Intratympanic Steroid Injections for Ear Fullness
Intratympanic (IT) steroid injections can help with ear fullness, particularly in patients with Ménière's disease, where one randomized controlled trial showed 48% improvement in aural fullness compared to 20% with placebo. 1
Evidence for Ear Fullness Relief
The most direct evidence comes from Ménière's disease studies, where ear fullness (aural fullness) is a cardinal symptom:
In Ménière's disease patients, IT steroid therapy improved aural fullness in 38% of patients, which was comparable to IT gentamicin therapy (31%). 1 This demonstrates that steroids specifically target the sensation of ear fullness, not just hearing or vertigo.
One RCT comparing IT steroids against placebo showed statistically significant improvement in fullness (48% vs 20%). 1 This represents a clinically meaningful difference with a number needed to treat of approximately 4 patients.
IT steroids work by stabilizing the vascular endothelium, improving cochlear blood flow through anti-inflammatory effects, and affecting cochlear ion and fluid homeostasis. 2 These mechanisms directly address the pathophysiology underlying ear fullness in conditions like endolymphatic hydrops.
Clinical Application
When to Consider IT Steroids for Ear Fullness
Patients with subclinical endolymphatic hydrops presenting with isolated aural fullness, stuffiness, or ear pressure after excluding other diagnoses showed 68.4% symptom improvement with dexamethasone inner ear perfusion. 3 This suggests benefit even without full Ménière's disease.
For active Ménière's disease not responsive to noninvasive treatments, IT steroids achieve 85%-90% improvement in vertigo symptoms compared to 57%-80% with placebo or conventional therapy. 2 While this data focuses on vertigo, the same patients experienced concurrent improvement in aural fullness.
Dosing Protocols
Use either dexamethasone or methylprednisolone, with dexamethasone showing significantly better outcomes in meta-analysis. 1
Dexamethasone: 4-10 mg/mL, inject 0.4-0.8 mL into middle ear space, from once only or up to 3-4 sessions every 3-7 days depending on clinical response. 1
Methylprednisolone: 30-40 mg/mL (stock) or 62.5 mg/mL (compounded), inject 0.4-0.8 mL into middle ear space, same frequency as dexamethasone. 1
Most successful protocols use at least 4 injections over 2 weeks via transtympanic needle perforation. 1
Safety Profile
IT steroids have minimal systemic side effects and are safer than oral steroids for patients with diabetes, cataracts, myasthenia gravis, or glaucoma. 1
Risk of treatment-associated hearing loss is 0-8% with IT steroids versus 12.5-15.4% with IT gentamicin. 1, 2
Principal risk is persistent tympanic membrane perforation, which is rare and frequently resolves spontaneously or with paper patch myringoplasty. 1
Transient adverse effects include pain at injection site and brief caloric vertigo. 2
Important Caveats
The exact molecular form matters significantly for efficacy. 4 Dexamethasone-phosphate has completely different pharmacokinetic properties than dexamethasone base, affecting entry into and elimination from perilymph. Ensure you know which formulation you're using.
Variable benefit exists for isolated aural fullness without other Ménière's symptoms. 1 Two systematic reviews comparing IT steroids against placebo showed no benefit in associated symptoms when vertigo was not the primary complaint, though individual RCTs did show benefit.
Combining IT steroids with oral betahistine may improve outcomes, with 73% symptom control versus 44% with IT steroids alone. 1, 2