Rate of tympanic membrane perforation after intratympanic steroid injection

Am J Otolaryngol. Jan-Feb 2017;38(1):21-25. doi: 10.1016/j.amjoto.2016.09.004. Epub 2016 Sep 28.

Abstract

Purpose: To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection.

Materials and methods: Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation.

Results: One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078).

Conclusions: The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Age Distribution
  • Aged
  • Audiometry / methods
  • Cohort Studies
  • Female
  • Follow-Up Studies
  • Hearing Loss, Sensorineural / diagnosis
  • Hearing Loss, Sensorineural / drug therapy*
  • Hearing Loss, Sudden / diagnosis
  • Hearing Loss, Sudden / drug therapy
  • Humans
  • Incidence
  • Injections, Intralesional / adverse effects*
  • Male
  • Meniere Disease / diagnosis
  • Meniere Disease / drug therapy*
  • Middle Aged
  • Predictive Value of Tests
  • Regression Analysis
  • Retrospective Studies
  • Risk Assessment
  • Sex Distribution
  • Steroids / administration & dosage*
  • Time Factors
  • Tympanic Membrane / drug effects
  • Tympanic Membrane Perforation / epidemiology
  • Tympanic Membrane Perforation / etiology*
  • Tympanic Membrane Perforation / physiopathology
  • Wound Healing / physiology

Substances

  • Steroids