Intratympanic corticosteroids injections: a systematic review of literature

Abstract

The objective of the study was to determine the evidence of intratympanic steroids injections (ITSI) for efficacy in the management of the following inner ear diseases: Ménière's disease, tinnitus, noise-induced hearing loss (NIHL) and idiopathic sudden sensorineural hearing loss (ISSNHL). The data sources were literature review from 1946 to December 2014, PubMed and Medline. A systematic review of the existing literature was performed. Databases were searched for all human prospective randomized clinical trials using ITSI in at least one treatment group. The authors identified 29 prospective randomized clinical trials investigating the benefits of an intratympanic delivery of steroids. Six articles on Ménière's disease were identified, of which one favored ITSI over placebo in vertigo control. Of the five randomized clinical trials on tinnitus therapy, one study found better tinnitus control with ITSI. The only available trial on NIHL showed significant hearing recovery with combination therapy (ITSI and oral steroids therapy). Seventeen studies were identified on ISSNHL, of which 10 investigated ITSI as a first-line therapy and 7 as a salvage therapy. Studies analysis found benefits in hearing recovery in both settings. Due to heterogeneity in treatment protocols and follow-up, a meta-analysis was not performed. Given the low adverse effects rates of ITSI therapy and good patient tolerability, local delivery should be considered as an interesting adjunct to the therapy of the ISSNHL and NIHL. Only one article over six where ITSI therapy offers potential benefits to patients with Ménière's disease in the control of tinnitus and vertigo was found. ITSI does not seem to be effective in the treatment of tinnitus.

Intratympanic Drug Delivery for Tinnitus Treatment

“…It emphasized that this treatment should be considered as an adjuvant one in sudden deafness [18] consistent with the findings of this study.…”

Simultaneous versus Sequential Intratympanic Steroid Treatment for Severe-to-Profound Sudden Sensorineural Hearing Loss

“…Because the only commercially available concentration of dexamethasone in Korea is 5 mg/mL, several previous studies conducted in Korea have used the same dexamethasone concentration [Ahn et al, 2008;Kim et al, 2012;Lee et al, 2010;. In other reports from Japan, Australia, and Germany, doses of 4-5 mg/mL have also been used for IT injections, and they have shown benefits as salvage treat- [Lavigne et al, 2016]. Since a higher dose of steroid in IT injections may have led to different results, further studies will be needed to clarify the superiority of simultaneous therapy over sequential therapy in SSNHL.…”

Hearing Changes After Intratympanically Applied Steroids for Primary Therapy of Sudden Hearing Loss: A Meta-analysis Using Mathematical Simulations of Drug Delivery Protocols

“…Drug application protocols and the choice of steroid vary considerably between studies. Variations in parameters such as the applied drug concentration, the applied volume and timing of injections with different treatment protocols makes it difficult to directly compare the outcome in studies, especially with respect to the actual dose of steroid delivered (2). …”