title: Chlorhexidine ototoxicity in ear surgery part II: survey of preparation solution used by otolaryngologists in Canada: is there a cause for concern?
abstract: OBJECTIVE
  To conduct a survey of the antiseptic preparations used for ear surgeries among otolaryngologists in Canada.
  
  
  METHODS
  An electronic survey was sent to active members of the Canadian Society of Otolaryngology-Head and Neck Surgery via e-mail. Questions included the use of antiseptic, choice of preparation solution, duration of preparation, use of a barrier method, and compliance with hospital protocol changes.
  
  
  RESULTS
  The e-mail was received by 253 otolaryngologists, and 85 completed the survey. Four of 85 respondents did not perform tympanoplasty surgery and were not included in the analysis. Of those who performed tympanoplasty (n  =  81), 78 of the 81 respondents (96%) used an antiseptic preparation solution at surgery, whereas 3 respondents (4%) did not. Sixty-six of the 77 respondents (86%) used aqueous povidone-iodine, 4 (5%) used a chlorhexidine-based preparation, 3 (4%) used an alcohol-based solution, 3 (4%) used others, and 1 answered "I don't know." Thirty-eight of 75 (29%) respondents used a barrier method, 23 (31%) answered "always," 18 (24%) answered "sometimes," and 5 (7%) answered "I don't know." When asked if they would comply with a hypothetical hospital policy to use chlorhexidine in ear surgery, 15 of 79 (19%) respondents agreed, whereas 64 (81%) disagreed. Among the aqueous povidone-iodine users (n  =  66), 7 (11%) agreed to change to chlorhexidine.
  
  
  CONCLUSIONS
  There is a wide variation in practice in the use of surgical preparation solution among otolaryngologists performing ear surgery. Surgeons must be vigilant to avoid ototoxicity. A national society consensus on appropriate preparation solutions for ear surgery would minimize patients' risk and minimize future medicolegal actions.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Toronto.
authors.forename: Philip
authors.initials: P
authors.lastname: Lai
authors.forename: Chris
authors.initials: C
authors.lastname: Coulson
authors.forename: David
authors.initials: D
authors.lastname: Pothier
authors.forename: John
authors.initials: J
authors.lastname: Rutka
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage / Q000633:toxicity*; D002170:Canada; D002710:Chlorhexidine / Q000008:administration & dosage / Q000633:toxicity*; D003638:Deafness / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D064420:Drug-Related Side Effects and Adverse Reactions; D004432:Ear, Middle / Q000187:drug effects*; D019983:Guideline Adherence; D006306:Health Surveys; D006801:Humans; D011206:Povidone-Iodine / Q000008:administration & dosage / Q000633:toxicity; D011795:Surveys and Questionnaires; D014433:Tympanoplasty; D014600:Utilization Review
chemical_list: D000891:Anti-Infective Agents, Local; D011206:Povidone-Iodine; D002710:Chlorhexidine