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Otitis externa - Management
Who should avoid using a topical ear preparation?
- People with (or history of) a local sensitivity reaction should avoid preparations with the same class of drug associated with the reaction. For example, if neomycin is thought to have caused a sensitivity reaction all preparations containing aminoglycosides should be avoided.
- People who have a perforated tympanic membrane should avoid topical aminoglycosides.
Clarification / Additional information
- Sensitivity reactions:
- Prolonged or recurrent use of topical preparations can result in sensitization of the auricle or external auditory canal, leading to an allergic reaction (secondary contact otitis) [Sood et al, 2002].
- This reaction can be caused by the drug itself or excipients found in the vehicle (see Table 1).
- The aminoglycoside, neomycin, is the most common substance in topical ear preparations causing sensitization [Sood et al, 2002; American Academy of Otolaryngology et al, 2006].
- Ototoxicity with aminoglycoside antibiotics:
- The Committee on Safety of Medicines (CSM) advises that topical ear canal treatment with aminoglycosides is contraindicated in people with a tympanic perforation [CSM, 1997].
Table 1. Compounds from topical ear preparations reported to cause sensitization.
Group | Chemicals |
|---|
Antibiotics | Aminoglycosides Neomycin Gentamicin sulphate 1% Framycetin Polymyxin B sulphate Chloramphenicol Bacitracin |
Corticosteroids | Hydrocortisone |
Excipients | Benzethonium chloride (preservative) Benzalkonium chloride 0.1% (preservative) Caine mix Methyl-methacrylate Methyl-p-oxybenzoate (preservative) Methylrosaniline (Gentian violet) Nickel sulphate 5% Propylene glycol (preservative) Quinolone mix 6% Thimerosal merthiolate (preservative) |
|
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