Ototoxic drugs are widely used in the developing world, without audiological monitoring. Epidemiological data on ototoxic deafness are lacking for developing countries. The public health aspect of ototoxicity is often overlooked, to the detriment of the individual patient. This paper reviews ototoxic hearing loss, particularly in sub-Saharan Africa, and also assesses the impact of treatments for tuberculosis, cancer and human immunodeficiency virus (the latter including highly active antiretroviral therapy) on ototoxic hearing loss. The paper also discusses obstacles to audiological monitoring for ototoxicity in the developing world, and the potential of audiology screening using applications for mobile devices.

Introduction: We hypothesised that general practitioners and ENT specialists manage discharging ears differently. This study was designed to investigate this further.

Methods and materials: Postal questionnaires were sent to all general practitioners in the Birmingham area and all UK consultants on the British Association of Otolaryngology–Head and Neck Surgery address list.

Results and discussion: In the presence of an intact tympanic membrane, 99 per cent of consultants and 90 per cent of general practitioners would use topical antibiotics. In the presence of a perforated tympanic membrane, 97 per cent of consultants would continue to use topical antibiotics, compared with only 43 per cent of general practitioners. This was attributed to a fear of ototoxicity. If a topical non-ototoxic antibiotic of proven efficacy could be made available, 93 per cent of consultants and 88 per cent of general practitioners in this study would seriously consider using it as first line treatment.

Conclusion: The majority of general practitioners would not use topical antibiotics in the presence of a perforated tympanic membrane. Most doctors would consider using a non-ototoxic topical antibiotic as first line treatment should one be made available.

In this study, the deposits of basophilic material on the cupula of the semicircular canals in temporal bones from patients who had aminoglycoside administration within six months prior to death were compared with normal temporal bones. Subjects were divided into two groups. Group I included 24 normal control temporal bones age-matched to group II patients. Group II consisted of 23 temporal bones that had received aminoglycosides within six months prior to death. All temporal bones were examined under light microscopy.

One (4.2 per cent) of 24 temporal bones in group I (normal) showed basophilic deposits. In group II, deposits were observed in 8 (34.8 per cent) of 23 temporal bones. The prevalence of basophilic deposits in group II was significantly higher than group I.

This study demonstrates that within six months after aminoglycoside administration there is an increased prevalence of basophilic deposits on the surface of the cupula. Such changes may be related to the benign paroxysmal positional vertigo (BPPV) seen in some patients who have had aminoglycoside administration.

Intratympanic gentamicin is increasingly used in the treatment of Ménière’s disease. Many protocols have been published for its use, but there is little difference in outcome between them. The goal of the study was therefore to assess current UK practice in the use of intratympanic gentamicin.

A postal and e-mail survey of consultant ENT surgeons in the UK was conducted. Of 34 consultants who regularly used intratympanic gentamicin, 21 used a protocol based upon a single intratympanic dose of gentamicin via a needle through the tympanic membrane and repeated after at least a week. The remaining 13 used either a regime of more frequent administration or attempted a more complicated route of delivery in an effort to improve reliability and selectivity of action.

In the absence of evidence demonstrating benefit from regimens of increased complexity the majority of consultants are using the simplest possible protocol.

The translation machinery recognizes codons that enter the ribosomal A site with remarkable accuracy to ensure that polypeptide synthesis proceeds with a minimum of errors. When a termination codon enters the A site of a eukaryotic ribosome, it is recognized by the release factor eRF1. It has been suggested that the recognition of translation termination signals in these organisms is not limited to a simple trinucleotide codon, but is instead recognized by an extended tetranucleotide termination signal comprised of the stop codon and the first nucleotide that follows. Interestingly, pharmacological agents such as aminoglycoside antibiotics can reduce the efficiency of translation termination by a mechanism that alters this ribosomal proofreading process. This leads to the misincorporation of an amino acid through the pairing of a near-cognate aminoacyl tRNA with the stop codon. To determine whether the sequence context surrounding a stop codon can influence aminoglycoside-mediated suppression of translation termination signals, we developed a series of readthrough constructs that contained different tetranucleotide termination signals, as well as differences in the three bases upstream and downstream of the stop codon. Our results demonstrate that the sequences surrounding a stop codon can play an important role in determining its susceptibility to suppression by aminoglycosides. Furthermore, these distal sequences were found to influence the level of suppression in remarkably distinct ways. These results suggest that the mRNA context influences the suppression of stop codons in response to subtle differences in the conformation of the ribosomal decoding site that result from aminoglycoside binding.

Erythema multiforme is an uncommon acute self-limiting condition characterized by mucocutaneous lesions of varying severity with a variable pattern of recurrence. This is a case of a four-year-old girl who developed erythema multiforme secondary to topical aural application of Gentisone HC drops (hydrocortisone acetate one per cent, gentamicin 0.3 per cent (as sulphate)) prescribed as a treatment for otorrhoea following grommet insertion. The clinical features are described and the literature reviewed. To my knowledge, this is the first reported case in the literature, of erythema multiforme secondary to a topical aminoglycoside/steroid preparation.

We report the first case in the world literature of deliberate ablation of vestibular function in unilateral Meniere's disease with aminoglycoside eardrops (Garasone).

These findings give conclusive proof that Garasone eardrops, and by implication, all topical aminoglycoside ear drops can be vestibulotoxic in the presence of a tympanic membrane defect. The lower concentration of gentamicin in Garasone, in comparison to the standard intratympanic preparations for chemical ablation of vestibular function, may also offer a reduction in the potential risk of cochleotoxocity.