Is ototopical nystatin ototoxic? A chinchilla model

Drug-Induced Ototoxicity: A Comprehensive Review and Reference Guide

OBJECTIVE

In an era of increasing polypharmacy, adverse drug effects such as ototoxicity have significant public health implications. Despite the availability of evidence, many health care professionals may not know the risk of ototoxicity in common medications. Therefore, the aim of this review is to provide a comprehensive, easy to use, ototoxic profile of medications with an assessment of supporting evidence.

METHODS

Medications of interest were identified through adverse drug reaction reports derived from Micromedex (IBM), Lexicomp (Wolters Kluwer), and the textbook, Drug Induced Diseases: Prevention, Detection, and Management. Additional evidence was identified though a query of PubMed and the Cochrane database. Evidence of causality was graded according to the following: A (randomized, controlled clinical trials), B (nonrandomized clinical trials, prospective observational studies, cohort studies, retrospective studies, case-controlled studies, and/or postmarketing surveillance studies), and C (case reports/case series).

RESULTS

A total of 194 systemically administered medications associated with ototoxicity were identified, most commonly antimicrobials (53), psychotropics (21), antihypertensive/antiarrhythmics (19), nonsteroidal antiinflammatory drugs (18), and antineoplastics (16). There was evidence of cochleotoxicity in 165 medications (evidence grading A [22], B [77], C [69]), vestibulotoxicity in 100 medications (evidence grading A [23], B [47], and C [30]), and dizziness in 142 medications (evidence grading A [50], B [76], and C [16]). In addition, a review of the evidence of ototoxicity in ototopical medications is also reviewed.

CONCLUSION

The effect and severity of ototoxicity can vary immensely depending on pharmacological and individual patient risk factors. The intent of this comprehensive review was to help health care providers of all sectors obtain a deeper knowledge of drug-induced ototoxicity to make more informed management decisions for their patients.

Ototoxicity of olive oil in a chinchilla animal model

OBJECTIVES/HYPOTHESIS

Olive oil is often used by patients to soften ear wax or to relieve ear canal obstruction. It is also sold in drugstores as a cerumenolytic. To date, no study has assessed the safety of ototopical olive oil on hearing in the presence of tympanic membrane perforation. The present study aimed to assess the safety of ototopic olive oil on hearing in the presence of tympanic membrane perforation.

STUDY DESIGN

Prospective, randomized, controlled trial in a chinchilla animal model.

MATERIALS AND METHODS

Eleven chinchillas underwent bilateral myringotomy. In each animal, one ear was randomly assigned to receive olive oil (experimental ear), while the contralateral control ear received normal saline. Auditory brain response (ABR) test was performed at baseline and then 7, 14, and 30 days following the application.

RESULTS

At 30 days follow-up, there was no significant change in auditory brain response thresholds at 8, 16, 20, or 25 kHz. Scanning electron microscope imaging showed no damage to the hair cells.

CONCLUSION

Olive oil does not seem to cause hearing loss in chinchillas with perforated tympanic membranes. Future clinical studies are required.

Topical treatment of chronic suppurative otitis media

Chronic suppurative otitis media (CSOM) is a chronic inflammation of the middle ear and mastoid cavity presenting with ear discharge or otorrhea through a non-intact tympanic membrane. CSOM is the most common cause of childhood hearing impairment in developing countries. Accurate diagnosis depends on a high index of suspicion, micro-otoscopic examination, and judicious use of imaging as required. CSOM can be classified into 3 types: tubotympanic, atticoantral, and post-tympanostomy tube insertion. Aerobes, anaerobes and fungi are all potential pathogens in CSOM. This review summarizes the results of recent studies on the bacteriology of CSOM, biofilms, and the role of the nasopharynx pathogens that may have important implications for the treatment of this important pathology; that is often associated with misdiagnosis or delayed diagnosis. Particular emphasis will be placed on topical treatment options including choices of antibiotic, antifungal, and antiseptic agents, delivery technique, spectrum of activity, and risk of ototoxicity.