title: Ototoxicity of polymyxin B, neomycin, and hydrocortisone suspension in tympanoplasty surgery.
abstract: OBJECTIVE
  (1) To determine the safety of using a commercially available suspension of polymyxin B, neomycin, and hydrocortisone (PNH) in tympanoplasty surgery. (2) To apply evidence-based medicine to tympanoplasty surgery when considering potential ototoxicity.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary otology practice, single surgeon.
  
  
  METHODS
  Approval for this study was obtained from the St. Dominic-Jackson Memorial Hospital Institutional Review Board. Data were gathered on 272 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 PNH suspension was placed in the middle ear to support the graft. Patients ranged in age from 3 years to 79 years. Preoperative and postoperative bone conduction thresholds were measured at 500, 1000, 2000, 3000, and 4000 Hz.
  
  
  RESULTS
  The average change in sensorineural hearing as measured by bone conduction thresholds was negligible, with a slight improvement in all frequencies tested except 4000 Hz. The changes by frequencies were as follows: 500 Hz (-1.624 dB), 1000 Hz (-1.399 dB), 2000 Hz (-0.975 dB), 3000 Hz (-0.596 dB), and 4000 Hz (+0.560 dB). The 5-frequency average change was -0.545 dB.
  
  
  CONCLUSIONS
  The commonly used otic solution containing polymyxin B, neomycin, and hydrocortisone demonstrates no ototoxicity in tympanoplasty surgery and is safe to use in this setting.
authors.affiliation: Jackson Ear Clinic, Jackson, Mississippi, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: House
authors.forename: Laura K
authors.initials: LK
authors.lastname: House
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001309:Auditory Threshold; D001844:Bone Conduction / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006309:Hearing / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009355:Neomycin / Q000008:administration & dosage*; D011112:Polymyxin B / Q000008:administration & dosage*; D012189:Retrospective Studies; D014433:Tympanoplasty; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D009355:Neomycin; D011112:Polymyxin B
keywords: Cortisporin; evidence-based medicine; ototoxicity; tympanoplasty