Intratympanic steroids are used in patients with sudden hearing loss who can not tolerate systemic steroids, or are suffering from diabetes, autoimmune compromised patients or in patients who do not respond to systemic therapy.
The Intratympanic steroid infusions / Gentamycin can also be used in Meniere’s disease.
The main benefits of intratympanic steroids are as follows:
- completely painless
- high concentration of active substance can be directly inserted to the diseased ear
- opposed to systemic administration, the local injection of steroids selects diseased ear
- rare side effects or complications
- only requires the application of a local anesthetic
- good adherence to treatment.
The main disadvantages associated with local steroid injections are the lack of data in the literature to demonstrate the effectiveness or its superiority versus treatment with systemic steroids. The complications of this technique are rare and include earache, feeling local sensation, tympanic membrane perforation and vertigo that lasts a few minutes and then subsides.
For injection we use 0,4 ml dexamethazone 8mg/2ml in 5 sessions over a period of 15 days. The patient is placed in supine position. Local anesthetic applied (0,1 ml cream Emla on the rear lower quadrant of the tympanic membrane for a period of 10 to 15 minutes or phenol. For the injection we use spinal needle 25 G and then diffuse approximately 0,4 ml solution Dexamethazone. Penetration is at the lower rear quadrant of the tympanic membrane. Following infusion, the patient is required to keep the head at an angle of 45 degrees to the healthy ear to avoid ingestion. The patient remains in this position for about 20 minutes.