Vehicles
Some of the studies done in animals reveal that other factors besides the active ingredient of the drug itself cause neurologic damage. For example, the alcohol bases of disinfectants, not the disinfectant itself, may cause the damage.
Aqueous povidone iodine seems to be safe in the middle ear, but tincture of iodine contains alcohol, so it is not safe to use. Alcohol-containing products should be avoided if the status of the eardrum cannot be determined. Could it be that some of the carrier vehicles in ointment bases cause increased contact of the antibiotic with these sensitive epithelial and nervous tissues? Many topical otic products contain propylene glycol, which may cause some inflammation in the external ear canal. However, in the middle ear, it causes increased inflammation of the mucoperiosteum, leading to excessive granulation tissue and bony changes within the bulla.9
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