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The intratympanic MicroWick was developed as a novel mechanism to traverse the tympanic membrane and deliver therapeutic medications to the inner ear structures via diffusion across the round window membrane. Intratymapnic medication delivery can benefit patients with various neurotologic disorders, including idiopathic sudden sensorineural hearing loss, Ménière Disease, or autoimmune inner ear disease. Intratympanic MicroWick placement may be performed easily as an office-based procedure and provides patient-driven medical management of inner ear disorders via at-home administration of otic medications, avoiding the adverse effects of systemic medication administration and the repetitive necessary office visits required for intratympanic injections. This activity reviews the indications, contraindications, risks, benefits, and procedural technique of intratympanic MicroWick placement and highlights the role of the interprofessional team in caring for patients requiring management of various inner ear disorders. Objectives: Correlate the anatomy and physiology of the middle and inner ear to the difficulties of delivering medications directly to these structures. Identify patients who may benefit from intratympanic MicroWick placement based on their clinical history. Apply best practices when placing an intratympanic MicroWick. Develop and implement effective interprofessional healthcare team strategies to improve outcomes for patients undergoing intratympanic MicroWick placement. Access free multiple choice questions on this topic.

Neurotology disorders of the inner ear, such as hearing loss, vertigo, and tinnitus, negatively affect a large proportion of the population.[1] Systemic medications rarely achieve the required therapeutic concentrations within the inner ear, and the direct delivery of medications to inner ear structures has long posed a challenge to practitioners. Intratympanic injections and tympanostomy tubes have been used to facilitate the transport of medications to these difficult-to-access structures. Intratympanic injections have been used to medically manage idiopathic sudden sensorineural hearing loss (ISSNHL), Ménière Disease (MD), and autoimmune inner ear disease (AIED).[2][3][4] The placement of an intratympanic MicroWick permits the distribution of therapeutic pharmaceuticals directly to the inner ear, specifically to the round window membrane and perilymph.[5]

While placing an intratympanic MicroWick is considered a safe procedure, it is not without risk of complications or adverse events. Concurrent use of antibiotic drops is recommended when administering intratympanic corticosteroids to decrease the risk of infection. Patients may report pain and pressure at the myringotomy site or transient dizziness.[19] Other potential complications or adverse events of intratympanic MicroWick placement include: Otitis media and otitis externa[4][16] Cholesteatoma development[4] Hearing loss[18] Adherence of the MicroWick to the round window niche[16] Loss or breakage of the MicroWick into the middle ear space[16] Persistent tympanic membrane perforation[4][5][16][18] Spontaneous myringotomy tube extrusion[16] Vertigo, usually transient[19] Injury to surrounding structures such as the ossicles or facial nerve.

Patients with inner ear pathologies frequently present to primary care practitioners with complaints of hearing loss, vertigo, or tinnitus. Prompt identification of neurotologic disorders with timely referral to specialty care improves patient outcomes. The medical management of inner ear disorders has primarily focused on the systemic delivery of drugs, surgical intervention, device use, and behavioral therapy. However, these approaches vary in effectiveness; a significant unmet need for treating inner ear disorders exists.[1] After a comprehensive specialty patient evaluation, including an audiology evaluation, select patients may benefit from intratympanic MicroWick placement for medication delivery. Clinical nursing and medical assisting staff play a critical role in the success of this office-based procedure. Pharmacists may assist with the procurement of necessary otic medication preparations. Depending on the underlying diagnosis, repeat audiology evaluation may be required.