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Ototoxicity of antimycotics

R R Marsh1, L W Tom

  • 1Department of Otolaryngology and Human Communication, Children's Hospital of Philadelphia, PA 19104.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|February 1, 1989
PubMed

Insights

Antimycotic medications applied to damaged eardrums may harm hearing. Acetic acid and propylene glycol preparations showed ototoxicity in guinea pigs, unlike tolnaftate and clotrimazole.

Area of Science:

  • Ototoxicology
  • Pharmacology
  • Otolaryngology

Background:

  • Otomycoses (fungal ear infections) and tympanic membrane perforations are common clinical conditions.
  • Antimycotic medications are used to treat fungal ear infections.
  • Potential for ototoxicity exists if medication enters the middle ear through a perforated tympanic membrane.

Purpose of the Study:

  • To evaluate the acute ototoxic potential of commonly used antimycotic preparations.
  • To determine if specific ingredients in antimycotic solutions contribute to ototoxicity.

Main Methods:

  • Five different antimycotic preparations were administered to guinea pigs.
  • Brainstem auditory evoked response (BAER) thresholds were measured to assess hearing function.
  • The study focused on the acute effects of the preparations on cochlear function.

Main Results:

  • Preparations containing acetic acid or propylene glycol significantly elevated BAER thresholds, indicating ototoxicity.
  • Antimycotic solutions of tolnaftate or clotrimazole in polyethylene glycol 400 caused minimal to no hearing impairment.
  • The vehicle (solvent) of the antimycotic preparation appears to influence its ototoxic potential.

Conclusions:

  • Certain antimycotic preparations, particularly those with acetic acid or propylene glycol, possess acute ototoxic potential.
  • Clinicians should exercise caution when prescribing topical antimycotics for fungal ear infections with tympanic membrane defects.
  • Further research into safer formulations of topical antifungals for otologic use is warranted.

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