Intratympanic Injections: An Unsolved Mystery


Aims: The aim of this study was to test the effectiveness of intratympanic dexamethasone injections as a treatment for severe disabling tinnitus and also observe its effect on hearing loss if any. Materials and Methods: Thirty patients with severe disabling tinnitus in the age group 20 to 60 years were selected and randomly assigned to receive intratympanic injections of a dexamethasone solution 4 mg/ml (0.5 ml) or isotonic saline (0.5 ml) solution under topical anaesthesia, once per week for 4 weeks using a zero degree endoscope. Improvement in tinnitus was assessed using a visual analog scale, considering 2-point improvement as significant and alteration in hearing if any was noted by pure tone audiometery before and after the therapy. Results: The improvement in tinnitus was not significant, with no alteration in audiometery reports. Conclusions: Intratympanic therapy is an attractive mode of treatment because of its highly targeted delivery, low concentration of the drugs required and a very good patient tolerance. Although there has been no breakthrough in intratympanic therapy for tinnitus or other otological conditions, accessibility to the inner ear through the semipermeable round window membrane holds many promises in the near future.

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Parelkar, K. , Thorawade, V. , Jagade, M. , Nagle, S. , Nataraj, R. , Pandare, M. , Hanwate, R. , Nagrale, B. , Kulsange, K. , Rangaraja, D. and Singhal, A. (2015) Intratympanic Injections: An Unsolved Mystery. International Journal of Otolaryngology and Head & Neck Surgery, 4, 124-132. doi: 10.4236/ijohns.2015.42022.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Goycoolea, M.V. and Lundman, L. (1997) Round Window Membrane. Structure Function and Permeability: A Review. Microscopy Research and Technique, 36, 201-211.<201::AID-JEMT8>3.0.CO;2-R
[2] Goycoolea, M.V. (2001) Clinical Aspects of Round Window Membrane Permeability under Normal and Pathological Conditions. Acta Oto-Laryngologica, 121, 437-447.
[3] Jahnke, K. (1980) The Blood-Perilymph Barrier. Archives of Otorhinolaryngology, 228, 29-34.
[4] Sakata, E., Itoh, A. and Itoh, Y. (1996) Treatment of Cochlear-Tinnitus with Dexamethasone Infusion into the Tympanic Cavity. International Tinnitus Journal, 2, 129-135.
[5] Shulman, A. and Goldstein, B. (2000) Intratympanic Drug Therapy with Steroids for Tinnitus Control: A Preliminary Report. International Tinnitus Journal, 6, 10-20.
[6] Cesarani, A., Capobianco, S., Soi, D., Giuliano, D.A. and Alpini, D. (2002) Intratympanic Dexamethasone Treatment for Control of Subjective Idiophatic Tinnitus: Our Clinical Experience. International Tinnitus Journal, 8, 11-113.
[7] Lustig, L.R. (2004) The History of Intratympanic Drug Therapy in Otology. Otolaryngologic Clinics of North America, 37, 1001-1017.
[8] Trowbridge, B.C. (1944) Injection of the Tympanum for Chronic Conductive Deafness and Associated Tinnitus Aurium: A Preliminary Report on the Use of Ethylmorphine Hydrochloride. Archives of Otolaryngology, 39, 523.
[9] Trowbridge, B.C. (1949) Tympanosympathetic Anesthesia for Tinnitus Aurium and Secondary Otalgia. Archives of Otolaryngology, 50, 200-215.
[10] Coles, R.R., Thompson, A.C. and O’Donoghue, G.M. (1992) Intra-Tympanic Injections in the Treatment of Tinnitus. Clinical Otolaryngology and Allied Sciences, 17, 240-242.
[11] Dodson, K.M. and Sismanis, A. (2004) Intratympanic Perfusion for the Treatment of Tinnitus. Otolaryngologic Clinics of North America, 37, 991-1000.
[12] Sakata, E. and Umeda, Y. (1976) Treatment of Tinnitus by Transtympanic Infusion of Lidocaine. Auris Nasus Larynx, 3, 133-138.
[13] Gouveris, H., Schuler-Schmidt, W., Mewes, T. and Mann, W. (2011) Intratympanic Dexamethasone/Hyaluronic Acid Mix as an Adjunct to Intravenous Steroid and Vasoactive Treatment in Patients with Severe Idiopathic Sudden Sensorineural Hearing Loss. Otology & Neurotology, 32, 756-760.
[14] Topak, M., Sahin-Yilmaz, A., Ozdoganoglu, T., Yilmaz, H.B., Ozbay, M. and Kulekci, M. (2009) Intratympanic Methylprednisolone Injections for Subjective Tinnitus. Journal of Laryngology & Otology, 123, 1221-1225.
[15] Takahashi, H., Sando, I. and Takagi, A. (1989) Computer-Aided Three-Dimensional Reconstruction and Measurement of the Round Window Niche. Laryngoscope, 99, 505-509.
[16] Salt, A.N. and Plontke, S.K. (2009) Principles of Local Drug Delivery to the Inner Ear. Audiology Neurotology, 14, 350-360.
[17] Muehlmeier, G., Biesinger, E. and Maier, H. (2011) Safety of Intratympanic Injection of AM-101 in Patients with Acute Inner Ear Tinnitus. Audiology Neurotology, 16, 388-397.
[18] Bird, P.A., Begg, E.J., Zhang, M., Keast, A.T., Murray, D.P. and Balkany, T.J. (2007) Intratympanic versus Intravenous Delivery of Methylprednisolone to Cochlear Perilymph. Otology & Neurotology, 28, 1124-1130.
[19] Rauch, S.D., Halpin, C.F., Antonelli, P.J., Babu, S., Carey, J.P., Gantz, B.J., et al. (2011) Oral vs Intratympanic Corticosteroid Therapy for Idiopathic Sudden Sensorineural Hearing Loss: A Randomized Trial. Journal of the American Medical Association, 305, 2071-2079.
[20] Conlin, A.E. and Parnes, L.S. (2007) Treatment of Sudden Sensorineural Hearing Loss: I. A Systematic Review. Archives of Otolaryngology—Head & Neck Surgery, 133, 573-581.
[21] Conlin, A.E. and Parnes, L.S. (2007) Treatment of Sudden Sensorineural Hearing Loss: II. A Meta-Analysis. Archives of Otolaryngology—Head & Neck Surgery, 133, 582-586.
[22] Denk, D.M., Heinzl, H., Franz, P. and Ehrenberger, K. (1997) Caroverine in Tinnitus Treatment. A Placebo-Controlled Blind Study. Acta Oto-Laryngologica, 117, 825-830.
[23] Montandon, P., Guillemin, P. and Hausler, R. (1988) Prevention of Vertigo in Ménière’s Syndrome by Means of Transtympanic Ventilation Tubes. ORL Journal of Oto-Rhino-Laryngology and Its Related Specialties, 50, 377-381.
[24] Sugawara, K., Kitamura, K., Ishida, T. and Sejima, T. (2003) Insertion of Tympanic Ventilation Tubes as a Treating Modality for Patients with Meniere’s Disease: A Short- and Long-Term Follow up Study in Seven Cases. Auris Nasus Larynx, 30, 25-28.
[25] Domeisen, H., Hotz, M.A. and Hausler, R. (1998) Caroverine in Tinnitus Treatment. Acta Oto-Laryngologica, 118, 606-608.
[26] Ehrenberger, K. (2005) Topical Administration of Caroverine in Somatic Tinnitus Treatment: Proof-of-Concept Study. International Tinnitus Journal, 11, 34-37.
[27] DeLucchi, E. (2000) Transtympanic Pilocarpine in Tinnitus. International Tinnitus Journal, 6, 37-40.
[28] Alzamil, K.S. and Linthicum, Jr., F.H. (2000) Extraneous Round Window Membranes and Plugs: Possible Effect on Intratympanic Therapy. Annals of Otology, Rhinology & Laryngology, 109, 30-32.
[29] Nomura, Y. (1984) Round Window Niche and Round Window Membrane. In: Pfaltz, C.R., Ed., Otological Significance of the Round Window. Advances in Oto-Rhino-Laryngology, Vol. 33, S. Karger AG, Basel, 27-37.
[30] Yoshioka, M., Naganawa, S., Sone, M., Nakata, S., Teranishi, M. and Nakashima, T. (2009) Individual Differences in the Permeability of the Round Window: Evaluating the Movement of Intratympanic Gadolinium into the Inner Ear. Otology & Neurotology, 30, 645-648.
[31] Plontke, S.K., Wood, A.W. and Salt, A.N. (2002) Analysis of Gentamicin Kinetics in Fluids of the Inner Ear with Round Window Administration. Otology & Neurotology, 23, 967-974.
[32] Banerjee, A. and Parnes, L.S. (2004) The Biology of Intratympanic Drug Administration and Pharmacodynamics of Round Window Drug Absorption. Otolaryngologic Clinics of North America, 37, 1035-1051.
[33] Bird, P.A., Murray, D.P., Zhang, M. and Begg, E.J. (2011) Intratympanic versus Intravenous Delivery of Dexamethasone and Dexamethasone Sodium Phosphate to Cochlear Perilymph. Otology & Neurotology, 32, 933-936.
[34] Becvarovski, Z., Bojrab, D.I., Michaelides, E.M., Kartush, J.M., Zappia, J.J. and LaRouere, M.J. (2002) Round Window Gentamicin Absorption: An in Vivo Human Model. Laryngoscope, 112, 1610-1613.
[35] Borkholder, D.A. (2008) State-of-the-Art Mechanisms of Intracochlear Drug Delivery. Current Opinion in Otolaryngology & Head & Neck Surgery, 16, 472-477.
[36] Borden, R.C., Saunders, J.E., Berryhill, W.E., Krempl, G.A., Thompson, D.M. and Queimado, L. (2011) Hyaluronic Acid Hydrogel Sustains the Delivery of Dexamethasone across the Round Window Membrane. Audiology Neurotology, 16, 1-11.
[37] Iwai, K., Nakagawa, T., Endo, T., Matsuoka, Y., Kita, T., Kim, T.S., et al. (2006) Cochlear Protection by Local Insulin-Like Growth Factor-1 Application Using Biodegradable Hydrogel. Laryngoscope, 116, 529-533.
[38] Paulson, D.P., Abuzeid, W., Jiang, H., Oe, T., O’Malley, B.W. and Li, D. (2008) A Novel Controlled Local Drug Delivery System for Inner Ear Disease. Laryngoscope, 118, 706-711.
[39] Sheppard, W.M., Wanamaker, H.H., Pack, A., Yamamoto, S. and Slepecky, N. (2004) Direct Round Window Application of Gentamicin with Varying Delivery Vehicles: A Comparison of Ototoxicity. Otolaryngology—Head and Neck Surgery, 131, 890-896.
[40] Sakamoto, T., Nakagawa, T., Horie, R.T., Hiraumi, H., Yamamoto, N., Kikkawa, Y.S., et al. (2010) Inner Ear Drug Delivery System from the Clinical Point of View. Acta Oto-Laryngologica, 563, 101-104.
[41] Salt, A.N., Hartsock, J., Plontke, S., LeBel, C. and Piu, F. (2011) Distribution of Dexamethasone and Preservation of Inner Ear Function Following Intratympanic Delivery of a Gel-Based Formulation. Audiology Neurotology, 16, 323-335.
[42] Chandrasekhar, S.S., Rubinstein, R.Y., Kwartler, J.A., Gatz, M., Connelly, P.E., Huang, E., et al. (2000) Dexamethasone Pharmacokinetics in the Inner Ear: Comparison of Route of Administration and Use of Facilitating Agents. Otolaryngology—Head and Neck Surgery, 122, 521-528.
[43] Mikulec, A.A., Hartsock, J.J. and Salt, A.N. (2008) Permeability of the Round Window Membrane Is Influenced by the Composition of Applied Drug Solutions and by Common Surgical Procedures. Otology & Neurotology, 29, 1020-1026.
[44] Qi, W., Ding, D. and Salvi, R.J. (2008) Cytotoxic Effects of Dimethyl Sulphoxide (DMSO) on Cochlear Organotypic Cultures. Hearing Research, 236, 52-60.
[45] Belhassen, S. and Saliba, I. (2012) Pain Assessment of the Intratympanic Injections: A Prospective Comparative Study. European Archives of Oto-Rhino-Laryngology, 269, 2467-2473.
[46] Stachler, R.J., Chandrasekhar, S.S., Archer, S.M., Rosenfeld, R.M., Schwartz, S.R., Barrs, D.M., et al. (2012) Clinical Practice Guideline: Sudden Hearing Loss. Otolaryngology—Head and Neck Surgery, 146, S1-S35.

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