Intratympanic Injections

What Is an Intratympanic Injection?

An intratympanic injection is a method of treating diseases of the inner ear. Medication is given through the ear drum into the inner ear. It is typically used for patients whose response to standard treatment is inadequate.

How Does the Injection Work?

By injecting medication through the ear drum, the middle ear space is filled with fluid containing the drug of choice. The inner ear absorbs some of the medication across the round window. The round window is a naturally occurring opening in the bone of the inner ear. Only a membrane separates the inner ear and middle ear within the round window. Medications can be slowly absorbed through this membrane into the inner ear.

Who Needs These Injections?

Intratympanic injections are used to treat inner ear diseases in special circumstances. The most commonly treated condition is endolymphatic hydrops, or Meniere’s disease. In this disorder, there is excess buildup of normally occurring fluid in the inner ear. The buildup waxes and wanes. When severe, patients experience hearing loss, vertigo, tinnitus, and pressure in their ear. There is damage to the hearing and balance cells of the inner ear with each attack.

Corticosteroids are strong anti-inflammatory medications that can be given to reduce the damage to these cells and treat hearing loss or vertigo. Gentamicin is an antibiotic that is toxic to the balance cells. It may be given to provide relief from vertigo.

Sudden hearing loss can also be treated by corticosteroids. If there is no improvement in hearing after taking steroid tablets, medication can be given by intratympanic injection.

In diabetics or certain stages of pregnancy, steroid tablets may have increased harmful effects. These effects are avoided by giving steroids through the ear drum.

Other medications such as neuromodulators are being studied for conditions such as tinnitus. They are not routinely given but are used in experimental trials.

How Will My Doctor Give the Injection?

The injection is given in the clinic. Your doctor will lay you back and turn your head so that the affected ear is up. The ear drum is visualized with a microscope and a drop of numbing medication is placed on the ear drum. A thin needle is then used to make a tiny hole in the ear drum and medication is given through the needle. Fullness, pressure, or mild discomfort may be experienced as the ear is filled with medication. You will then be asked to lay quietly without speaking or swallowing while the medication is absorbed by your inner ear.

Are There Any Drawbacks?

After an injection, residual fluid in the middle ear may cause temporary pressure, fullness, discomfort or dizziness. A dose of Tylenol will provide relief. The ear drum will heal within a few days to weeks. In a small percentage of injections, the ear drum does not heal. This is usually not a problem as a tiny hole causes no symptoms. Rarely, the hole will need repair.