We appreciate Dr Cunningham's comments and would first like to take this opportunity to clarify our methods. We did not notice, until after publication, a typographical error in our "Methods" section. To clarify, we used commercially available 0.25% phenylephrine hydrochloride. The treated ear received 4 drops as stated in our article.
There were no cardiovascular complications in our study's patient population, nor has there been any in the subsequent few thousand patients in which the phenylephrine drops have been used since the completion of our study. The phenylephrine advisory panel suggested a maximum initial dose of 0.5 mg of phenylephrine hydrochloride, or approximately 4 drops of 0.25% nasal solution,1 which presumes complete (100%) absorption. The cases discussed in the aforementioned report involved topical intranasal or injected submucosal administration, which is expected to have a much higher systemic absorption rate than topical instillation into the external auditory canal and middle ear via the tympanostomy tube.
Altman JS, Haupert MS, Hamaker RA, Belenky WM. Caution Advised When Using Diluted Phenylephrine Hydrochloride. Arch Otolaryngol Head Neck Surg. 1999;125(10):1170. doi: