AB - Objective: Review largest series of patients treated with transtympanic steroids, including outcomes, steroid dosing and adverse outcomes. Review first reported cases of systemic side effects from transtympanic steroids. Methods: A retrospective case series of 166 patients who underwent placement of transtympanic Silverstein tube with microwick for steroid administration was reviewed. Results: 5/166 patients developed systemic side effects, 9/166 patients developed local side effects. 48/166 (29%) of patients had a persistent perforation after therapy. The percent of patients with improvement as a function of symptoms: hearing loss 42%, tinnitus 56%, vertigo 68%, aural fullness 25% and dysequilibrium 66%. Conclusions: While our study revealed a significant risk of persistent tympanic membrane perforation, the incidence of systemic and local side effects from transtympanic steroid administration is low.
OBJECTIVES: To determine whether transtympanic steroid administration may be an effective treatment for sudden onset sensorineural hearing loss (SSNHL) in patients for whom systemic steroid treatment has failed or who were not candidates for systemic steroids. METHODS: The standard medical regimen for SSNHL usually involves systemic steroid therapy. Unfortunately, some patients do not respond successfully to or are poorly tolerant of systemic steroids. Transtympanic administration of steroids has been suggested as an alternative to systemic therapy. A prospective study was designed to evaluate the hearing outcomes in SSNHL patients treated with transtympanic steroids. Patients received transtympanic steroids if oral steroids had failed to work or if they were not able to tolerate oral steroids. Transtympanic steroids were administered through a ventilation tube placed with the patient under local anesthesia. Steroid administration was performed on 4 separate occasions over the course of 10 to 14 days. Hearing was assessed immediately before therapy and within 1 to 2 weeks after therapy. RESULTS: Hearing improvement was documented in 10 of 23 patients (44%) who underwent transtympanic steroid administration. This represents a 44% hearing salvage in patients for whom steroid treatment would otherwise have been considered a failure. CONCLUSION: Transtympanic steroid therapy may be an alternative treatment for patients with SSNHL for whom systemic steroid therapy had failed or who could not tolerate systemic steroid therapy.