What treatment option should NOT be used if a tympanic membrane perforation is suspected in otitis externa?

When a tympanic membrane perforation is suspected in a case of otitis externa, the use of aminoglycoside combination therapy is contraindicated. Aminoglycosides, such as gentamicin, are ototoxic, meaning they can cause damage to the structures of the inner ear, particularly when they come into direct contact with the middle ear via a perforated tympanic membrane. This can lead to hearing loss and other auditory issues.

In contrast, other treatment options like ciprofloxacin/dexamethasone ear drops and topical anesthetics do not carry the same risk of ototoxicity when used appropriately. Ciprofloxacin is a safe choice for treating infections when the tympanic membrane is intact, and when a perforation is suspected, it can still be used cautiously as it has a lower risk of ototoxic effects compared to aminoglycosides. Isopropyl alcohol and acetic acid also do not present the same risk of causing harm to the inner ear structures, although care must always be taken to avoid introducing substances into the ear canal in the case of perforation.

Understanding the risks associated with various medications plays a crucial role in managing patients with ear complications effectively.