Safe Drugs for the Tympanic Bulla

There is a very short list of products that can be infused into the tympanic bulla with­out the risk of ototoxicity. These products are generally recognized as safe. Before selecting a product for use in the bulla, the ingredients contained in the preparation should be evaluated to determine the ototoxic potential.

For antibiotics, the fluoroquinolones (ciprofloxacin, enrofloxacin, and ofloxacin), aqueous penicillin G, some semisynthetic penicillins (carbenicillin and ticarcillin), and some cephalosporins (ceftazidime and cefmenoxime) are safe to use in middle ear disease.¹⁴

The antifungals clotrimazole, miconazole, nystatin, and tolnaftate can be safely infused.

The aqueous forms of the antiinflammatories dexamethasone and fluocinolone are safe in the middle ear.

Most ceruminolytics cannot be used in the bulla. The exception is Squalene (Cerumene, Evsco), which has been shown to be safe. Tris-EDTA as a flushing agent is safe.