the recently created controversy on the pros and cons of the use of topical aminoglycosides in the presence of a tympanic membrane perforation.

In a debate format, Dr. Rutka describes the theoretical reasons against the use of these drugs that, in some cases, have ototoxic properties. He points out that some of the newer topical agents are safer and as effective. Dr. Haynes takes the side for continued use of the topical aminoglycosides in the presence of a tympanic membrane perforation accompanied by otorrhea. In an extensive review of the literature, he finds that there are very few cases reported in which aminoglycoside-containing drops have been implicated as a cause of ototoxicity when used to treat chronic ear disease. He describes the report of a survey of 2,235 otolaryngologists, 94% of whom use ototoxic agents to treat post-tympanostomy tube otorrhea, and 75% of whom use them intraoperatively. He explains that in the 1990s; the manufacturer of polymyxin/neomycin/hydrocorctisone otic suspension reported that it had sold 1.5 million bottles over a 2-year period. He concludes that aminoglycoside-containing drops, although having some potential for ototoxicity, continue to be used widely and can be prescribed with confidence.

Polymyxin/neomycin/hydrocortisone in an aqueous suspension has been used by otologists for more than 40 years with success, and with more safety than is expected with most other drugs. There is no good reason to stop using this time-proven treatment now. It has been and continues to be used by otologists in surgery to saturate Gelfoam placed in the tympanum and external auditory canal during tympanoplasty. Good judgment dictates that it is not used when there is a canal fistula or round or oval window fistula.

There is no question that the addition of new antibiotics and otic drops improves our ability to cure more patients, just as the introduction of gentamicin and carbenicillin radically changed the previously universally fatal course of malignant otitis externa. Every doctor who treats otitis media will want to keep this supplement close at hand.

JACK L. PULEC, MD

Editor-in-Chief

EAR, NOSE & THROAT JOURNAL