Clinical effect of intratympanic dexamethasone injection in acute unilateral tinnitus: A prospective, placebo‐controlled, multicenter study

Abstract

Objective: The purpose of this study was to investigate the effectiveness of intratympanic dexamethasone injection (ITDI) in acute tinnitus of presumed cochlear origin.Study Design: A prospective, randomized, placebo-controlled, double-blinded, multicenter study. Methods: Between August 2013 and December 2015, 54 patients with unilateral tinnitus were enrolled at four different centers. Patients were assigned either to an ITDI (n 5 27) or an intratympanic normal saline injection (ITNI; n 5 27) group through block randomization. Intratympanic injections were administered four times over 2 weeks. At 4 weeks after initial injection, we analyzed the improvement rates of tinnitus using the tinnitus handicap Inventory (THI) and visual analogue scale (VAS) for loudness, awareness, and annoyance. We defined improvement as the reduction of more than 7 points or of more than 20% in the final THI score compared to the initial THI score.Results: The initial mean hearing thresholds and VAS and THI scores of the two groups did not differ significantly. At 4 weeks after initial injection, the mean VAS and THI scores of both groups had significantly reduced. However, the improvement rate did not differ significantly between the groups (ITDI, 51.9%; ITNI, 59.3%). Conclusion:The results indicate that ITDI might not be more effective than ITNI for the treatment of acute unilateral tinnitus. Therefore, ITDI should not be considered as the main treatment for patients presenting with acute tinnitus as the primary symptom.

Effectiveness of Intratympanic Dexamethasone Injection for Tinnitus Treatment: A Systematic Review and Meta-Analysis

“…Usually, tinnitus improvement was defined as a reduction in the THI score of 5 or more points [9,10]. However, a study used a definition of a reduction of more than 7 points or more than 20% in the THI score [11] and other studies defined tinnitus improve- A study with acute tinnitus (within 3 months). ment as a >20-point reduction in THI [12,17,19,20].…”

“…Usually, tinnitus improvement was defined as a reduction in the THI score of 5 or more points [ 9 , 10 ]. However, a study used a definition of a reduction of more than 7 points or more than 20% in the THI score [ 11 ] and other studies defined tinnitus improvement as a >20-point reduction in THI [ 12 , 17 , 19 , 20 ]. Tinnitus loudness matching was defined as a decrease in loudness by at least 5 dB SL [ 21 ].…”

“…Four studies were included in the quantitative meta-analysis of the efficacy of ITDI compared with placebo (Table 1) [7,[9][10][11]. The results of these four studies showed that ITDI did not have a differential effect in reducing the incidence of tinnitus (OR, 1.38; 95% CI, 0.53-3.61; P=0.51) compared with placebo (Fig.…”

“…2). The THI was used in three studies as a parameter for assessing the handicap due to tinnitus [9][10][11], while one study [7] did not use the THI.…”

Corticosteroids in Otorhinolaryngology

“…The addition of dexamethasone to melatonin therapy had a statistically significant effect on reducing tinnitus compared to melatonin alone [58]. Most articles on the subject conclude that intratympanic steroid injections are effective mostly in patients with acute tinnitus and mostly show no effect in those with chronic tinnitus [52,59]. The studies presented here primarily utilize dexamethasone as the drug administered to the patient; however, it is not the only substance used.…”