||In the presence of a TM perforation the following precautions should be taken into account when topical aminoglycoside drops are prescribed:
a. The drops should be used for the shortest duration possible and never in the presence of what amounts to a normal healthy looking middle ear.
b. The patient should be instructed precisely regarding the duration and dosage of therapy and advised to stop treatment as soon as the discharge stops.
c. Therapy should not exceed 5-7 days without the need for reassessment.
d. The patient should be advised to stop treatment immediately if hearing loss, tinnitus, vertigo or imbalance is noted.
e. When otorrhea persists despite an appropriate trial of medical treatment, the possibility of a referral to an ENT specialist should be considered.
Finally in all patients with tympanic membrane defects, the risks of using aminoglycoside otic preparations should be carefully weighed against the potential benefits.