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6 results

  • Why are ototopical aminoglycosides still first-line therapy for chronic suppurative otitis media? A systematic review and discussion of aminoglycosides versus quinolones

  • A S Harris, H A Elhassan, E P Flook
  • Journal:
    The Journal of Laryngology & Otology / Volume 130 / Issue 1 / January 2016
    Published online by Cambridge University Press:
    20 November 2015, pp. 2-7
    Print publication:
    January 2016
  • Objective:

    This systematic review aimed to establish that quinolones are as effective as aminoglycosides when used to treat chronic suppurative otitis media.

    Method:

    The review included good quality, randomised, controlled trials on human subjects, published in English, that compared topical aminoglycosides with topical quinolones for the treatment of chronic suppurative otitis media.

    Results:

    Nine trials met the criteria. Two studies showed a higher clinical cure rate in the quinolone group (93 per cent vs 71 per cent, p = 0.04, and 76 per cent vs 52 per cent, p = 0.009). Four studies showed no statistically significant difference in clinical outcome. A significant difference in microbiological clearance in favour of quinolones was shown in two studies (88 per cent vs 30 per cent, p < 0.001, and 88 per cent vs 30 per cent, p < 0.001).

    Conclusion:

    Topical quinolones do not carry the same risk of ototoxicity as aminoglycosides. Furthermore, they are equal or more effective in treating chronic suppurative otitis media and when used as prophylaxis post-myringotomy. Topical quinolones should be considered a first-line treatment for these patients.

  • Case 93 - Nonconvulsivestatus epilepticus

  • from Section II - Neurocritical care
  • Edited by George A. Mashour, Ehab Farag
  • Book:
    Case Studies in Neuroanesthesia and Neurocritical Care
    Published online:
    03 May 2011
    Print publication:
    03 February 2011, pp 314-316

  • Summary

    Encephalopathies are commonly encountered in the intensive care unit (ICU) and portend worse outcomes. This chapter presents a case study of a 54-year-old man with a history of alcohol abuse and cirrhosis who was admitted to the neurologic ICU after drainage of a large right-sided subdural hematoma. His mental status returned to baseline after treatment with lactulose and neomycin. A general physical examination should search for evidence of trauma or intoxication. Meningismus should be evaluated. A fundoscopic examination may reveal papilledema. Electroencephalographic monitoring during administration of flumazenil can be used to determine if an occasional subclinical seizure can be detected. Inflammatory mediators have also been implicated in the etiology of hepatic encephalopathy. Ruling out physiologic, pharmacologic, and neurologic etiologies requires a thorough history, careful physical examination, and the appropriate use of laboratory and imaging tests. Treatment should be tailored to the underlying etiology of the encephalopathy.

  • Nasal bacterial carriage in adult epistaxis: is neomycin the answer?

  • F D L Walker, D E C Baring
  • Journal:
    The Journal of Laryngology & Otology / Volume 123 / Issue 6 / June 2009
    Published online by Cambridge University Press:
    02 September 2008, pp. 623-625
    Print publication:
    June 2009
  • Introduction:

    After treatment of epistaxis, patients are routinely supplied with an intranasal bactericidal cream containing neomycin. Neomycin cream is effective in preventing recurrent paediatric epistaxis. This study aimed to assess whether there is an increased rate of nasal bacterial infections in adult epistaxis patients.

    Methods:

    Between October 2004 and April 2005, nasal swabs were taken from adult patients presenting with epistaxis, and from a control group comprising elective ENT patients.

    Results:

    There were 23 controls and 26 epistaxis patients. Staphylococcus aureus was grown in 21 per cent and 23 per cent, respectively. There was no significant difference in bacterial carriage rates between the epistaxis and control groups.

    Conclusions:

    The epistaxis and control groups demonstrated the same bacterial species and the same proportion of bacterial carriage. Although the majority of bacterial species encountered were sensitive to neomycin, a significant proportion was not. These results do not support the routine use of neomycin in the prevention of recurrent adult epistaxis.

  • Naseptin® and peanut oil: a survey of practitioners' awareness in the UK

  • T Abed, S Farhat, G Watters
  • Journal:
    The Journal of Laryngology & Otology / Volume 122 / Issue 6 / June 2008
    Published online by Cambridge University Press:
    01 August 2007, pp. 650-652
    Print publication:
    June 2008
  • Objective:

    The aim of this study was to determine how aware ENT practitioners are that Naseptin® (Alliance), widely used in ENT practice, contains peanut oil and to what extent this is conveyed to patients.

    Methods:

    A questionnaire was sent out to all ENT practitioners registered with the British Association of Otolaryngologists.

    Result:

    Analysis of the data confirmed that Naseptin cream is widely used in ENT practice and showed that although most practitioners are aware that Naseptin cream contains refined peanut oil (arachis oil) (74.3 per cent of consultants and 93.6 per cent of registrars) not all ask their patients whether they are allergic to peanuts (62.6 per cent of consultants and 87.3 per cent of registrars).

    Conclusion:

    The results suggest that more should be done to raise awareness amongst practitioners that Naseptin cream contains peanut oil and should be avoided in patients with a peanut allergy, as recommended by national guidelines. The use of Naseptin cream when contraindicated may have medicolegal implications.

  • Potential ototoxicity from triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl™) cream

  • S P Thomas, J R Buckland, S R Rhys-Williams
  • Journal:
    The Journal of Laryngology & Otology / Volume 119 / Issue 1 / January 2005
    Published online by Cambridge University Press:
    08 March 2006, pp. 48-50
    Print publication:
    January 2005

  • 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.