From the FDA Drug Label
Due to its acidity, which may cause burning and stinging, neomycin and polymyxin B sulfates and hydrocortisone otic solution should not be used in any patients with a perforated tympanic membrane. The FDA drug label does not answer the question about ear tubes (tympanostomy tubes) specifically, but it does mention that the product should not be used in patients with a perforated tympanic membrane.
- Neomycin is not recommended for use in patients with certain ear conditions, but the label does not explicitly address ear tubes.
- The label warns of potential ototoxicity and hearing loss, which could be a concern for patients with ear tubes.
- However, without direct information about ear tubes, a conclusion cannot be drawn. 1
From the Research
Neomycin is not safe to use in patients with ear tubes due to the risk of ototoxicity, and fluoroquinolone ear drops are preferred as first-line treatments. The use of neomycin eardrops in patients with nonintact tympanic membranes, such as those with ear tubes, is controversial due to the potential for ototoxicity 2. A study published in 2013 found that short-term use of neomycin eardrops in patients with nonintact tympanic membranes is not associated with an increased risk of sensorineural hearing loss, but repeated doses showed a significant association with an increased risk of sensorineural hearing loss 2. Another study published in 2012 found that many children with nonintact tympanic membranes receive exposure to neomycin otic preparations, despite the availability of safer alternatives 3. The mechanism of action of neomycin can damage the hair cells in the cochlea when it reaches the inner ear in sufficient concentration, and ear tubes create a direct pathway from the ear canal to the middle ear, increasing the risk of permanent hearing loss.
Some key points to consider when treating patients with ear tubes include:
- The potential for ototoxicity with neomycin use
- The preference for fluoroquinolone ear drops as first-line treatments
- The importance of avoiding neomycin use in patients with ear tubes whenever possible
- The need for careful monitoring and follow-up to prevent and detect potential complications. The study by 2 is the most recent and highest quality study, and its findings support the recommendation to avoid neomycin use in patients with ear tubes.
In terms of treatment options, fluoroquinolone ear drops such as ciprofloxacin or ofloxacin are typically preferred for patients with ear tubes who develop ear infections, as they provide effective antimicrobial coverage without the risk of ototoxicity. A typical regimen might include ciprofloxacin/dexamethasone drops, 4 drops in the affected ear twice daily for 7 days. It is essential to prioritize the safety and well-being of patients with ear tubes and to use the most effective and safest treatment options available.