A child has been receiving combination hydrocortisone-neomycin-polymyxin B eardrops for otitis externa for 3 days but still complains of difficulty hearing. The nurse notes redness and swelling of the canal

Question

The nurse would be correct to suspect which of the following?
a. Worsening of the otitis externa
b. Allergy to the nonantibiotic component of the drops
c. Neomycin toxicity
d. Development of necrotizing otitis externa

Answer 1

ANS: C
Neomycin is ototoxic and can cause local swelling and erythema in about 15% of patients.
Most infections begin to improve in 3 days and resolve completely by 10 days. No substantial information points to worsening of the otitis externa.
An allergy to the nonantibiotic component of the drops is not a feasible option, because hydrocortisone reduces inflammation and edema.
Development of necrotizing otitis externa is highly unlikely. It is almost exclusive to two groups of high-risk individuals, the elderly with diabetes and the immunocompromised, especially those infected with the human immunodeficiency virus (HIV). None of the information given supports the likelihood that the child is immunocompromised.