2024 Volume 117 Issue 11 Pages 961-969
Recently, intratympanic steroid injection (ITSI) has come to be widely used, especially as salvage treatment, for idiopathic sudden sensorineural hearing loss (iSSNHL). However, the optimal protocol for ITSI remains unclear.
In this study, we investigated the relationship of the background characteristics of the patients and the method of ITSI with the effect of the latter on hearing improvement. We also examined the proportion of cases and factors related to the risk of development of tympanic membrane perforation as a complication of ITSI.
The subjects of this study were 167 cases of iSSNHL treated by ITSI between 2007 and 2021.
The background characteristics of the patients analyzed included the age, sex, affected side, presence/absence of underlying diabetes mellitus, hearing level on the affected side before treatment, and improvement with first-line treatment. In regard to the factors associated with the ITSI, the duration from onset of hearing loss to the start of ITSI, the number of injections, the average interval between injections, the injection site on the tympanic membrane, and the need for a ventilation hole were considered.
When the effectiveness of salvage treatment was defined as a hearing improvement of 10 dB or more, the treatment was found to be effective in 80 out of 132 cases (57.6%). The interval from onset to the start of ITSI and age were identified as being statistically significantly associated with the efficacy of ITSI.
The proportion of tympanic membrane perforation was 8.7% (13 out of 149 cases). The injection site (anterior inferior quadrant) on the tympanic membrane was the only factor that was identified as being statistically significantly associated with the risk of tympanic membrane perforation.
In conclusion, differences in the method of ITSI within the scope of this study did not affect the efficacy of ITSI as a salvage treatment. The proportion of cases that developed tympanic membrane perforation was, however, slightly higher than in previous reports, so that it seems necessary to consider ways to reduce the proportion of cases developing tympanic membrane perforation, especially by modifying the site of injection on the tympanic membrane.
