Intratympanic steroid injection

Considerations

• 2008: Issues, indications, and controversies regarding intratympanic steroid perfusion

  • No convincing evidence that ITPs is effective in sudden sensorineural hearing loss

  • Inconsistent results of ITPs in controlling vertigo and few studies focused on hearing recovery in Meniere’s disease

  • No studies comparing ITPs results to the natural history of Meniere’s disease

  • Given the recognized difficulties in conducting randomized controlled clinical trails, it is suggested that studies evaluating “therapeutic gain” of ITPs relative to current treatments and to the natural history of Meniere’s disease should be acceptable alternatives

  • For Meniere's consider the alternatives

    • 2012: 

Preparation

Procedure

1. Anesthesize patient (optional)

2. Position the patient the head turned slightly towards to opposite ear

3. Draw up 1 ml of Decadron 10 mg/ml in a TB syringe and attach a 25 gauge spinal needle

4. Consider poking a vent hole in the superior anterior quadrant of the TM prior to injection

5. Inject the steroid through the superior anterior quadrant of the TM

6. Inject enough to fill up the middle ear as much as possible (usually 0.3 to 0.8 ml.) You should be able to see the meniscus after the injection. Ensure that that round window is well below the meniscus

7. Allow the steroid to sit in the middle ear for 20 to 30 minutes. Ask the patient not to swallow to avoid the escape of the injected steroid prematurely through the Eustachian tube. Providing an oral suction can help the patient manage saliva

8. After 20 to 30 minutes, suction any fluid from the ear canal. The injected steroid will dissipate over time.

Post-procedure

High-Yield

Links

• Dizziness and Balance.com - Intratympanic Steroid Treatment For Meniere's Disease