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Family Medicine (Expert Forum)
Cortisporin Ototoxicity
Answered by
Kevin Pho, MD - Internal Medicine
KevinMD.com
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Cortisporin Ototoxicity
by samroad, Sep 11, 2005 12:00AM
Hello,
My Dr. has prescribed me Cortisporin (neomycin, polymyxin b and hydrocortisone) for otitis externa.
In doing research I found that neomycin is extremely ototoxic (and permanently so), and am therefore very surprised that it is used as a topical solution applied directly to the ear canal.
From what I've read the greatest risk appears to be when used in someone with a perforated eardrum because that allows the drug to enter the inner ear where it does damage (is this correct?). However, some of the literature I've found online suggests ototoxicity has been reported when using topical neomycin even in the absence of a perforated eardrum, but it seems the jury is out on a definitive answer.
I'm thinking of asking my Dr. to switch to Cipro HC Otic, but am concerned about potential damage from the few doses ( 8 drops total in one ear) of Cortisporin I've already taken.
In addition, one study stated that ototoxicity may occur for a long time after topical administration as neomycin applied topically is cleared from the inner ear very slowly and can basically stay in the ear and do damage for a protracted amount of time.
My questions are:
1. Does ototoxicity only occur when neomycin enters the inner ear?
2. If so, what is the likelihood of the solution entering the inner ear of someone without a perforated eardrum?
3. What is the likelihood I may have sustained any ototoxicity from a day of usage, even so minor that it can only be measured by very sensitive testing?
I realize I may seem like a hypochondriac about this given it is a common treatment, but nonetheless that does not console me because there seems to be a real documented risk. Music is my life and I'd rather lose my sight than even the slightest amount of hearing/balance function. Thank you and I look forward to your input.
Doctor's Answer
by Kevin Pho, MD, Sep 12, 2005 12:00AM
, Sep 12, 2005 12:00AM
To answer your question:
1) I believe that the ototoxicity occurs in the oral, not topical, form. From a drug information database here are the side effects:
"Oral:
>10%: Gastrointestinal: Nausea, diarrhea, vomiting, irritation or soreness of the mouth or rectal area
<1% (Limited to important or life-threatening): Dyspnea, eosinophilia, nephrotoxicity, neurotoxicity, ototoxicity (auditory), ototoxicity (vestibular)
Topical: >10%: Dermatologic: Contact dermatitis"
2) It would be unlikely for the medication to enter the ear without a perforated eardrum.
3) It also would be unlikely for ototoxicity to occur from topical cortisporin.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
1) I believe that the ototoxicity occurs in the oral, not topical, form. From a drug information database here are the side effects:
"Oral:
>10%: Gastrointestinal: Nausea, diarrhea, vomiting, irritation or soreness of the mouth or rectal area
<1% (Limited to important or life-threatening): Dyspnea, eosinophilia, nephrotoxicity, neurotoxicity, ototoxicity (auditory), ototoxicity (vestibular)
Topical: >10%: Dermatologic: Contact dermatitis"
2) It would be unlikely for the medication to enter the ear without a perforated eardrum.
3) It also would be unlikely for ototoxicity to occur from topical cortisporin.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
http://www.straightfromthedoc.com
