Potential ototoxicity from triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl) cream.
Although rare, ototoxicity from the use of aminoglycoside drops is well recognized. Ototoxicity has not been described with the use of combination aminoglycoside-steroid-antifungal creams or ointments. We present the case of a 60-year-old man with a perforated tympanic membrane who suffered a total hearing loss after the instillation of cream containing triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl cream) into his ear canal. On balance, we believe that a number of potentially ototoxic constituents in this cream were responsible. Other possible causes of sensorineural hearing loss and the possible mechanisms of ototoxicity of this cream are discussed. The reasons why such creams may be particularly ototoxic, compared with drops, are also considered. The authors caution against the use of such creams or ointments in the ear if there is any suspicion of a tympanic membrane perforation.
Thomas
S P
SP
Department of Otolaryngology, Poole Hospital NHS Trust, Poole, Dorset BH15 2JB, UK. SebT@quista.net
Buckland
J R
JR
Rhys-Williams
S R
SR
D000287:Administration, Topical; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D003638:Deafness / Q000139:chemically induced*; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006096:Gramicidin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000009:adverse effects*; D009761:Nystatin / Q000009:adverse effects*; D014222:Triamcinolone Acetonide / Q000009:adverse effects*; D018058:Tympanic Membrane Perforation / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D004338:Drug Combinations; C014118:Gramicidin, Neomycin Sulfate, Nystatin, Triamcinolone Acetonide Drug Combination; D009761:Nystatin; D006096:Gramicidin; D014222:Triamcinolone Acetonide; D009355:Neomycin