Are Cortisporin (neomycin and polymyxin B) ear drops safe for otitis media?

Cortisporin Ear Drops for Otitis Media: Safety Concerns and Alternatives

Cortisporin (neomycin and polymyxin B) ear drops are not safe for otitis media when the tympanic membrane is perforated due to risk of permanent sensorineural hearing loss. 1

Safety Concerns with Cortisporin in Otitis Media

Ototoxicity Risk

• Neomycin can induce permanent sensorineural hearing loss due to cochlear damage, primarily through destruction of hair cells in the organ of Corti 1
• Cortisporin should not be used in any patients with a perforated tympanic membrane due to its acidity, which may cause burning and stinging 1
• Laboratory studies have demonstrated that Cortisporin is highly toxic to cochlear outer hair cells 2, 3
• Direct application of Cortisporin to the middle ear in animal studies resulted in:
  • Degeneration of all inner and outer hair cells throughout the cochlea
  • Severe damage to the stria vascularis
  • Moderate to severe degeneration of vestibular receptor organs 4

Additional Concerns

• Neomycin can cause cutaneous sensitization with an incidence of 13-30% on patch testing in patients with chronic otitis externa 5
• Prolonged use may result in overgrowth of nonsusceptible organisms, including fungi 1
• Contains potassium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms 1

Recommended Alternatives

Quinolone Ear Drops

• Quinolone ear drops (such as ofloxacin) have not shown ototoxicity even when used with non-intact tympanic membranes 5, 6
• Quinolone ear drops are recommended in the United States over systemic treatment for otitis media with tympanic membrane perforation 5
• Ear drops containing a combination of antibiotics and corticosteroid are the most clinically effective and cost-effective management strategy in children developing uncomplicated, acute ear discharge 5

Comparative Efficacy and Safety

• Clinical trials have shown that ofloxacin otic solution is as effective as Cortisporin for treating ear infections, with comparable cure rates 7, 8
• Ofloxacin otic solution does not have the risk of ototoxicity associated with neomycin and provides effective pain relief without the risks associated with Cortisporin 7

Treatment Algorithm for Otitis Media with Discharge

1. Assess tympanic membrane integrity

   • If tympanic membrane is perforated or patient has tympanostomy tubes:
     • Avoid Cortisporin and other neomycin-containing products
     • Use quinolone ear drops (e.g., ofloxacin) as first-line treatment

2. Administration of ear drops

   • Clean ear canal of debris before administration for optimal results 6
   • Limit therapy to a single course of no more than 10 days to prevent fungal overgrowth 6, 1

3. Monitoring

   • Watch for signs of sensitization or irritation (reddening, swelling, dry scaling, itching)
   • Discontinue immediately if these occur 1
   • If infection does not improve after 1 week, obtain cultures and susceptibility tests 1

Special Considerations

• Allergic cross-reactions may occur with kanamycin, paromomycin, streptomycin, and possibly gentamicin 1
• For children with tympanostomy tubes or tympanic membrane perforation, quinolone ear drops are safer and equally effective compared to Cortisporin 6, 7

Remember that the primary concern with Cortisporin in otitis media is the potential for permanent hearing loss if the tympanic membrane is not intact, making quinolone ear drops a safer alternative with comparable efficacy.