Ear & Hearing

About Intratympanic Injections

The middle ear is also known as the tympanum. Hence an intratympanic injection is a procedure where a medication, typically a corticosteroid, is injected directly into the middle ear. 

The most common use for intratympanic injections is in the treatment of sudden sensorineural hearing loss (SSNHL) – a condition where a patient experiences a rapid deterioration in hearing that is not due to a problem of the outer or middle ear, but rather a failure of the cells with detect sound and the nerves which transmit information about sound from the inner ear to the brain.

While most patients are treated with corticosteroid tablets in the initial 1-2 weeks of treatment for SSNHL, your doctor may offer you intratympanic injection of corticosteroids if the treatment needs to be continued beyond this period. This is to avoid the potential complications and side effects of prolonged use of corticosteroids. Some patients with certain pre-existing risk factors for complications of corticosteroid treatment may also be advised to start on intratympanic steroids from the outset e.g. brittle diabetes mellitus, chronic hepatitis, glaucoma, severe osteoporosis. 

Intratympanic injection can usually be performed comfortably while you are awake. The procedure requires the use of an operating microscope. Your doctor will first need to clean your ear canal and then apply a layer of topical anaesthetic cream on your eardrum. After about 15 minutes, your doctor will check that your eardrum is numb. He will then carefully insert a fine needle through the eardrum and gently fill the middle ear cavity with the corticosteroid solution. You will then be advised to remain in a lying position for about 30 min to allow the corticosteroid to diffuse into the inner ear. There is usually minimal or no bleeding at all with this procedure. Antibiotic ear drops may be prescribed for a few days as a preventive measure. The procedure is repeated according to a schedule which your doctor will discuss with you. 

Intratympanic injections are also used in the treatment of Meniere’s disease, a condition characterised by repeated episodes of vertigo, tinnitus, ear blockage/fullness and hearing loss. If you have severe symptoms of Meniere’s disease, both corticosteroids and gentamicin injections have been used but with different treatment goals. You will need to have a detailed discussion with your doctor to decide which treatment approach is best for you.