ttp://www.bsava.

com PAPER

Brainstem auditory evoked responses

in 37 dogs with otitis media before
and after topical therapy
S. Paterson1

Department of Dermatology, Rutland House Veterinary Hospital, Abbotsfield Road, St Helens, Merseyside WA9 4HU, UK
1
Corresponding author email: spatersonvetmb1959@btinternet.com

OBJECTIVES: The objective of this study was to determine whether intra-aural administration of aqueous
solutions of marbofloxacin, gentamicin, tobramycin and ticarcillin (used off-licence) was associated
with changes in hearing as measured by brainstem auditory evoked responses.
MATERIALS AND METHODS: Dogs diagnosed with otitis media (n=37) underwent brainstem auditory evoked
response testing and then were treated for their ear disease. First, the external ear canal and middle
ear were flushed with sterile saline followed by EDTA tris with 0·15% chlorhexidine. Then, a combination
of aqueous antibiotic mixed with an aqueous solution of EDTA tris was instilled into the middle ear.
Follow-up examinations were undertaken for each dog, and treatment was continued until there were no
detected infectious organisms or inflammatory infiltrate. Brainstem auditory evoked response testing
was repeated after resolution of the infection and discontinuation of therapy.
RESULTS: Brainstem auditory evoked responses in dogs treated with aqueous solutions of marbofloxacin
or gentamicin remained unchanged or improved after therapy of otitis media but were impaired in dogs
treated with ticarcillin or tobramycin.
CLINICAL SIGNIFICANCE: If off-licence use of topical antibiotics is deemed necessary in cases of otitis media,
aqueous solutions of marbofloxacin and gentamicin appear to be less ototoxic than aqueous solutions
of ticarcillin or tobramycin.

Journal of Small Animal Practice (2017)

DOI: 10.1111/jsap.12711
Accepted: 29 May 2017

INTRODUCTION may consist of glucocorticoids, antibiotics or both (Gotthelf 2004,

Dogs with otitis media (OM) commonly demonstrate a reduc-
tion in their hearing as measured by brainstem auditory evoked
responses (BAER). This hearing loss may be conductive because
of reduction in the lumen of the ear canal, damage to the tym-
panic membrane or accumulation of fluid within the middle ear
(Strain 1996) or sensorineural damage due to the penetration of
bacterial toxins (Lundman et al. 1992, Stenqvist et al. 1997) or
ototoxic drugs (Brummett et al. 1976, Strain 1996) through the
round window to cause cochlear damage. Current therapeutic rec-
ommendations for OM are to flush the tympanic bulla and then
instil topical drugs. Depending on diagnostic findings, treatment
Morris 2004, Palmeiro et al. 2004, Harvey & Paterson 2014).
Choosing appropriate topical therapy is difficult. There are very
few well-designed clinical trials investigating ototoxicity from ear
medications in humans. Animal reports and case reports make up
most of the data (Phillips et al. 2007). The same is true for dogs
and cats, where much of the information is based on results in
guinea pigs, mice, rabbits and chinchillas or what are often anec-
dotal case reports (Brummett et al. 1976, Federspil et al. 1976,
Morizono et al. 1980, Galle & Venker-Van Haagen 1986, Brown-
lee et al. 1992, Jakob et al. 1995, Serin et al. 2007, Jang et al. 2008,
Kavanagh et al. 2009, Oghan et al. 2011). The lack of clinical evi-
dence, together with the lack of topical drugs licensed for canine

Journal of Small Animal Practice • © 2017 British Small Animal Veterinary Association 1
 S. Paterson
OM, makes therapeutic decisions difficult. Veterinary surgeons
must therefore try to select drugs for therapy that have the low-
est potential for ototoxicity whilst being mindful that a failure to
treat infection adequately may lead to hearing loss and vestibu-
lar disease through the elaboration of exotoxins from the bacteria
(Stenqvist et al. 1997). In an attempt to provide useful information
on the ototoxic potential of drugs used to treat OM, this retrospec-
tive study describes the changes in minimum auditory thresholds
before and after administration of topical therapy to the tympanic
bulla. Data is taken from the clinical records of cases presented
to the author and reflects the standard treatment protocol under-
taken in the clinic, where BAER testing is always performed at the
time of the dog’s first examination and again after complete clinical
and cytological resolution of the disease. In all cases, written owner
consent was obtained before admission of the dog for investigation
and therapy, including the potential use of unlicensed drugs.
MATERIALS AND METHODS
The data assessed in this study represent that obtained from 37
dogs that were presented to the author’s clinic during a 12-month
period for the investigation and eventual successful treatment
of infectious OM. During this period, a total of 60 dogs were
referred with OM. Six were deemed after examination to have
irreversible otitis and were referred for total ear canal ablation
and bulla osteotomy. Data from 17 dogs were excluded because
of the following reasons: their medication was changed part
way through their course (8), they failed to respond to medical
therapy and were treated surgically (4), they failed to come back
for reassessment whilst still on medication and only returned
when the disease had relapsed (3), they failed to have treatment
administered by the owner due to their behavioural problems
(1) or were lost to follow-up (1). Of the 37 dogs included, 17
had bilateral OM and 20 had unilateral OM, accounting for a
total of 54 ears. In all cases, a diagnosis of OM was made by the
referring clinician on the basis of clinical signs, cytology, culture
and otoscopic examination, which had confirmed the absence
of a tympanic membrane in all cases. At the time of admission,
all owners were made aware of the potential use of off-licence
drugs in the treatment of OM and the potential for the drugs to
produce ototoxic effects. They were also made aware that there
are currently no drugs licensed to treat OM. All clients provided
written informed consent for their dogs to be treated. After
admission, a physical and dermatological examination, includ-
ing a basic neurological assessment, was performed on all dogs.
Both left and right ears were examined initially with a hand-held
otoscope (MacroView; Welch Allyn). All dogs were sedated using
10 mcg/kg medetomidine hydrochloride (1 mg/mL Domitor;
Elanco Animal Health) and 0·1 mg/kg butorphanol (10 mg/mL
Torbugesic; Pfizer Ltd). A full general anaesthetic was induced
using 1·5 mg/kg propofol (10 mg/mL Propoflo; Abbott Labora-
tories). All dogs were intubated and maintained on inhalation
anaesthesia with isoflurane (100% w/w IsoFlo; Abbott Labo-
ratories). All ears were examined using a video-otoscope (Karl
Storz, GmbH and Co). An electrophysiological examination of
2 Journal of Small Animal Practice
hearing was performed in all cases before ear flushing, according
to a standard protocol (Mason et al. 2013), using BAER. The
BAER was recorded using a neurodiagnostic unit with a built-
in signal averager (Nihon Kohden Neuropack µmodel; Nihon
Kohden, Surbiton). Stainless steel electrodes were placed subcu-
taneously (sc) with the active electrode (+) placed at the vertex
(skull mid-line approximately mid-way between the eyes and the
nuchal crest), the reference electrode (−) at the tragus (just rostral
to the ear canal of the stimulated ear) and the ground electrode at
an inactive site on the dorsal neck. To ensure correct insertion of
electrodes, the recording electrode impedance was checked to see
if it was less than 5 kΩ. The pinna was folded dorsomedially, and
to avoid ear canal collapse, a headphone was gently held in con-
tact with the ear being tested and positioned to direct noise into
the ear canal. The BAER was elicited by applying multiple click
stimuli of 0·1-millisecond duration. Impulses were filtered at
100 Hz to 3 kHz, averaged and displayed on a computer screen.
An average of 600 click stimuli were delivered to the ear, and the
response from the first 10 milliseconds after click stimulus was
averaged until the waveform remained stable. Masking noise was
used for the contralateral ear. Positive electrode activity at the
recording (vertex) electrode produced an upwards-deflected read-
ing. The initial stimulus level in each dog was 90 decibels (dB)
normal hearing level (nHL). The stimulus level was then reduced
by 20 dB increments until no response could be detected. The
ear was then tested with increasing five decibels increments until
the minimum hearing threshold (MHT) was determined in the
patient. This was defined as the smallest dB measurement when
waveform V was detected and five decibels above when the BAER
reading was flat and non-responsive. The procedure was repeated
on the contralateral ear where appropriate. These BAER readings
were recorded as pretreatment values (see Table 1).
A standard OM treatment protocol was undertaken in each
case. Samples of mucopurulent material were taken from the
tympanic bulla by aspiration through a 5 Fr catheter (Karl
Storz). A sample of the discharge was submitted for culture and
sensitivity, and a small amount of discharge was smeared onto
a microscope slide, heat-fixed and stained with Diff Quik. All
discharge was then removed from the canal by flushing with ster-
ile saline through a clean 5 Fr catheter via the working channel
of the video-otoscope. Once the ear was clean, a second flush
of ethylene diamine tetra-acetic acid (EDTA) tris with 0·15%
chlorhexidine (Trizchlor flush, Dechra Veterinary Products) was
performed through a further clean catheter. After this, 0·5 mL of
a combination of EDTA tris (Trizaural flush, Dechra Veterinary
Products) and antibiotic (see Table 2) was instilled into the bulla.
The initial choice of antibiotic was made on the basis of previ-
ous culture and sensitivity results. If no culture and sensitivity
results were available, marbofloxacin was chosen as the first-line
antibiotic. If there was resistance to a fluoroquinolone but not
to gentamicin on a previous culture and sensitivity, gentamicin
was chosen as the second-line antibiotic. Tobramycin or ticarcil-
lin were only selected as topical therapy if resistance had been
identified to fluoroquinolone and gentamicin but not to these
drugs. Where subsequent culture and sensitivity showed resis-
tance to the prescribed antibiotic, it was changed on the basis
• © 2017 British Small Animal Veterinary Association
 BAER results in dogs with OM after topical therapy

Table 1. Details of 37 dogs included in the data and their pre- and after-treatment BAER readings
Case Dog Ear Bact Antibiotic treatment BAER measurement recording the lowest
threshold for hearing in each ear
Pre-tx BAER (dB nHL) (a) Post-tx BAER Difference between
(dB nHL) (b) (a) and (b)
1 Cocker spaniel Left Ps Marbofloxacin 50 30 20
Right Ps 50 25 25
2 Labrador Left Ps 45 15 30
Right Ps 40 20 20
3 Cocker spaniel Left Ps 50 25 25
Right Ps 40 40 0
4 Bichon frise Left Ps/S 50 25 25
Right S 45 25 20
5 West Highland White terrier Left S 40 25 15
Right S 40 10 30
6 Basset hound Left S 30 5 25
Right S 45 10 35
7 Clumber spaniel Left Ps/S 45 10 35
Right Ps 30 20 10
8 German shepherd dog Left Ps/S 50 20 30
Right S 25 20 5
9 Sussex spaniel Left Ps/S 45 20 25
Right S 50 15 35
10 Newfoundland Left S 40 10 30
Right S 40 10 30
11 West Highland White terrier Left S 45 10 25
12 Border terrier Left S 45 15 30
13 Golden retriever Right S 50 15 35
14 Boxer Left S 35 10 25
15 Labrador Right S 50 15 35
16 Newfoundland Right S 40 10 30
17 Rottweiler Left S 35 10 25
Average of difference (a) and (b)=+25
18 Cocker spaniel Left Ps/S Gentamicin 30 25 5
Right Ps/S 50 25 25
19 Bloodhound Left Ps/S 35 20 15
Right S 20 15 5
20 West Highland White terrier Left Ps/S 20 15 5
Right Ps/S 40 35 5
21 Labrador Left S 40 5 35
Right S 30 20 10
22 Boxer Left S/Prt 35 20 15
Right Prt 30 10 20
23 Cocker spaniel Right S 40 30 10
24 German shepherd dog Right Ps 20 20 0
25 Miniature schnauzer Left S 25 15 10
26 Springer spaniel Left S 45 20 25
27 Labrador Right S 20 10 10
28 Miniature poodle Left S 25 20 5
Average of difference (a) and (b)=+12·5
29 Cocker spaniel Left Ps Tobramycin 15 45 −30
Right Ps 20 60 −40
30 Clumber spaniel Left Ps 30 70 −40
Right Ps 30 90 −60
31 Labrador Left Ps 25 85 −50
32 Clumber spaniel Left Ps 40 100 −60
33 West Highland White terrier Right Ps 20 80 −70
Average of difference (a) and (b)=−50
34 Cocker spaniel Left Ps Ticarcillin 50 40 10
35 Bull mastiff Left Ps 30 50 −20
36 English Bull terrier Right Ps 50 90 −40
37 Labrador Right Ps 45 70 −25
Average of difference (a) and (b)=−18·75
Bact Bacteria, Ps Pseudomonas species, S Staphylococcus species, Prt Proteus species, Pre tx Pretreatment, Post tx Post-treatment, dB Decibels, nHL normal hearing level

Journal of Small Animal Practice • © 2017 British Small Animal Veterinary Association 3
 S. Paterson

of the sensitivity result but that case’s data was not included
(eight cases). An intravenous injection of dexamethasone (2 mg/
mL Dexadreson; MSD Animal Health) at a dose of 0·1 mg/kg
bodyweight was given at the end of the procedure and before
anaesthetic recovery to reduce inflammation caused through the
flushing process.
Dogs were discharged with flush solution EDTA tris with
0·15% chlorhexidine (Trizchlor flush, Dechra Veterinary Prod-
ucts) and the extra-label combination of EDTA tris (Trizaural
flush, Dechra Veterinary Products) and antibiotic as treatment.
Owners were instructed to flood the ear with flush solution
once daily to clean it before instilling 0·5 mL of the treatment
solution once or twice daily (see Table 2). All dogs were reas-
sessed at three-week intervals. At these time points, each dog
was examined in the clinic, and the affected ear(s) re-examined
using a hand-held otoscope. A sample of discharge taken from
the horizontal canal was examined by cytology. Dogs were con-
sidered to be infection-free when examination of the external
ear canal showed no visual signs of disease and cytology failed
to reveal signs of an inflammatory infiltrate or bacteria. In all 37
cases, this occurred at the six-week recheck. At this point, the
dog was readmitted to the clinic and anaesthetised according to
the previously described protocol. The ear was reassessed using
video-otoscopy to ensure that the tympanic membrane had
healed, and a repeat BAER was performed; results were recorded
as after-treatment levels. Where video-otoscopy six weeks after
starting therapy revealed recovery from infection was incom-
plete, that is, bacteria or inflammatory cell remained on samples
or the tympanic membrane had not healed (four cases) or where
therapy had been changed during the treatment process (eight
cases), the dog’s clinical details were not included in the final
data. The readings from the pre- and after-treatment BAER
values were compared for each case, and the difference between
the two values was also recorded in Table 1.
RESULTS
BAER measurements were recorded in decibels (nHL) for each
dog for the lowest threshold for hearing for each ear as a pre-
treatment and an after-treatment level. The lowest threshold
was assessed as the point where the typical five-peak wave form
of the BAER was lost and the trace became flat. A mean score
was calculated for each case based on the difference between the
two BAER values. These are tabulated in Table 1. This work was
undertaken by a veterinary nurse in the practice (see Acknowl-
edgements section) without any knowledge of the treatment that
had been prescribed for each dog. A value of zero was taken as
an indication that the threshold had remained unchanged. A
positive value was taken as an indication that the hearing had
improved, that is, the lowest threshold for hearing was lower. A
negative value was taken as deterioration in hearing, that is, the
lowest threshold for hearing had increased. For the marbofloxa-
cin group, no negative scores were obtained. The range of scores
was from 0 to 35, and the mean score was 25. For the gentamicin
group, no negative scores were obtained. The range of scores was
0 to 35 with a mean value of 12·5. For the tobramycin group, all
scores were negative scores. The range of scores was from −30 to
−70 with a mean score of −50. For the ticarcillin group, three out
of four scores were negative. The range of scores was from 10 to
−40, and the mean value was −18·75.
DISCUSSION

Canine OM presents a difficult therapeutic challenge. In most

Table 2. Antibiotics used in topical therapy
Drug (final Off-licence concentration
concentration of
solution)
200 mg/mL Five millilitre of solution
Marbofloxacin, added to 118 mL of
Marbocyl SA EDTA tris (Trizaural
injection (Vetoquinol flush; Dechra Veterinary
animal health) Products)
(0·85% solution)
80 mg/2 mL Eight millilitre of solution
Gentamicin (Roche) added to 118 mL of
(0·27% solution) EDTA tris (Trizaural
flush, Dechra Veterinary
Products)
40 mg/mL Tobramycin Eight millilitre of solution
(1% solution) added to 32 mL of
EDTA tris (Trizaural
flush, Dechra Veterinary
Products)
3·2 g Ticarcillin vials 3·2 g Ticarcillin mixed
(2·5% solution) with 6 mL sterile water,
frozen in aliquots for
weekly use. One millilitre
of defrosted solution
added to 20 mL of
sterile water each week
cases in dogs, OM occurs because of a descending infection from
Instructions for
administration
the external ear canal (Gotthelf 2004, Harvey & Paterson 2014).
Once infection becomes trapped inside the middle ear, lavage
Apply 0·5 mL into of the tympanic bulla and administration of topical drugs is
the ear once daily recommended as treatment (Gotthelf 2004, Morris 2004, Pal-
after cleaning meiro et al. 2004, Harvey & Paterson 2014). Although there are
numerous texts detailing treatment protocols, there are only a
handful of papers detailing the potential ototoxicity of drugs that
Apply 0·5 mL into may be used. The aim of this retrospective study was to compare
the ear twice daily
after cleaning
the ototoxicity of four different aqueous antibiotic solutions used
to treat OM. Aqueous solutions were chosen because of the fact
that some solvents, such as propylene glycol, can have ototoxic
Apply 0·5 mL into
the ear twice daily
effects in experimental animals (Morizono et al. 1980). To allow
after cleaning a meaningful comparison of all four antibiotics, as many factors
as possible were kept constant. This included the initial flushing
process, the flush solution, the solution in which antibiotics were
Apply 0·5 mL into
the ear once daily mixed and the volume of drugs administered. The end point in
after cleaning each case was designated when there was no inflammatory infil-
trate or bacteria on cytology samples taken from the horizon-
tal canal and the tympanic membrane had healed. Where drugs
were changed part way through the treatment process or dogs

4 Journal of Small Animal Practice • © 2017 British Small Animal Veterinary Association
 BAER results in dogs with OM after topical therapy
had failed to respond to treatment after six weeks of therapy, their
data were not included.
EDTA tris (Trizaural flush, Dechra Veterinary Products) was
chosen as a diluent for the antibiotic solutions because it is rec-
ognised as having a low ototoxic potential (Gotthelf 2004, Mills
et al. 2005, Harvey & Paterson 2014). A combined EDTA tris
with 0·15% chlorhexidine (Trizchlor flush, Dechra Veterinary
Products) was used to flush the ears before application of topical
antibiotics. Chlorhexidine at concentrations of less than 0·2%
has also been shown to be safe within the middle ear of dogs
(Merchant et al. 1993). BAER testing was used to try to assess
the ototoxic effects of therapy by recording the lowest thresholds
for hearing for each drug before and after therapy. The greatest
limitation of this methodology is that because the BAER readings
were obtained using air conduction sounds, rather than through
vibrations using a bone stimulation transducer, it is impossible to
differentiate between sensorineural and conductive hearing loss
(Strain 2011). Pretreatment BAER values were therefore likely to
be a combination of conductive hearing loss caused by a reduc-
tion in the lumen of the ear canal due to swelling, damage to
the tympanic membrane and/or through fluid within the middle
ear (Strain 1996) together with sensorineural damage due to the
penetration of bacterial toxins (Lundman et al. 1992, Stenqvist et
al. 1997) through the round window causing cochlear damage.
After-treatment values would similarly be a combination of some
conductive hearing loss due to the lack of a normal otic anat-
omy together with the presence of fluid within the ear and some
sensorineural loss due to damage from infection and the effect
of topical medication. It was hoped that by standardising tech-
niques, the degree of conductive hearing loss could be kept con-
stant. In addition, by only using cases where the correct therapy
was selected initially, on-going hearing damage from infection
could be minimised, meaning changes in the minimum auditory
threshold could be attributed to the treatment. The differences
between the lowest threshold for hearing before therapy and at
the end of therapy were recorded as an indication of any ototoxic
effects of the topical drug. Where hearing thresholds remained
unchanged after resolution of the disease, it was assumed that the
initial hearing loss had been a combination of sensorineural and
conductive effects and that topical therapy had not lead to oto-
toxic damage. Where the minimum hearing threshold improved
(positive value), it was assumed that hearing loss had principally
been conductive, and resolution of the disease together with an
improvement in the condition of the middle ear and external ear
canal had led to an improvement in hearing. In these cases, it
appears unlikely that the drug had produced any ototoxic effects.
Where the hearing threshold increased (negative value) after ther-
apy, it was assumed that despite improvement of the condition of
the ear and resolution of disease, the drugs must have produced
ototoxic effects, leading to sensorineural hearing loss.
Minimum auditory threshold scores after the use of topi-
cal marbofloxacin produced no negative values. Scores ranged
from 0 to 35 with a mean value of 25, suggesting no ototoxic-
ity was seen with this drug. There are no references in either
the veterinary or human literature about the topical use of mar-
bofloxacin to treat OM. There are numerous papers discussing
Journal of Small Animal Practice • © 2017 British Small Animal Veterinary Association
the topical use of ciprofloxacin, a closely related drug, in mice
(Kavanagh et al. 2009), guinea pigs (Brownlee et al. 1992) and
humans (Ozagar et al. 1997, Kutz et al. 2013, Samarei 2014).
Results from these studies suggest it is a very safe drug when used
topically in OM; in fact, current opinions in human otology are
that fluoroquinolones are safer than aminoglycosides when used
topically and should be considered as first-line drugs for OM
(Harris et al. 2016). The results from this study would concur
with that view. No negative scores were found in the gentamicin
group. Scores ranged from 0 to 35 with a mean value of 12·5.
Gentamicin is commonly used to treat OM in people, and most
authors suggest that it is relative safe but should only be used for
short periods (Ozagar et al. 1997, Phillips et al. 2007); others
report hearing loss (Wong & Rutka 1997, Pappas et al. 2006).
A single report in the veterinary literature suggests gentamicin-
based solutions are safe in the canine middle ear (Strain et al.
1995); these results also suggest that aqueous gentimicin may
be applied safely to the canine middle ear. As both tobramy-
cin and ticarcillin were not used as first-line treatments in this
study, the numbers of dogs in these groups was much smaller.
Despite this, significant changes were seen in the minimum
auditory thresholds for both drugs after successful therapy. For
the tobramycin group, all scores had negative values. The range
of scores was −30 to −70 with a mean score of −50. Tobramycin
is recognised as having ototoxic effects when it is given systemi-
cally (Zheng et al. 2001), but there are only a few reports of its
effect when used topically in humans (Fradis et al. 1997) or ani-
mals (Oghan et al. 2011), where it appears to show a variable
degree of ototoxicity. In this study, it led to an increase in the
threshold for hearing in all of the dogs treated with it. Although
it was successful in resolving their infections, it appeared to lead
to a reduction in their hearing. Although the final concentra-
tion of tobramycin was used according to the recommendation
of previous authors (Morris 2004), it should be noted that the
final treatment concentration was approximately four times the
concentration of the gentamicin (gentamicin 0·27% solution,
tobramycin 1·0% solution). It may be that at lower concentra-
tions the tobramycin may not show the same degree of ototoxic-
ity, although it is also questionable whether it would produce the
same therapeutic benefits. For the ticarcillin group, three out of
four scores were negative. The range of scores was 10 to −40 with
a mean value of −18·75. There is only a single veterinary study
describing ticarcillin in the treatment of otitis externa in the dog
(Nuttall 1998). There are no studies describing the use of ticar-
cillin in canine OM and only a single report that describes the
changes that ticarcillin produces in the middle ear, and this is
in chinchillas (Jakob et al. 1995): significant toxic effects were
described in the middle and inner ear that included inflamma-
tion, haemorrhage and effusions. Moreover, with prolonged use,
cholesteatomas were observed at four weeks. The recommenda-
tions from Jakob et al.’s (1995) study were that ticarcillin should
not be used in ototopical preparations. These findings would be
in agreement with those from the current study, which also sug-
gest that ticarcillin is an ototoxic drug. However, as in the case
of the tobramycin, ticarcillin was used at a high concentration
(2·5%) compared to the other drugs and the ototoxic effects may
5
 S. Paterson
also be, in part, due to the high concentration. Therapy with
ticarcillin led to a dramatic reduction in the hearing of 75% of
the dogs with OM. This would mean that whilst it may be suit-
able to treat cases of otitis externa, it should not be used if the ear
drum is damaged or cannot be seen.
In summary, successful therapy of infectious OM is possible
with topical drugs. Topical antibiotics can be used in combi-
nation with flushes with a low degree of ototoxicity. Based on
current literature and the results from this study, aqueous solu-
tions of fluoroquinolones appear to be the safest. Gentamicin
also appears safe, but both tobramycin and ticarcillin appear to
be ototoxic when used topically to treat OM. Neither of these
drugs should be used unless fluoroquinolones, gentamicin or a
combination of both have failed to resolve infection. In all cases,
owners should be made aware of the unlicensed use of aqueous
antibiotics to treat OM and the potential ototoxic effects. Addi-
tionally, if tobramycin or ticarcillin are used to resolve infection
to avoid the need for total ear canal ablation and bulla osteotomy,
owners should be made aware of the risk of damage to their dog’s
hearing.
Acknowledgements
The author acknowledges Ms L. Payne VN for her help in analy-
sis of the results.
Conflict of interest
The author is a veterinary adviser for Vetruus and has received
consultancy fees from Dechra Animal Health and Elanco over
the last two years.
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