To the Editor: Systemic ototoxicity secondary to the use of aminoglycosides is well known in clinical medicine, and appropriate monitoring measures to prevent vestibulo-cochlear ototoxicity are routinely performed. Less well known is the potential for topical ear drops, particularly the aminoglycoside group, to cause both vestibular and cochlear damage when introduced through a patent grommet or tympanic membrane perforation for the treatment of infection.1 Although the incidence of aminoglycoside ototoxicity with ear drops is uncommon (for cochlear toxicity, in the order of one in 10 000 patients treated2), individual susceptibility and patient compliance problems may lead to inner ear damage.
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- 1. Couzos S, Lea T, Mueller R, et al. Effectiveness of ototopical antibiotics for chronic suppurative otitis media in Aboriginal children: a community based, multicentre, double-blind randomised controlled trial. Med J Aust 2003; 179: 185-190. <MJA full text>
- 2. Roland PS. Clinical ototoxicity of topical antibiotic drops. Otolaryngol Head Neck Surg 1994; 110: 598-602.
- 3. American Academy of Otolaryngology — Head and Neck Surgery. Efficacy and safety of topical antibiotics in the treatment of ear disease: consensus panel update 2004. Otolaryngol—Head Neck Surg 2004; 130: S51-S94.
- 4. Committee on Safety of Medicines. Reminder: ototoxicity with aminoglycoside eardrops. Curr Prob Pharmacovigilance 1997; 23: 14.
- 5. Pilla NJ, Rosser WW, Pennie RA, and the Anti-Infective Review Panel. Anti-infective guidelines for community acquired infections. Toronto: MUMS Guidelines Clearinghouse, 2001: 15.
Zoran Becvarovski, Harvey Coates, and Christopher Perry received honoraria for attendance at scientific meetings sponsored by Alcon Laboratories, which maufactures ciprofloxacin ear drops.