Intra Tympanic Injection - DRHC Dubai ENT Clinic

What is Intra Tympanic Injection:

Intratympanic injection is used to treat symptoms of inner ear disease, like Meniere’s disease or (SSHL) idiopathic sudden sensorineural hearing loss, which considered an ontological emergency,
Meniere's disease causes fluctuating sensorineural hearing loss, vertigo and tinnitus due to the inner ear mechanisms' failure.

Indications:

1. Idiopathic Sudden Sensorineural Hearing Loss
2. Meniere Disease
3. Refractory Tinnitus
4. Autoimmune Inner Ear Diseases

Contraindications:

1. Uncooperative patient: full cooperation is required
2. Acute otitis externa or otitis media
3. middle ear tumor or vascular malformation

Equipment and preparation:

• Binocular otology microscope
• Cottonwool soaked with Emla cream 5% or phenol, or xylocaine 10% spray applied to tympanic membrane for 30 minutes.
• Steroid - methylprednisolone (30 /mL) – or dexamethasone 8mg/ml, at body temperature to prevent caloric reaction.
• It is important to warn the patient that they may feel dizzy following the procedure, so it is advised that they have someone to take them home.

Use an otology microscope and speculum to see the anteroinferior quadrant of the tympanic membrane.
you have to remove the wax and debris in the external auditory canal to offer good visualization of the entire tympanic membrane.
Topical anesthetic spry or cream can be applied on the anteroinferior quadrant of the tympanic membrane.

0.4 to 0.8 mL methylprednisolone is injected using a 25-gauge spinal needle through the anteroinferior anesthetized region into the middle ear space until full. A second tympanic membrane hole can be done as a safety borehole, made on the tympanic membrane to relieve pressure. At the same time, the medication is being injected, avoiding barotrauma to the round window. Alternatively, a grommet can be placed for patients requiring regular intratympanic medication. after administration of the medicine ,advise the patient to remains in supine position with injected ear up and avoids swallowing, yawning, or speaking for 30 minutes to facilitate steroid absorption through the round window membrane and reduce leakage into the eustachian tube.

Complications:

The most common side effects are transient vertigo , pain, ear fullness and a burning sensation Other rare possible complications or side effects include:

• Headache
• Dizziness
• Persistent tympanic membrane perforation
• Tinnitus
• Infection
• Syncopal episode
• Hearing loss

Advantages of Intratympanic Injection:

• No systemic side effects
• higher local concentration of the drug compared to systemic steroids.
• Low morbidity
• Reduced drug amount required compared to systemic steroids
• The procedure is generally well-tolerated
• outpatient procedure requiring only topical local anesthesia
• Low cos

Definition of sudden sensory neural hearing loss:

Defined as deafness or hearing loss of cochlear or retro cochlear origin within 72 hours, affecting at least 3 consecutive frequencies by 30 dB or greater with no identifiable cause. Global incidence estimated 5 -20 per 100,000 persons per year. Guidelines from the American Academy of Otolaryngology-Head and Neck in 2019 advise that clinicians offer patients intratympanic steroid salvage therapy where there is incomplete recovery from sudden sensorineural hearing loss 2 to 6 weeks after onset of symptoms.

Menier Disease:

is a unilateral disease, causes:

fluctuating sensorineural hearing loss, vertigo and tinnitus due to the extra fluid retention in the inner ear The International Consensus on treating Meniere disease highly recommends Intratympanic steroid injection as second-line therapy when medical treatment has failed by another medication.

Our highly skilled team at the Dr. Rami Hamed Center, the leading ENT clinic in Dubai specializes in Intra Tympanic Injection.

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