From the Guidelines
Intratympanic steroid injection can be indicated for right-sided hearing loss in certain clinical scenarios, particularly for sudden sensorineural hearing loss after failure of oral steroid therapy, or as first-line treatment when oral steroids are contraindicated, as supported by the most recent and highest quality study 1.
Clinical Scenarios for Intratympanic Steroid Injection
This treatment involves injecting corticosteroids (commonly dexamethasone 4-24 mg/ml or methylprednisolone 40-80 mg/ml) directly into the middle ear through the tympanic membrane. The procedure usually involves 3-5 injections spaced 3-7 days apart, with the patient remaining in a position that maximizes drug contact with the round window for 30 minutes after injection.
Mechanism and Benefits
Intratympanic steroids work by reducing inflammation and immune-mediated damage in the inner ear, with the advantage of delivering high concentrations directly to the affected ear while minimizing systemic side effects. This approach is most effective when initiated within 2-4 weeks of hearing loss onset, though some benefit may still occur with later treatment.
Side Effects and Considerations
Side effects are generally mild and may include temporary pain, dizziness, tympanic membrane perforation, or middle ear infection. The decision to use intratympanic steroid injection should be based on individual patient circumstances, including the severity of hearing loss, the presence of other symptoms, and the patient's overall health status, as discussed in 1 and 1.
Key Points
- Intratympanic steroid injection is a viable option for sudden sensorineural hearing loss, especially when oral steroids are not effective or contraindicated.
- The procedure involves injecting corticosteroids into the middle ear, with 3-5 injections spaced 3-7 days apart.
- Benefits include reduced inflammation and immune-mediated damage in the inner ear, with minimal systemic side effects.
- Side effects are generally mild, but may include temporary pain, dizziness, or tympanic membrane perforation.
- The decision to use intratympanic steroid injection should be individualized based on patient circumstances, as supported by 1, 1, and 1.
From the Research
Indications for Intratympanic Steroid Injection
- Right hearing loss can be an indication for intratympanic injection of steroid (corticosteroid) in cases of sudden sensorineural hearing loss (SNHL) that has not responded to systemic therapy 2, 3, 4.
- The effectiveness of intratympanic steroids in treating SNHL has been demonstrated in several studies, with significant improvements in hearing recovery and pure-tone averages (PTA) observed in patients who received intratympanic dexamethasone or methylprednisolone 2, 3, 5, 4.
Comparison of Steroids
- Studies have compared the effectiveness of different steroids, including dexamethasone and methylprednisolone, with varying results 3, 5, 6.
- One study found that methylprednisolone was more effective than dexamethasone in improving hearing in patients with severe hearing loss 5.
- Another study found that intratympanic dexamethasone was more effective in reducing tinnitus handicap inventory (THI) scores in patients with high-frequency sudden deafness, while subperiosteal injection of methylprednisolone was more effective in improving pure-tone threshold in patients with low-frequency sudden deafness 6.
Safety and Efficacy
- Intratympanic steroid injection has been shown to be a safe and effective treatment for SNHL, with minimal morbidity and no significant adverse events reported in most studies 2, 3, 4.
- However, one study noted that intratympanic dexamethasone carried a risk of perforation of the tympanic membrane, although this was rare and resolved with follow-up 6.