Sensorineural Hearing Loss with Neomycin Ear Drops

Abstract

Objective: Neomycin ear drops are contraindicated with non-intact TMs (NITM), either perforation (TMP) or tube (TT) because of the risk of ototoxicity. The aim of this study was to evaluate the comparative risk of sensorineural hearing loss (SNHL) with neomycin and quinolone ear drops and NITMs. Method: Pediatric Medicaid beneficiaries from 29 states, 1999-2006, were studied if they received a study drug within 12 months of TMP or TT, and were continuously enrolled ≥6 months before and 12 months after first dispensing. We compared the 12-month risk of SNHL using Cox regression adjusted for SNHL risk factors. Results: We found 1935 SNHL cases in 139,906 children treated with neomycin or quinolone eardrops (1-year incidence = 1.38). Within those with neomycin, 76.3% received 1 dose and 17.4% received 2. The adjusted hazard ratio (HR) for 1, 2, and ≥3 prescriptions of neomycin was 0.99 (95% CI 0.89-1.12), 1.32 (1.05-1.67), and 1.34 (0.89-2.01), respectively, when adjusted for SNHL risk factors and total number of otic antimicrobial prescriptions. Conclusion: Short-term use of neomycin ear drops in patients with NITMs does not appear to carry a significant risk of SNHL. Repeated doses of topical neomycin are associated with an increased SNHL risk.