Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections

Abstract

Objectives/Hypothesis To investigate the risk of residual tympanic membrane (TM) perforation after intratympanic (IT) steroidal treatment administered via transtympanic injection compared with trans‐tympanostomy tube (TyT). Study Design Case series, systematic review and meta analysis. Methods Data were retrieved from the medical files of an original cohort of all consecutive patients with sudden sensorineural hearing loss necessitating IT steroidal treatment in a tertiary medical center between January 1, 2016 and November 20, 2020. A systematic literature search of “MEDLINE” via “PubMed,” “Embase,” and “Web of Science” on comparable published cases was performed and meta‐analysis was established. Results Eighteen studies describing 818 ears were included in the quantitative meta‐analysis in addition to a local cohort of 140 ears. The proportion of residual TM perforation was 1.11% and 1.14% (95% confidence interval: 0.01%–3.27% and 0.028%–2.38%) in the TyT and trans‐tympanic groups, respectively, suggesting no significant difference in residual TM perforation risk between these techniques. Conclusion IT steroid therapy via trans‐TyT is not associated with more residual perforations than IT steroid therapy via transtympanic injections. Level of Evidence NA Laryngoscope, 131:E2583–E2591, 2021

Letter to the Editor Regarding “Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis” by Kim et al

“…Our independent meta‐analysis on the same subject, “Residual Perforation Risk Assessment of Intratympanic Steroids via Tympanostomy Tube Versus Transtympanic Injections,” was published May 2021 in the The Laryngoscope. 2 While both of these systematic reviews were conducted almost simultaneously at 2 opposite sides of the globe (the Far East and the Middle East), they arrived at different conclusions: while our meta‐analysis found out no association between the modality of intratympanic administration of steroids (ITAoS) and risk of iatrogenic residual tympanic membrane perforation (IRTMP), theirs found a statistically significant association between them, with an IRTMP rate of 0.073 (95% CI, 0.0459‐0.1113) in the ventilation tube group and 0.010 (95% CI, 0.0045‐0.0216) in the myringocentesis group ( P <. 001).…”

Surdité brusque : diagnostic et prise en charge en 2021

“…Passé ce délai, seule une réhabilitation auditive est recommandée. 2 FIG 222 L'adjonction d'un gel hydrosoluble résorption lente, comme l'acide hyaluronique, pourrait permettre de prolonger la durée de diffusion cochléaire23 et réduire la fuite par la trompe d'Eustache. Le tableau 3 donne un exemple de protocole de préparation d'injection trans tympanique.…”