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© Mat Daniel 2019       

Ear drops and ototoxicity

 

Traditionally, the ear drops that we had available for treating ear infections were based on a group of drugs called aminoglycosides; examples include Gentisone and Sofraxed drops. Aminoglycoside antibiotics can RARELY cause ototoxicity, which means that they could damage hearing or balance. Therefore, we had a conundrum: the ear drops that we use for ear infections could damage hearing!

 

If the ear drum is intact like in otitis externa, the concern doesn't arise because ototoxicity only happens in the inner ear; in otitis externa the infection is in the outer ear, and drops cannot get to the inner ear. But when a patient has a grommet in place or a perforated ear drum, the drops could get to the middle ear and then to the inner ear, and potentially damage hearing or balance.

The ENT professional body addressed the question of potential ototoxicity. It stated:

"ENT-UK recommends that when treating a patient with a discharging ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. etc..."

More recently, we have started using another alternative, ciprofloxacin drops. These were initially available as eye drops only, but are now widely used as ear drops too. They are not ototoxic, so there are no concerns about them damaging hearing or balance in the presence of a grommet or perforated ear drum.

However, it isn't as simple as that. Some bacteria are only sensitive to either aminoglycosides or ciprofloxacin, and may not be sensitive to both. Also, resistance to ciprofloxacin could happen quicker than to aminoglycosides, so potentially more ciprofloxacin use could mean more antibiotic resistance in the future! Certainly most doctors are very cautious about using ciprofloxacin tablets unless there is a really good reason, because it is generally reserved for specific circumstances.

So what does all that mean in practice?

For otitis externa, where infection is confined to the outside of the ear drum, we will use aminoglycosides in majority of patients. There is no risk of ototoxicity here, because the drops won't get to the inner ear.

For infected grommets or perforated ear drums, either aminoglycosides or ciprofloxacin drops are fine. Both are used. Your doctor may well discuss the issue of ototoxicity with you. In some patients, only one choice would be appropriate, in which case there will be little or no choice!

 

If you are using aminoglycosides, please remember that the risk is tiny, their use is supported by the ENT professional body in the UK, and we do need to treat the infection. If we don't treat the infection, that itself could affect hearing! The risks of untreated infection may well be greater than the risk of ototoxicity related to aminoglycosides.

If you are concerned about ototoxicity, then ciprofloxacin may be a better choice for you and your child.

If you have a preference or question, please talk to your treating doctor. The information offered here is generic, and cannot replace individual advice from your doctor tailored to your child.