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May 2004
Ototoxicity
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Table of Contents
OTOTOXIC Effects of Five Commonly Used Topical Antimycotic Agents
Territory Managers
SPECIALS
DermaPet Vision Statement
DermaPet Mission Statement
OTOTOXIC Effects of Five Commonly Used Topical Antimycotic
Agents
Ped ENT Dept, Children's Hospital Philadelphia
OBJECTIVE: To determine the ototoxic effects of five commonly used topical antimycotic agents-clotrimazole, miconazole, nystatin, tolnaftate, and gentian violet-in the guinea pig. DESIGN: A controlled animal study in which the ototoxicity of commonly used topical antifungal agents was investigated by measurement of hair cell loss.
METHODS: Several readily available topical antimycotic preparations were instilled into the middle ears of female Hartley guinea pigs over a 1-week period. Two weeks after the last instillation, the animals were euthanized. An active control group was treated with neomycin to confirm the adequacy of the treatment in delivering a known ototoxin; an untreated control group defined the normal distribution of hair cells. The temporal bones were removed, and the cochleas were fixed and dissected. The basilar membranes were examined under the scanning electron microscope. A map of hair cell survival was made for each row in segments of each turn.
RESULTS: The untreated control animals had no discernible hair cell loss in
the two lower turns. In the apical turn and sometimes the third turn, loss of
hair cells was a common finding, this is a known effect of aging in this species.
The animals treated with neomycin had damage consistently in the basal turn,
sometimes extending into the second turn, as well as the expected hair cell
loss in the apical turn. Clotrimazole, miconazole, or tolnaftate did not cause
any hair cell loss in the first two turns. Hair cell loss in the third and fourth
turns was similar to that of the untreated control group. Likewise, nystatin
exhibited no evidence of ototoxicity. Of note, however, the preparation used
in this study left a persistent residue in the round window niche. Of the first
four animals treated with gentian violet, three developed pronounced behavioral
signs of vestibular damage, and three demonstrated extensive middle ear inflammation
and extensive new bone growth. Hair cell!
counts were not attempted because the extreme bone growth interfered with successful
perfusion and dissection.
CONCLUSIONS: Extrapolating from guinea pigs to humans requires caution. However, it is likely that guinea pigs are, if anything, more susceptible to topical ototoxins than are humans. The specific antimycotics clotrimazole, miconazole, and tolnaftate appear to be safe. Gentian violet has the potential for severe damage. The persistent residue left by the nystatin preparation is cause for concern and is a reminder that both the active ingredient and vehicle must be considered in evaluation of safety.
The above article is pertinent as a comment to the rising interest in the use
of Gentian Violet. Interestingly, it comes on the heels of the article on hearing
by Celia Cox http://dermapet.com/articles/hearing.html. She commented that any
product containing any dilution of chlorhexidine should not be used nor should
the standard foaming, alcohol and DSS containing cleansers.
NEWSFLASH
Any thoughts of my early retirement were dashed when both of my daughters,
JESSICA and STACEY, became engaged within one month.
KC, Derm meeting
Perhaps due to the WCVD5, there was a much smaller turnout. I was greeted as
I entered by STEVE WAISGLASS (Toronto) who brought his daughter, MINDY, JACK
WHITE worked the show for his 20th time. YASUYO YAMAZAKI (Vancouver, WA) and
CLAUDIA NETT (SWITZERLAND) agreed to do chapters on the next edition of my Skin
Diseases book. Yasuyo stipulated that I must spell her name right this time.
At the festive IVD party, we were entertained by the YEASTY BOYS (JIMMY NOXON
and pals from ISU) band with a special guest appearance by DANNY SCOTT on the
lead guitar and vocal. The crowd ate, danced and partied till the music stopped.
It appeared the European and CA contingent, led by PETER IHRKE and his disciples,
partied hardest. Old pal, STEVE JOSEPH (IVD), one of our esteemed hosts, led
the way.
VCA Golf, Mountaingate, LA
WILSON CONSTANTINE, ED HADAD and PHIL POSNER (all from SCHEIN) made up our awesome
foursome. I won a golf bag. Well, Phil won a putter and couldn't fit it in his
luggage so he gave it to me. And I traded some kind vet who wanted the putter
for the bag. I actually "won" a box of the excellent ProVIx balls.
Before anyone concludes these wins were on the merit of my play, I must admit
that it was in the after golf raffle. BOB and ART ANTIN, our excellent hosts,
not only provided us with a great lunch, stylish shirt, cap and a sleeve of
balls, but, they also had a feast for us after at the awards banquet where most
went home happy and with excellent prizes. For those who wonder what exactly
RON LACHARITIE does for VCA besides play golf, this is it.
PetCARE Television Network,
Inc (PTNW,) the fast growing reception based client education network that
wants to be in your reception area, released a DVD using the talented STACEY
MELMAN. They also announced the addition of COLIN BURROWS to their veterinary
advisory board. Now is the time to join the 3,000 veterinary subscribers to
this educational / marketing monthly video magazine.
We will be at the Georgia VMA June 3-5 and June 17-20, we will be in Myrtle Beach for the SEVC. I should be stopping by the LA Medrx meeting on June 6 as well.
MedRxis offering CE with EAR Seminars by LOU GOTTHELF on the road next in LEXINGTON, KY on May 23, LOS ANGELES on JUNE 6 and ST. LOUIS on JUNE 13. Call 888-392-1234 to register or find out when one is coming near you.
JAY MAIDEN is our TM for the SE US. Jay can be reached at 727-560-2325, jaymaiden@verizonmail.com.
COLIN FERGUSON, formerly of IVD, is our Midwest rep. He can be reached at 614-539-9176, cferguso@columbus.rr.com.
JOYCE HEFLIN is our West Coast TM. The "old work-horse"
CHUCK MICHAELS (NE TM) and PATRICK RAYBURN (SW TM) continue to ride with distributor reps.
All our sales are guided by the capable JACK WHITEjag6410@aol.com or call 866-DERMAPET.
For the TM nearest you please email, look at our web site or call us.
2nd Quarter Special
Buy 3 cases of MalAcetic Shampoo, Conditioner or Wet Wipes and get a FREE case of shampoo
DermAllay Shampoo. Buy one case get one case FREE.
Gallons. Buy 3 and Get 1 FREE.
EicosaDerm is now available in a 32 ounce economy size
Call your DermaPet Distributor or 800 755 4738 for ordering information.
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To contribute to your growth and that of the veterinary industry by providing
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Steve Melman VMD
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