Transtympanic Gentamicin Ablation

Transtympanic administration of drugs, especially ototoxic preparations, should be avoided in PLF patients. While ototoxic ablation of inner ear hair cells might improve or relieve

PLF-related symptoms in patients with unilateral PLFs and a normal opposite ear, ablation of inner ear hair cells does not address the mechanical problem of the open fistula or otic capsule defect. The instillation of ototoxic agents into the middle ear of the PLF patient is associated with a greater risk of ototoxic hearing loss and destruction of vestibular hair cells than would occur in a nonfistulous ear. The treatment also leaves the fistula open, placing the patient at risk of potentially serious complications (see below). For these reasons, we believe that treating the symptoms of active PLF with transtympanic ototoxic agents is inappropriate.

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