Ototoxicity and topical eardrops

TLDR

Topical aminoglycoside ear drops are potentially ototoxic when used in the presence of a tympanic membrane perforation. The authors reviewed 12 documented cases of prolonged topical gentamicin-containing ear drops (Garasone®) and an additional nine cases from the literature. Vestibular toxicity predominated, with severe bilateral disability often leading to litigation, whereas unilateral cases typically compensated.

Abstract

Topical aminoglycoside ear drops are theoretically acknowledged to be potentially ototoxic when administered in the presence of a tympanic membrane perforation. Although the development of clinical ototoxicity appears to be rare, nine well-documented and incontrovertible cases (12 ears in total) of iatrogenic topical vestibulotoxicity are presented, representing the largest series in the English language world literature to date. All patients were treated with the topical gentamicin-containing ear drops Garasone®, (betamethasone sodium phosphate and gentamicin sulphate) for prolonged periods. Toxicity was found to be primarily vestibular rather than cochlear. Further review of five previously reported cases in addition to the findings from another four patients identified with topical ototoxicity are described. Although compensation occurred in unilateral cases the disability in bilateral cases was typically severe and often resulted in litigation.