In an attempt to define the clinical parameters and relevance of ototopical medications, including their usefulness in permanent inner ear damage, a questionnaire survey was sent to 7463 otolaryngologists within the United States, of which 2235 responded. The four main categories were demographic data, patterns of practice, factors influencing use of ototopicals, and opinions/impressions of ototopicals under various circumstances. The vast majority of respondents use ototopical preparations in the presence of a draining perforation (84.1%), in the presence of drainage through a ventilation tube (93.7%), and in the presence of an open, draining tympanomastoid cavity (92.8%). A significant number of clinicians use ototopicals with intraoperative packing (75.3%) and postoperative prophylaxis against infection (57.9%). Eighty percent of respondents indicate that the risks for ototoxicity of otitis media is as great as, or greater than, the risks for ototoxicity of an ototopical preparation. Seventy-five percent of respondents stated that ototopicals are safe in a fresh postoperative ear. Some respondents (3.4%) reported that they had witnessed irreversible inner ear damage unquestionably related to ototopicals.