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Survey on the use of ototopical medications by New Zealand otolaryngologist/head and neck surgeons.

AIM
There is increasing awareness of the potential for ototoxicity with the administration of aminoglycoside eardrops in the presence of a non-intact tympanic membrane, whether that is due to a perforation or due to the presence of a patent ventilating tube. Expert panels in the USA, Canada, UK, and Australia have all advocated the preferential use of non-ototoxic topical antibiotics for the discharging middle ear and/or mastoid cavity. The advent of non-ototoxic fluoroquinolone eardrops provides the first real opportunity to prescribe topical therapy in accordance with such guidelines.


METHOD
We surveyed practicing otolaryngology/head and neck surgeons in New Zealand to ascertain their clinical preferences as well as to gauge any impediments to utilising safer medical therapies.


RESULTS
The major results of this survey, with a 72% response rate, are presented. Notably, a total of 24 cases of sensorineural hearing loss were reported that may have been caused by the use of topical ototoxic medications.


CONCLUSION
Based on our survey results and current evidence available in the broader scientific literature, recommendations are made for the prescription of non-ototoxic medications in at-risk situations. However clinicians may be prevented from following such guidelines by the increased costs of these medications, thus leading to decreased patient compliance. There was widespread support for subsidies to be available for the prescription of non-ototoxic fluoroquinolone eardrops for appropriate indications.