Topical Antiseptics in Ear Surgeries and Ototoxicity Effect: Review Article.

Abstract

Background: There is a wide variation in practice in the use of surgical preparation solutions among otolaryngologists in ear surgery. Chlorhexidine gluconate, povidone-iodine and alcohol are common topical antiseptics solution. The literature for risk and mechanisms of the ototoxicity by Antiseptics solution if reaches the tympanic cavity and inner ear causing functional impairment and cellular damage to tissues is being reviewed and compared. Aim: We present the current antiseptics solutions used during ear surgery and their risk of ototoxicity. Depending on the available clinical trials that have shown their clear effect on both animal models and human ears. Result: The three widely used topical antiseptics preparations for ear surgeries and have been studied in literature are: Alcohol, Chlorhexidine gluconate and Povidone-iodine. Alcohol and chlorhexidine gluconate have a toxic effect on the vestibular and cochlear function proven by significant changes in Vestibular evoked myogenic potential (VEMP) and Auditory brainstem response (ABR). On the other hand, low concentration of Povidone-iodine (5%) does not have this adverse effect, However non-significant changes in the ABR was found to be related to a high concentration of Povidoneiodine (10%). Conclusion: Chlorhexidine gluconate and alcohol have a clear ototoxic effect and are not safe in ear surgery especially with perforated tympanic membrane, whereas diluted low concentration povidone-iodine is safe and to date is the standard topical antiseptic solution to be used for ear surgeries.

Efficacy of topical povidone iodine ear drops 5% in chronic suppurative otitis media

“…Povidone iodine works by inhibiting metabolism of bacterial enzymes thereby interfering with the multiplication of bacteria so that they become weak. 18,19 There is no adverse effect of PVP-I 5% on hearing function. 7,8 Reports of ototoxic, such as the finding of Piromichai 6 who reported the use PVP-I 10% in cases of ear injury are very concerning.…”