20Jan 2017


  • Otolaryngology department, King Fahad Central Hospital, Jizan, KSA Otolaryngology department, Aseer Central Hospital, Abha, KSA Otolaryngology department, College of medicine, Assistant Professor, King Khalid University, KSA.
Crossref Cited-by Linking logo
  • Abstract
  • Keywords
  • References
  • Cite This Article as
  • Corresponding Author

Background: There is a wide variation in practice in the use of surgical preparation solutions among otolaryngologists in ear surgery. Chlorhexidine gluconate, povidone-iodine and alcohol are common topical antiseptics solution. The literature for risk and mechanisms of the ototoxicity by Antiseptics solution if reaches the tympanic cavity and inner ear causing functional impairment and cellular damage to tissues is being reviewed and compared. Aim: We present the current antiseptics solutions used during ear surgery and their risk of ototoxicity. Depending on the available clinical trials that have shown their clear effect on both animal models and human ears. Result: The three widely used topical antiseptics preparations for ear surgeries and have been studied in literature are: Alcohol, Chlorhexidine gluconate and Povidone-iodine. Alcohol and chlorhexidine gluconate have a toxic effect on the vestibular and cochlear function proven by significant changes in Vestibular evoked myogenic potential (VEMP) and Auditory brainstem response (ABR). On the other hand, low concentration of Povidone-iodine (5%) does not have this adverse effect, However non-significant changes in the ABR was found to be related to a high concentration of Povidone-iodine (10%). Conclusion: Chlorhexidine gluconate and alcohol have a clear ototoxic effect and are not safe in ear surgery especially with perforated tympanic membrane, whereas diluted low concentration povidone-iodine is safe and to date is the standard topical antiseptic solution to be used for ear surgeries.

  1. Mangram AJ, Horan TC, Pearson ML, Silver LCJarvis WR.. Guideline for prevention of surgical site infection 1999: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1999;20:250–78
  2. Philip L, Chris C, David P, John R. Chlorhexidine Ototoxicity in Ear Surgery Part II: Survey of Preparation Solution Used by Otolaryngologists in Canada: Is There a Cause for Concern? Journal of Otolaryngology -- Head & Neck Surgery. 2011 Dec;40(6): 441-445.
  3. Hugo WB. A brief history of heat and chemical preservation and disinfection. J Appl Bacteriol 1991;71:9–18.
  4. Zamora JL. Chemical and microbiologic characteristics and toxicity of povidone-iodine solutions. Am J Surg 1986;151:400–6.
  5. Larson EL. APIC guideline for hand washing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–69.
  6. McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev 1999;12:147–79.
  7. Rutala WA. APIC guideline for selection and use of disinfectants. 1994, 1995, and 1996 APIC Guidelines Committee. Association for Professionals in Infection Control and Epidemiology. Am J Infect Control 1996;24:313–42.
  8. Davies GE, Francis J, Martin AR, Rose FL, Swain G.. 1:6-Di-49- chlorophenyldiguanidohexane (Hibitane); laboratory investigation of a new antibacterial agent of high potency. Br J Pharmacol Chemother 1954;9:192–6.
  9. Lim KS, Kam PC. Chlorhexidine-pharmacology and clinical applications. Anaesth Intensive Care 2008;26:502–12
  10. Denton GW. Chlorhexidine. In: Block S, editor. Disnfection, sterilization, and prevention. Philadelphia: Lippincott, Williams and Wilkins; 2000. p. 321–36.
  11. Yasuda-Yasuki Y, Namiki-Kanie S, Hachisaka Y. Inhibition of germination of Bacillus subtilis spores by alcohols. In: Chambliss G, Vary J C, editors. Spores VII. Washington, D.C: American Society for Microbiology; 1978. pp. 113–116
  12. Trujillo R, Laible N. Reversible inhibition of spore germination by alcohols. Appl Microbiol. 1970 Oct; 20(4):620-3.
  13. Bush LW, Benson LM, White JH. Pig skin as test substrate for evaluating topical antimicrobial activity. J Clin Microbiol. 1986 Sep; 24(3):343-8.
  14. Klein M, Deforest A. Principles of viral inactivation. In: Block S S, editor. Disinfection, sterilization and preservation. 3rd ed. Philadelphia, Pa: Lea & Febiger; 1983. pp. 422–434
  15. Coulthard C E, Skyes G. Germicidal effect of alcohol. Pharm J. 1936;137:79–81
  16. Özkiri? M, Kapusuz Z, Saydam L. Ototoxicity of Different Concentrations Povidone-Iodine Solution Applied to the Middle Ear Cavity of Rats. Indian J Otolaryngol Head Neck Surg. 2013 Apr; 65(2): 168–172.
  17. Yagiz R, Tas A, Uzun C, Adali MK, Koten M, Karasalihoglu AF. Effect of topically applied povidone-iodine on transient evoked otoacoustic emissions in guinea pigs.The Journal of Laryngology & Otology September 2003 Sep;117: 700–703
  18. Ichibangase T, Yamano T, Miyagi M, Nakagawa T, Morizono T. Ototoxicity of Povidone-Iodine applied to the middle ear cavity of guinea pigs. International Journal of Pediatric Otorhinolaryngology 2011;75(9):1078–1081
  19. Morizono T, Sikoro MA. The ototoxicity of topically applied povidone-iodine preparations. Arch Otolaryngol 1982;108:210–3
  20. Aursnes J. Ototoxic effect of iodine disinfectants. Acta Otolaryngol 1982;93:219–26
  21. Galle HG, Venker-van Haagen AJ. Ototoxicity of the antiseptic combination chlorhexidine/cetrimide (Savlon): effects on equilibrium and hearing. Vet Q 1986;8:56–60.
  22. Igarashi Y, Suzuki J. Cochlear ototoxicity of chlorhexidine gluconate in cats. Arch Otorhinolaryngol 1985;242:167–76
  23. Aursnes J. Cochlear damage from chlorhexidine in guinea pigs. Acta Otolaryngol (Stockh) 1981;92:259–71
  24. Aursnes J. Vestibular damage from chlorhexidine in guinea pigs. Acta Otolaryngol (Stockh) 1981;92:89–100
  25. Igarashi Y, Oka Y. Vestibular ototoxicity following intratympanic applications of chlorhexidine gluconate in the cat. Arch Otorhinolaryngol 1988;245:210–7
  26. Morizono T, Johnstone BM, Entjep J. Sensorineural deafness caused by preioperative antiseptics. Otologia Fukuoka 1974;20:97–9.
  27. Morizono T, Sikora MA. Ototoxicity of Ethanol in the Tympanic Cleft in Animals Acta Otolaryngol. 1981 Jul-Aug;92(1-2):33-40.
  28. Perez RFreeman SSohmer HSichel JY. Vestibular and cochlear ototoxicity of topical antiseptics assessed by evoked potentials. 2000 Sep;110(9):1522-7.
  29. Bicknell PG. Sensorineural deafness following myringoplasty operations. J Laryngol Otol 1971;85:957–61.
  30. Ballantyne JC. Sensorineural deafness following myringoplasty operations. J Laryngol Otol 1970;84:967
  31. Bicknell PG. Sensorineural deafness following myringoplasty operations. The Journal of Laryngology & Otology  1971 Sep;85(9): 957-962.

[Tawfiq Khurayzi, Abdullah Alhelali and Sarah Alshehri. (2017); TOPICAL ANTISEPTICS IN EAR SURGERIES AND OTOTOXICITY EFFECT: REVIEW ARTICLE Int. J. of Adv. Res. 5 (1). 553-558] (ISSN 2320-5407). www.journalijar.com

Abdullah Alhelali


Article DOI: 10.21474/IJAR01/2780       DOI URL: http://dx.doi.org/10.21474/IJAR01/2780

Share this article