Evidence review and ENT-UK consensus report for the use of aminoglycoside-containing ear drops in the presence of an open middle ear.
Phillips JS., Yung MW., Burton MJ., Swan IR.
UNLABELLED: BACKGROUND AND OBJECTIVES OF REVIEW: The use of aminoglycoside drops in the presence of a perforation/grommet is still a common practice amongst the UK ENT community, in spite of theoretical risk of ototoxicity. Mindful of the need to produce clinical guidelines based on the best available evidence, it was the intention of the Clinical Audit and Practice Advisory Group of the British Association of Otolaryngologists - Head and Neck Surgeons (ENT-UK) to produce evidence-based guidelines. In the absence of good evidence, intentions were shifted towards producing consensus guidelines using validated methodology. TYPE OF REVIEW: Literature review, review of international guidelines and consensus guidelines. SEARCH STRATEGY: A MEDLINE literature search (1966 to August 2006) was conducted, using the following strategies: 'ototoxicity and drops', 'ototoxic and drops', 'vestibulotoxicity and drops', 'vestibulotoxic and drops', 'cochleotoxicity and drops', 'cochleotoxic and drops'. Foreign language articles were not excluded. RESULTS OF THE LITERATURE REVIEW: The inclusion of foreign language articles and manually searching the reference sections of identified articles revealed further evidence not considered in previous reviews on this subject. However, the available 'evidence' that does exist remains to be of poor quality, consisting of data from a number of case reports and small case series. Prospective studies into the ototoxic effects of aminoglycoside ear drops either support their use but lack power to statistically confirm this, or are performed in conditions that are not representative of normal clinical conditions. EVALUATION METHOD: In the light of issues raised from the literature review, a questionnaire was produced. The questionnaire was initially completed by council members of the British Society of Otology, then revised and presented at a meeting of the British Society of Otology, where a consensus panel was formed. CONCLUSIONS: ENT-UK recommends that when treating a patient with a discharging ear, in whom there is a perforation or patent grommet: if a topical aminoglycoside is used, this should only be in the presence of obvious infection. Topical aminoglycosides should be used for no longer than 2 weeks. The justification for using topical aminoglycosides should be explained to the patient. Baseline audiometry should be performed, if possible or practical, before treatment with topical aminoglycosides.