Intratympanic Injection Therapy

Intratympanic Injection Therapy - DRHC Dubai ENT Clinic 

Intratympanic (IT) steroid therapy is gaining popularity as a treatment for SSNHL( SUDDEN SENSORY NEURAL HEARING LOSS) and Meniere disease particularly in refractory cases or those in which systemic steroids may be hazardous,but again evidence is lacking.

There have been many small studies often with very small numbers but many are retrospective without controls and the steroid dosage, delivery method and frequency of injection have varied considerably, making it difficult to assess and compare outcomes.

The main advantage of IT treatment is the reduction in systemic corticosteroid side effects. IT steroids very rarely cause changes in serum glucose levels in patients with diabetes. They may also be given to patients with cataracts, myasthenia gravis and glaucoma.

Three separate randomized controlled trials comparing IT + oral steroids and with oral steroids alone found that the addition of IT steroids did not show a significant benefit when compared to corticosteroids alone, although there was a trend towards greater improvement with the combination therapy.

The efficacy of three different steroid treatments: IT, IT + oral steroids and oral steroids alone. Their results showed similar hearing recovery rates in all three groups.

The efficacy of simultaneous versus subsequent IT steroid with oral steroids has also been studied. The results showed that the administration of simultaneous IT steroid with oral steroid did not confer additional hearing gain or earlier recovery rate over those that had subsequent treatment with IT steroid.

Choice of Steroid and Dose

The most frequently administered IT steroids are dexamethasone and solumedrol (methyl prednisolone sodium succinate). The research shows a wide variation in the concentration given.

Most studies quote doses of 10–24 mg/mL dexamethasone and 30–40 mg/mL solumedrol.

Higher concentrations may have better outcomes. 

Frequency and injection technique

Studies vary widely in the frequency of IT steroid injection, from self-administration several times a day by the patient across a grommet to clinician administered on consecutive days to weekly.

A variety of methods of administration have been reported via a spinal needle on a syringe, through a grommet or myringotomy, via a MicroWick or microcatheter, hydrogel applications and nanoparticles. Transtympanic needle or grommets are the most frequently used.

It is used for treatment of the vertigo in Meniere disease, especially if the other treatments  have failed. Aminoglycosides has an ototoxicity(especially vestibulotoxicity) after intravenous use.

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