In general, systemic steroid therapy is used to treat idiopathic sudden sensorineural hearing loss (ISSHL). In Clinical Practice Guidelines for the Diagnosis and Management of Acute Sensorineural Hearing Loss 2018, intratympanic (IT) steroid treatment is recommended as salvage treatment for ISSHL. IT steroid administration is associated with fewer complications of steroid treatment than systemic steroid administration. Some patients develop dizziness or persistent perforation after IT injection. We examined the efficacy and complications of IT steroid treatment in 11 patients with ISSHL who received IT steroid administration as primary or salvage treatment between April 2017 and March 2020 at our hospital. Various methods of IT steroid administration have been described in previous reports, and the optimal method of administration is not indicated clearly in the guidelines. We made 2 holes in the anterior-superior quadrant and anterior-inferior quadrant of the tympanic membrane, and injected dexamethasone through the former. Each patient received IT steroid administraion twice a week for 2 consecutive weeks. In regard to the hearing outcomes, the hearing improved in 8 patients, but remained unchanged in the remaining 3 patients. According to past reports, persistent perforation occur in 2%–20% of patients after IT steroid injection, but the rate in our present series was higher: 5 out of the 11 patients developed persistent perforation; we performed myringoplasty in 2 of the 5 patients. Two holes are made in the tympanic membrane in order to reduce the pressure in the tympanum by injection, but then this may also increase the risk of perforation. The risk of persistent perforation also depends on the preceding systemic steroid dose. IT steroid treatment is useful for ISSHL, although it is important to establish an optimal method of IT injection and devise ways to reduce the risk of persistent perforation.
