A nurse is reviewing medications for a client with a perforated eardrum. Which medication should be avoided?

Introduction: When the tympanic membrane (TM) is perforated, the middle ear is exposed to the external ear canal. Certain topical medications contain ingredients that are ototoxic and can cause permanent damage to the hair cells of the cochlea or vestibular apparatus if they pass through a ruptured eardrum. A. Ciprofloxacin otic solution is generally considered safe for use in patients with perforated eardrums or tympanostomy tubes. It is a fluoroquinolone antibiotic that does not carry the same risk of ototoxicity as aminoglycosides. B. CORTISPORIN (a combination of neomycin, polymyxin B, and hydrocortisone) must be AVOIDED in cases of PERFORATED EARDRUM. The NEOMYCIN component is an aminoglycoside that is highly OTOTOXIC and can lead to permanent hearing loss if it enters the middle ear. C. Ofloxacin is another fluoroquinolone that is specifically approved for use in patients with a ruptured TM or ear tubes. It is effectively used to treat middle ear infections without the risk of damaging the delicate structures of the inner ear. D. Amoxicillin is a systemic oral antibiotic. While it is used to treat otitis media, it is not a topical otic drop. Systemic medications do not pose the same risk of direct contact ototoxicity that topical drops do when the protective barrier of the TM is missing.