Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension in Tympanoplasty Surgery

Abstract

Objectives: 1) Determine the safety of using a commercially available suspension of polymycin B, neomycin, and hydrocortisone in tympanoplasty surgery.2) Apply evidence based medicine in tympanoplasty surgery when considering potential ototoxicity. Methods: Study Design: Retrospective chart review. Setting: Tertiary otology practice, single surgeon. Data were gathered on 277 consecutive type 1, underlay tympanoplasties for which both pre- and postoperative audiometric data were available over a 10 year period. In each surgery, gelatin sponge saturated in a commercially available suspension of polymycin B, neomycin, and hydrocortisone was placed in the middle ear to support the graft. Patients ranged from age 3y/o to 79y/o. Preoperative and postoperative bone conduction audiometric thresholds were measured at 500, 1000, 2000, 3000, and 4000Hz. Results: The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000Hz. The changes by frequencies were as follows: 500Hz (-1.624dB), 1000Hz (-1.399dB), 2000Hz (-0.975), 3000Hz (-0.596dB), and 4000Hz (+0.56dB). The five frequency average change was (-0.545dB). Conclusions: The commonly used otic solution containing polymycin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.