Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 Articles
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2022
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Health and Drug Alerts

Ototoxic effects from gentamicin ear drops

Eric Wooltorton
CMAJ July 09, 2002 167 (1) 56;
Eric Wooltorton
Editorial Fellow
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading

Reason for posting: Gentamicin ear drops can cause serious side effects (e.g., vertigo, imbalance, ataxia, oscillating vision, hearing loss and tinnitus) when used by patients with perforated tympanic membranes or tympanostomy tubes.1 Despite previous warnings2,3,4 ototoxic adverse events continue to occur. The incidence of such events is unknown, but 20 cases have been reported in Canada since 1981,5 with 17 involving vestibular disorders and 3 involving hearing loss. In most cases the conditions being treated were middle-ear disorders with otorrhea; in 1 case gentamicin ear drops were being given to treat Ménière's disease (along with high-dose intratympanic gentamicin infusions). Six patients had used the drops for no more than 5–7 days. The damage was often persistent: in 16 patients the symptoms had not resolved at the time the case was reported to Health Canada.5

The drug: Several preparations of topical gentamicin sulfate solution are marketed in Canada to treat superficial ear and eye infections. Indications for otic preparations include otitis externa6 (“swimmer's ear”). Preparations that include a steroid (e.g., betamethasone) are indicated for acute otitis externa, eczematoid dermatitis, seborrheic dermatitis and contact dermatitis with secondary infection6 and are often prescribed for off-label use to treat chronic suppurative otitis media.7 Prolonged use of these combination topical agents can result in a secondary fungal infection and mycelial plug,7 and use of any gentamicin ear drops can lead to the development of aminoglycoside-resistant organisms.8

Although the risk of ototoxic effects from aminoglycoside otic preparations has long been recognized,9 its importance may have previously been underappreciated. In a survey of 2235 otolaryngologists in the early 1990s, 84% reported using ototopical agents in the presence of a perforated tympanic membrane, and only 3.4% reported having witnessed irreversible ear damage caused by such agents.10

What to do: Acute and uncomplicated otitis externa is often prevented with a few drops of vinegar in each ear after swimming and can be treated with an antiseptic solution such as aluminum acetate.7 When gentamicin ear drops are indicated otoscopic examination is essential, because aminoglycoside ear drops are contraindicated in patients with a perforated tympanic membrane (including those with tympanostomy tubes). The treatment duration should be as short as possible, often less than 7 days, and the drug should be stopped immediately if ototoxic symptoms develop. Patients should be assessed for adverse effects after the first 5–7 days of use, and regularly thereafter if treatment is prolonged. Audiometric assessment is not an appropriate screening tool for ototoxicity,11 because ototoxic effects of topical gentamicin solutions appear to be primarily vestibular rather than cochlear.3,4 Although ototoxicity in patients with intact tympanic membranes has not yet been reported, patients taking the drug for chronic otitis media often systemically absorb detectable levels of the drug.11 Thus, it may be appropriate to warn all patients taking gentamicin ear drops of possible ototoxic effects. When a topical agent is required in patients with a perforated tympanic membrane, non-ototoxic ear drops such as ciprofloxacin solution may preferable.

Eric Wooltorton CMAJ Editorial Fellow

References

  1. 1.↵
    Important safety information: Garasone/ Garamycin [Dear Healthcare Professional Letter]. Pointe-Claire (QC): Schering Canada Inc.; 2002 May 30. Available: www.hc-sc.gc.ca/hpb-dgps/therapeut/htmleng/adviss_ind_e.html (accessed 2002 June 13).
  2. 2.↵
    Hélal A. Aminoglycoside ear drops and ototoxicity. Can ADR Newsl 1997;7(2):3. (Also in CMAJ 1997;156[7]:1056.)
    OpenUrl
  3. 3.↵
    Marais J, Rutka JA. Ototoxicity and topical ear drops. Clin Otolaryngol 1998;23(4):360-7.
    OpenUrlCrossRefPubMed
  4. 4.↵
    Bath AP, Walsh RM, Bance ML, Rutka JA. Ototoxicity of topical gentamicin preparations. Laryngoscope 1999;109:1088-93.
    OpenUrlCrossRefPubMed
  5. 5.↵
    Stockwell M. Gentamicin ear drops and ototoxicity: update. Can Adverse Drug Reaction Newsl 2001; 11(1):3-4. (Also in CMAJ 2001;164[1]:93-4.)
    OpenUrl
  6. 6.↵
    Garamycin Ophthalmic/Otic Preparations and Garasone Ophthalmic/Otic Preparations. In: Compendium of Pharmaceuticals and Specialties; Ottawa: Canadian Pharmacists Association; 2002. p. 686-7.
  7. 7.↵
    Ontario Anti-infective Review Panel. Anti-infective guidelines for community-acquired infections. 2nd ed. Toronto: Publications Ontario; 2001.
  8. 8.↵
    Clayton MI, Osborne JE, Rutherford D, Rivron RP. A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in treatment of otorrhea. Clin Otolaryngol 1990;15:7-10.
    OpenUrlCrossRefPubMed
  9. 9.↵
    Morizono T, Johnstone BM Ototoxicity of topically applied gentamicin using a statistical analysis of electrophysiological measurement. Acta Otolaryngol 1975;80:389-93.
    OpenUrlCrossRefPubMed
  10. 10.↵
    Lundy LB, Graham MD. Ototoxicity and ototopical medications: a survey of otolaryngologists. Am J Otol 1993;14:141-6.
    OpenUrlPubMed
  11. 11.↵
    Lancaster JL, Mortimore S, McCormick M, Hart CA. Systemic absorption of gentamicin in the management of active mucosal chronic otitis media. Clin Otolaryngol 1999;24(5):435-9.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

CMAJ
Vol. 167, Issue 1
9 Jul 2002
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Ototoxic effects from gentamicin ear drops
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Ototoxic effects from gentamicin ear drops
Eric Wooltorton
CMAJ Jul 2002, 167 (1) 56;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Ototoxic effects from gentamicin ear drops
Eric Wooltorton
CMAJ Jul 2002, 167 (1) 56;
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Nefazodone (Serzone) withdrawn because of hepatotoxicity
  • Safety updates: repaglinide (GlucoNorm) and bicalutamide (Casodex)
  • Paroxetine (Paxil, Seroxat): increased risk of suicide in pediatric patients
Show more Health and Drug Alerts

Similar Articles

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
  • Accessibiity
  • CMA Civility Standards
CMAJ Group

Copyright 2022, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: cmajgroup@cmaj.ca

Powered by HighWire