Ototoxicity of Ototopical Dropsdan Update David S
Otolaryngol Clin N Am 40 (2007) 669–683 Ototoxicity of Ototopical DropsdAn Update David S. Haynes, MDa,*, John Rutka, MD, FRCSCb, Michael Hawke, MD, FRCSCb, Peter S. Roland, MDc aThe Otology Group of Vanderbilt, Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Medical Center East S. Tower 7209, 1215 21st Avenue South, Nashville, TN 37232-5555, USA bDepartment of Otolaryngology, University of Toronto, 190 Elizabeth Street, Room 3S438, Fraser Elliot Building, Toronto, Ontario M5G 2N2, Canada cDepartment of OtolaryngologydHead and Neck Surgery, The University of Texas Southwestern Medical Center, Dallas, TX, USA Topical antibiotic solutions are frequently indicated in patients who have external or middle ear infections. It is well known that any substance that can enter the middle ear can access the inner ear via the permeability of the round window membrane (RWM) (and theoretically the annular liga- ment of the stapes/microfractures of the otic capsule), where it may cause adverse effects to the cochlear and vestibular apparatus [1]. The actual po- tential for ototoxicity of these ototopical preparations has been a subject of considerable debate. The introduction of non-ototoxic fluoroquinolone ear drops in 1997–1998, recent literature regarding the possible issues of unrecognized ototoxicity from ototopical preparations, and increasing litigation from alleged inappropriate use of ototopical drops has garnered significant attention among practitioners on the subject of ototoxicity from ototopical preparations. This ongoing debate led the American Acad- emy of Otolaryngology–Head and Neck Surgery (AAO-HNS) to convene expert panels to review this issue and address the issue of ototoxicity of ototopical preparations and make an evidence-based recommendation regarding their use [2].
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