Treatment: Intratympanic Steroid Injection

What is an intratympanic steroid injection?

Behind the eardrum in the middle ear space is a structure called the round window. This is sealed with a membrane behind which are the fluids of the inner ear, vital for hearing and balance function.

An intratympanic steroid injection is an outpatient procedure performed by an ENT (ear, nose and throat) surgeon where a drug is injected through the eardrum to fill the middle ear allowing the medication to diffuse across the round window membrane and into the cochlear.

Why is an intratympanic steroid injection given?

Intratympanic steroid injection enables ear specialists to treat and improve impaired hearing caused by conditions that affect the inner ear such as Meniere’s Disease, sudden onset sensorineural hearing loss, autoimmune inner ear disease and other scenarios.

Although oral steroids can be used to treat these conditions, an injection directly into the middle ear aims to achieve a higher concentration of the drug in the area where it’s needed. This also avoids the side effects associated with tablet steroids due to drug absorption throughout the body.

As the effect of steroids is cumulative, it’s common for patients to need 3 or 4 injections, spaced apart by days or weeks, but this varies according to the condition that’s being treated.

Preparing for an intratympanic steroid injection

Before the procedure, you’ll have an initial consultation with your ENT specialist who will take a detailed history of your symptoms, examine the inside of your ear and arrange a same-visit hearing test. This will help them determine which ear is causing the problem and how severely your hearing has been affected.

What does an intratympanic steroid injection involve?

Intratympanic steroid injections are relatively straightforward to administer in experienced hands. Your surgeon will apply a topical local anaesthetic to the ear drum (tympanic membrane). Once the area is numb, the steroid is injected into the middle ear using a fine needle.

You’ll be lying face up during the procedure and then asked to remain in a still position for 20 to 30 minutes to stop the steroid from leaking out of the middle ear too quickly, allowing for maximum effectiveness.

Recovering from an intratympanic steroid injection

Some patients can feel a little dizzy or disorientated after the procedure but these side effects will settle quickly. Certain steroid preparations can cause strong pain, but this will typically settle by the next morning and your consultant will discuss the choice of steroid with you. The procedure can also cause a feeling of fullness in the ear but rarely cause any discomfort. Patients are able to leave the clinic by foot without problem, although driving straight after the procedure is recommended against.

Intratympanic steroid injection risks

Intratympanic steroid injection is a common and well-practised treatment. It’s generally very safe and there are rarely complications.

Documented associated risks of such injections would include:

• Hearing Loss
• Perforation of the eardrum
• Infection
• Scarring of the eardrum
• Vertigo
• Tinnitus