Is it safe to use commercially available polymyxin B, neomycin, and hydrocortisone suspension in routine tympanoplasty?
Background: Over the last couple of decades, there have been questions regarding the use of polymyxin B, neomycin, and hydrocortisone suspension (PNH, Cortisporin, Alcon Manufacturing) in tympanoplasty, specifically regarding potential ototoxicity of neomycin. In 2004, an AAO-HNS–sponsored consensus panel published an evidence-based literature review specifically addressing the potential ototoxicity of topical drops in the middle ear. They recommended use of ototoxic drops only if no non-ototoxic drops are available as an alternative and only in infected ears.
Explore this issue:March 2014
Study design: Case series with chart review.
Setting: Private practice.
Synopsis: The authors of this current study have not clinically witnessed ototoxicity related to PNH. Therefore, they undertook a retrospective chart review of their type I tympanoplasties. Over a 10-year period, 272 ears met their criteria: tympanoplasty only, ears excluded for incomplete follow-up, incomplete audiograms, and drilling (i.e., lateral grafts). The patient age range was 3 to 79 years, with 24.4 years the average age and 15 years the median age, indicating a preponderance of pediatric patients. In each patient, Gelfoam soaked with PNH was used to fill the middle ear and ear canal to support the graft. A post-operative audiogram no sooner than four months was obtained and then compared with pre-operative audiograms. There was no significant change in the audiometric thresholds (500, 1000, 2000, 3000, and 4000 Hz). While recognizing the limitations of their study, the authors concluded that there is grade B evidence that Cortisporin suspension shows no evidence of cochlear ototoxicity when used in tympanoplasty surgery.
Bottom line: Cortisporin use in routine tympanoplasty does not cause cochlear ototoxicity.
Citation: House JR III, House LK. Ototoxicity of polymyxin B, neomycin, and hydrocortisone suspension in tympanoplasty surgery. Otolaryngol Head Neck Surg. 2014;150:282-284.