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Intratympanic steroids - to give or not to give?
The treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) is controversial and different modes of steroids have been tried without any universal consensus. Various authors have reported combined oral and intratympanic steroid therapy in SSNHL, with consistent results in several...Intratympanic treatments for subjective idiopathic tinnitus
Direct application of medication into the ear is long established, going back as far as written records. In the modern era, greater understanding of aural anatomy revealed that drugs instilled in the middle ear could potentially diffuse into the cochlea...
Do intratympanic injections require local anaesthesia?
Intratympanic injections are becoming increasingly acceptable in the management of Meniere’s disease, tinnitus and sudden hearing loss. This is because they avoid the need for hospitalisation and can be performed as low-cost outpatient procedures. It is traditional to freeze the...Intratympanic steroids in Ménière's disease: what’s the evidence?
The days of drastic surgery for Ménière's disease are long gone. We know that intratympanic injections can deliver high doses of medication to the inner ear with minimal discomfort and minimal risk. But how do we choose from the myriad...
Adjuvant intratympanic steroid therapy in sudden sensorineural hearing loss
Sudden sensorineural hearing loss (SNHL) means abrupt hearing loss by 30dB affecting three consecutive frequencies within 72 hours. This is treated by high tapering doses of systemic steroids, the role of which is controversial and fraught with possible complications in...
Round window niche drilling with intratympanic for ISSHL. A new option for salvage?
This paper from China compares the technique of widening the round window via a posterior tympanotomy approach and steroid-soaked gelatin sponge with intratympanic steroids alone for salvage therapy in severe idiopathic sensorineural hearing loss. Salvage therapy was defined as patients...
Should intratympanic steroids be the first line treatment for sudden sensorineural hearing loss?
This article looked at whether intratympanic steroids (ITS) provide more benefits over systemic steroid therapy (SST) as initial therapy in patients with idiopathic sudden sensorineural hearing loss (ISSHL). This meta-analysis study, based on published RCTs, concluded that ITS treatment exhibited...
Role of intratympanic corticosteroid for treatment of Bell’s palsy and Ramsay Hunt syndrome
Acute peripheral facial palsy occurs annually in 30 in 1,000,000 individuals in the general population. Bell’s palsy and Ramsay Hunt syndrome account for about 70% of cases of peripheral facial palsy. They are believed to be caused by viral reactivation...
Oral versus oral and intratympanic corticosteroid treatment for sudden sensorineural hearing loss
The 2012 American Academy of Otolaryngology- Head and Neck Surgery Foundation (AAO-HNSF) clinical practice guidelines on sudden sensorineural hearing loss (SNHL) have two statements that address steroid use. Statement eight indicates an option to offer corticosteroid as initial treatment for...
Low risk options following failure of intratympanic gentamicin for Meniere’s
This article is a useful summary of the options available when intratympanic gentamicin (ITG) fails to adequately control vertigo episodes in Meniere’s patients. The authors describe the anatomical reasons that may impede drug delivery to the round window with the...
High dose betahistine as effective as, but slower acting compared to intratympanic dexamethasone in intractable Meniere’s disease
The management of intractable Meniere’s disease poses a complex conundrum to otolaryngologists. The focus of treatment is decreasing the severity and frequency of vertigo and tinnitus whilst trying to preserve hearing. Betahistine has been used for many years in the...
