Supervisors info:
Βασιλείου Αλεξάνδρα, Επιστημονική Συνεργάτης, Ιατρική Σχολή, ΕΚΠΑ
Μαραγκουδάκης Παύλος, Καθηγητή, Ιατρική Σχολή, ΕΚΠΑ
Δελίδης Αλέξανδρος, Αναπληρωτής καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Summary:
Introduction: The World Health Organization (WHO) estimates that by 2050, 25% of the global population will experience some degree of hearing loss, thus it is imperative to address and prevent possibly modifiable or preventable causes, such as drug ototoxicity. In daily clinical practice, otolaryngologists frequently prescribe antibiotic ear drops to patients with ear conditions. This literature review aims to investigate the ototoxicity of these antibiotic ear drops.
Methodology: A systematic review of the literature was conducted using three different databases (PubMed, Google Scholar, CENTRAL) to identify studies published in English from 01/01/1994 to 01/10/2024, which examine the ototoxicity of antibiotic ear drops.
Results: Based on the aforementioned methodology, 34 publications were identified that met all the selection criteria established during the design of this literature review. Among 9 studies involving the administration of ofloxacin (with or without steroids) to 1,331 participants, and 17 studies involving 856 individuals who received ciprofloxacin drops and 1,300 individuals who received a combination of ciprofloxacin with steroids, no adverse events related to treatment were classified as severe or indicative of cochleotoxicity. In studies where potential vestibulotoxicity manifestations, such as dizziness and vertigo, were reported, these events were relatively rare (0.7–3.6%). In three studies involving 133 individuals who received aminoglycoside drops, no adverse effects suggestive of ototoxicity were recorded. At the same time, six case series studies were presented, detailing 46 instances of ototoxicity following the use of aminoglycoside drops (with or without steroids). Furthermore, one retrospective study highlighted an increased risk of ototoxic effects associated with prolonged use of aminoglycoside drops, and another publication described the prolonged use of gentamicin/betamethasone drops for treating Ménière's disease, where 85% of the 20 participants experienced ototoxicity.
Discussion: In none of the studies involving the administration of ofloxacin or ciprofloxacin drops (alone or in combination with steroids) were adverse events identified as a result of the ototoxic effects of these pharmaceutical agents. Even in studies where a small percentage of participants (receiving ciprofloxacin or ofloxacin drops) exhibited symptoms potentially indicative of vestibulotoxicity, the researchers did not classify these occurrences as severe. These events were transient and were primarily attributed to improper instillation techniques. Regarding studies on the administration of aminoglycoside antibiotic drops (with or without steroids), some did not report adverse events suggestive of ototoxicity. However, documented cases of confirmed ototoxicity (particularly vestibulotoxicity) due to topical administration were also presented. Both a retrospective study and analysis of case histories from some ototoxicity incidents demonstrated a clear increased risk of ototoxic effects with prolonged use of aminoglycoside drops. The literature review also identified areas requiring further investigation or improvement, including patient education on proper drop administration, the establishment of protocols for early detection of ototoxicity, the lack of pharmaceutical options to address the emergence of antibiotic-resistant bacterial strains, the role of genetic predisposition in the development of ototoxicity, and the potential benefits of co-administering otoprotective agents.
Conclusion: Both ciprofloxacin and ofloxacin ear drops are considered safe therapeutic options for the management of a wide range of ear conditions, as they are not associated with ototoxic effects. In contrast, the ototoxicity of aminoglycoside ear drops, while rare, has been documented and appears to be primarily linked to prolonged administration in the middle ear. Moreover, further research into the ototoxic potential of antibiotic ear drops is strongly recommended, as this review highlights the presence of inadequately substantiated studies and a notable lack of research in certain related domains.
Keywords:
Ototoxicity, Cochleotoxicity, Vestibulotoxicity, Cochlear toxicity, Vestibular toxicity, Cochlear dysfunction, Vestibular dysfunction, Ototoxic, Antibiotic ear drops, Topical ear drops, Topical antibiotic ear drops, Ototopical antibiotics, Topical antibiotic solutions
