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Intratympanic steroid injection is used to treat cochleovestibular symptoms of inner ear disease, such as Meniere's disease or idiopathic sudden sensorineural hearing loss. This procedure involves using a syringe needle to penetrate the tympanic membrane to inject the steroid into the middle ear. This activity describes this technique and its role in treating the symptoms of inner ear disease. It is generally well-tolerated and can avoid the potential side effects of systemic steroid administration. Objectives: Outline the steps of intratympanic steroid injection. Describe the indications for an intratympanic steroid injection. Explain the physiology of intratympanic steroid injection. Summarize some interprofessional team strategies that can be employed to ensure optimal outcomes for patients who need an intratympanic steroid injection. Access free multiple choice questions on this topic.

Steroid treatment is routinely given for patients with inner ear disorders, such as unremitting Meniere's disease or idiopathic sudden sensorineural hearing loss (ISSNHL). However, for some patients, systemic steroids may be unsuccessful or contraindicated; therefore, intratympanic steroid (ITS) administration may be a suitable alternative for rapid symptom control.[1][2] ITS is increasingly used as a treatment for inner ear disease. It is generally well-tolerated, has been shown to result in superior perilymph concentration of steroids without the risk of systemic side effects, and so can be used as an alternative or in addition to systemic steroid use.[3] Idiopathic sudden sensorineural hearing loss (ISSNHL), considered an otological emergency, is defined as deafness of cochlear or retrocochlear origin within 72 hours, affecting at least 3 consecutive frequencies by 30 dB or greater with no identifiable cause. Global incidence has been estimated to be 5 to 20 per 100,000 persons per year.[4][5] In the UK, the National Institute for Health and Care Excellence (NICE) recommend steroids as first-line treatment for ISSNHL. This can comprise oral steroids, intratympanic steroid injections (ITSI), or a combination of both. Guidelines from the American Academy of Otolaryngology-Head and Neck in 2019 advise that clinicians offer patients intratympanic steroid salvage therapy where there is incomplete recovery from sudden sensorineural hearing loss (SSHL) 2 to 6 weeks after onset of symptoms.[6] Meniere's disease causes unstable or fluctuating sensorineural hearing levels and vestibular function due to the inner ear mechanisms' failure. The International Consensus (ICON) on treating Meniere disease recommends ITS as second-line therapy when medical treatment has failed.[7]

Intratympanic steroids have minimal morbidity; however, there are some potential complications or side effects that must be considered and thoroughly discussed with the patient before undergoing the procedure. The most common side effects are transient dizziness, injection site pain, and a burning sensation.[30] Other possible complications or side effects include: Pain Ear fullness Vertigo (generally temporary) Headache Dizziness Persistent tympanic membrane perforation Tinnitus Infection Syncopal episode Hearing loss Tongue numbness[30]

ISSNHL has high rates of spontaneous recovery; reported rates range from 32 to 65%. ITS treatment modality needs to be used cautiously due to a lack of confirmed understanding of the underlying etiology of some inner ear diseases.[31] An interprofessional team, particularly between the otolaryngologist, audiovestibular doctor, and audiologist, should provide a holistic and integrated approach to care that can help achieve the best possible outcomes. It is important that the ISSNHL is recognized early and referred appropriately to give these patients the opportunity access to ITS, should it be appropriate. Studies have shown that earlier time to initiating injections produce higher rates of hearing improvement.[32] ITS is a procedure that is easily performed, relatively safe, and very effective with a low complication rate and few contraindications. A study by Sugihara et al. (2018) suggested the frequency of intratympanic steroid injections does not significantly affect hearing outcomes.[32] Following treatment, there should be an audiological follow-up with a repeat audiometric assessment. One study found that the recovery rate on the 7th day of treatment to be useful for predicting final hearing recovery.[33] If there is no improvement in repeat audiometry, then a further ITS may be considered.

Regular audiometric testing may be required to monitor the hearing levels. If a course of ITS is unsuccessful in providing adequate improvement in the hearing, then the patient may be considered for hearing aid device assessment, if appropriate.