Is Locacorten Safe with Ear Drum Perforation?
No, Locacorten (hydrocortisone-containing drops) should not be used when there is a tympanic membrane perforation. When a perforation exists or is suspected, you must use only non-ototoxic, fluoroquinolone-based preparations that are specifically approved for middle ear exposure 1.
Why Hydrocortisone-Containing Drops Are Contraindicated
The presence of hydrocortisone creates two critical problems with perforated eardrums:
Impaired healing: Hydrocortisone directly delays tympanic membrane perforation healing, as demonstrated in animal models where topical hydrocortisone application prevented closure for 50+ days compared to 9-12 days in controls 2. Even brief exposure to dexamethasone (a related corticosteroid) causes statistically significant delays in healing by day 10 3.
Middle ear access: When the tympanic membrane is not intact, any substance entering the ear canal can directly access middle ear structures, making the choice of preparation critical for preventing permanent hearing damage 1.
Clinical evidence of harm: Patients receiving intratympanic steroid treatment through myringotomy tubes show a significantly increased incidence of persistent tympanic membrane perforations 4.
Safe Alternatives for Perforated Eardrums
Use only fluoroquinolone-based topical antibiotics when treating ear conditions with known or suspected perforation:
First-line options: Ciprofloxacin-dexamethasone or ofloxacin drops are the recommended safe choices because they lack ototoxicity even with direct middle ear exposure 1.
Ofloxacin is preferred if healing is a concern: While ciprofloxacin-dexamethasone delays healing (though all perforations eventually close by day 20), ofloxacin-exposed tympanic membranes heal at the same rate as controls 3.
Treatment duration: Limit to a single course of no more than 10 days to prevent otomycosis from prolonged quinolone use 1.
How to Identify a Perforation
If you taste the eardrops, there is likely a hole or perforation of the eardrum, so inform your doctor immediately 5. This is a key warning sign that patients should be educated about.
Before prescribing any ear drops, obtain a detailed history:
- Ask about previous ear surgery, as the tympanic membrane may be thinned or atrophic and vulnerable 5.
- Patients with tympanostomy tubes should be treated as having non-intact tympanic membranes—assume tubes are patent for at least 6-12 months after placement 1.
- Even when you cannot visualize the tympanic membrane due to canal edema or debris, assume a perforation may be present and avoid potentially harmful preparations 1.
Critical Clinical Pitfall
The American Academy of Otolaryngology-Head and Neck Surgery mandates using only non-ototoxic preparations when the tympanic membrane is not intact 1. This means:
- Avoid all aminoglycoside-containing drops (neomycin, gentamicin) as they cause severe hearing loss after prolonged or repetitive administration through perforations 1.
- Avoid alcohol-containing drops, as alcohol in the middle ear space is both painful and potentially ototoxic 5.
- Do not irrigate the ear canal when perforation is present or suspected, as this can cause middle ear infection, vertigo, or ototoxicity 1.