Tympanic Membrane Perforation After Intratympanic Steroid Injection: A Systematic Review and Meta‐analysis

Abstract

Objective We investigated the incidence of tympanic membrane (TM) perforations induced after intratympanic steroid injection (ITSI) in patients with sudden sensorineural hearing loss (SSNHL) through a systematic review and meta-analysis. Data Sources PubMed, Embase, and MEDLINE. Review Methods Primary database searches were performed, and 1901 records were identified. After removal of 1802 articles through abstract screening, the remaining 99 full-text journals were assessed for eligibility to be included in the study. Fifty-eight studies that used either ventilation tubing (VT) or tympanocentesis (TC) for ITSI were selected for analysis. The subjects were divided into VT and TC groups. The rate of TM perforation after ITSI in 2 groups, sites of ITSI, needle gauge, and influence on residual hearing were investigated. Results The cohorts comprised patients who underwent VT (n = 257, 9.6%) and TC (n = 2415, 90.4%). The proportion of TM perforation after ITSI in each group was 0.073 (95% CI, 0.0469-0.1113) and 0.010 (95% CI, 0.0045-0.0215), respectively, which suggested that the VT group showed a significantly higher TM perforation rate than the TC group ( P < .001). In the subgroup analyses, there was no significant difference in the odds ratio for the rate of TM perforation according to the injection site and needle gauge for TC. The proportion of surgical repair showed no significant difference between the 2 groups. Conclusion ITSI via VT may have a significantly higher risk of TM perforation than ITSI via TC, although those are relatively small overall. ITSI should be performed in the direction to minimize possible adverse effects.

Delivery of Dexamethasone to the Round Window Niche by Saturated Gelatin Sponge for Refractory Sudden Sensorineural Hearing Loss: A Preliminary Study

“…In our series, persistent TM perforation was found in 5% (1 of 20) of the patients after treatment, which is similar to the rate reported in the literature for local application of steroids through ventilation tube. The meta-analysis by Kim et al (24) showed that the proportion of TM perforation after ITS was 7.3% in the ventilation tubing group. Robey et al (25) reported a much higher risk of TM perforation after placement of transtympanic Silverstein microwick for steroid administration, with 29% (48 of 166) of patients having a permanent perforation.…”

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

“…Among the various attempts to treat tinnitus, ITDI is clinically burdensome in that it is slightly invasive. Complications such as hearing loss, eardrum perforation, and middle ear inflammation are known to be rare after ITDI [ 22 ], but clinicians feel these complications to be more difficult than those after ITDI used to treat other diseases (such as sudden sensorineural hearing loss or Menière disease). In this study, we evaluated the effectiveness of ITDI for tinnitus treatment.…”

Sordera súbita idiopática

“…Aunque no existe acuerdo en el tipo de corticoide, concentración, número de inyecciones, forma y frecuencia de aplicación [6, 12], el Consenso Español del año 2019 [5] al igual que otros [1, 6], aconseja una inyección transtimpánica semanal de dexametasona 8mg/ml, durante 3 semanas. El riesgo principal es la perforación timpánica [34].…”