Abstract
Objective
Intratympanic steroid injection (ITSI) can be an effective treatment for sudden sensorineural
hearing loss or Meniere's disease. Tympanic membrane (TM) perforation after ITSI is
a major complication which needs additional treatment. The purpose of this study is
to assess the factors associated with TM perforation after ITSI.
Methods
We obtained the clinical data of patients who underwent ITSI treatment at the Department
of Otolaryngology JR Tokyo General Hospital from April 2013 to March 2021. The data
included age, sex, treated side, number of injections, average interval between injections,
TM anesthesia with Zentöl solution, which contains phenol, any history of diabetes
and any concurrent use of oral or intravenous steroids. We evaluated the association
between these variables and TM perforation after ITSI using the Student's t-test,
the chi-squared test, univariate logistic regression analysis and multivariate logistic
regression analysis. TM perforation was defined as a case in which perforation was
observed at least once during outpatient visits.
Results
Records of 205 ears in 190 patients were analyzed. The overall proportion of TM perforation
in the early period after ITSI was 12.7% (26 out of 205 ears), which decreased to
9.3% (19 out of 205 ears) and 5.9% (12 out of 205 ears) at the 1- and 3-month follow-ups,
respectively. The proportion of TM perforation in the early period after ITSI without
TM anesthesia was 3.5% (5 ears out of 145 ears), which decreased to 1.4% (2 ears)
or 0% at the 1- or 3- month follow-ups, respectively. The use of tympanic anesthetics
which contain phenol was significantly associated with TM perforation in univariate
logistic regression analysis (odds ratio: 15.08, 95% confidence interval: 5.34–42.56,
p < 0.001) and in multivariate analysis (odds ratio: 20.76, 95% confidence interval:
6.31–68.3, p < 0.001). All TM perforation cases without TM anesthesia healed spontaneously or
with paper tympanic closure treatment. TM perforation in 6 ears out of 21 ears with
TM anesthesia did not heal during the follow-up.
Conclusion
The overall proportion of TM perforations from the early period after ITSI was 12.7%,
9.3% at the 1-month post-ITSI outpatient follow-up, 5.9% at the 3-month post-ITSI
outpatient follow-up. Tympanic anesthesia was significantly associated with TM perforation
after ITSI, which indicated that TM anesthesia with solutions containing phenol is
not recommended for ITSI.
Keywords
Abbreviations:
ITSI (Intratympanic steroid injection), MD (Meniere’s disease), SDHL (Sudden sensorineural hearing loss)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 10, 2023
Accepted:
January 24,
2023
Received:
September 18,
2022
Publication stage
In Press Corrected ProofFootnotes
The authors have no funding, financial relationships, or conflicts of interest to disclose.
This study was approved by the regional ethical standards committee in the JR Tokyo General Hospital.
Identification
Copyright
© 2023 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.
