Procedures · Ear
Intratympanic corticosteroid injection
Intratympanic injection delivers corticosteroid directly to the middle ear, from where it reaches the inner ear at a higher concentration than can be achieved orally, with less effect on the rest of the body. It is used mainly in sudden hearing loss and in selected cases of Ménière's disease. It is carried out in the consulting room, under local anaesthesia.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
What the procedure is
The inner ear is protected by barriers that make it hard for orally administered medication to reach. To achieve an adequate concentration there, a high dose would be needed throughout the body — with the effects that entails.
Intratympanic injection gets round that problem. Corticosteroid is delivered through the eardrum, into the middle ear, and from there crosses the round window into the inner ear. Local concentration is higher, and exposure of the rest of the body is lower.
When is it indicated?
- Sudden hearing loss. The most frequent indication. It may be used as initial treatment, alongside oral corticosteroid, or as salvage where the response to oral treatment has been insufficient. Here time matters: the earlier it begins, the better.
- Ménière’s disease, in selected cases, to control attacks of vertigo.
- Situations where oral corticosteroid is inadvisable, such as poorly controlled diabetes, hypertension, glaucoma or other conditions the physician takes into account.
How is it carried out?
- The ear is examined and local anaesthetic is applied to the eardrum.
- After the anaesthetic has taken effect, a fine needle passes through the eardrum and the medication is deposited in the middle ear.
- You remain lying down, with the treated ear uppermost, for a few minutes, without swallowing or speaking, so the fluid stays in contact with the round window.
- At the end, you receive the aftercare instructions.
The procedure is carried out in the consulting room, without admission, and takes 30 to 40 minutes including the anaesthetic and the rest afterwards.
What to expect afterwards
- A blocked sensation in the ear for some hours.
- Brief dizziness, common in the first minutes, because the fluid reaches the inner ear at a temperature different from that of the body.
- A small opening in the eardrum, which usually closes on its own.
- A dry ear for the period advised.
About the outcome
The response varies between individuals and depends on factors such as the cause, the degree of hearing loss and the time between the onset of symptoms and treatment. Follow-up is therefore carried out with audiometry, compared against the test performed before the procedure.
It is not possible to predict the individual outcome before starting, and the plan is reviewed over the course of follow-up.
Where it is carried out
At Clínica Rhinus, in the Renascença district of São Luís, in the consulting room, by the ENT specialist.
This procedure is carried out on a self-pay basis only. The consultation and follow-up audiometry follow the rules of your health plan. Contact our team to arrange booking.
How should I prepare for this test?
- Bring the medical request: it is required.
- Fasting is not required, but avoid a heavy meal immediately beforehand.
- Bring your most recent audiogram: it is the reference for comparison afterwards.
- Tell us about all your current medication and whether you have diabetes, glaucoma or hypertension.
- Tell us if you have had a perforated eardrum or ear surgery on the side to be treated.
- Come accompanied if possible: brief dizziness after the procedure is common.
Sources: Brazilian Society of Otology · Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about ear
Why deliver the corticosteroid inside the ear?
Because the inner ear is difficult for medication taken by mouth to reach. Delivered into the middle ear, corticosteroid crosses the round window and reaches the inner ear at a higher concentration, with less exposure for the rest of the body — which matters for people with diabetes, hypertension or glaucoma.
Does the procedure hurt?
Discomfort is usually minor. Local anaesthetic is applied to the eardrum beforehand. Many people report a sensation of pressure and a blocked ear, and brief dizziness is common when the fluid, cooler than body temperature, reaches the inner ear. That dizziness usually lasts a few minutes.
When is it indicated?
Mainly in sudden hearing loss, as initial treatment or as salvage where oral corticosteroid has not produced a sufficient response. It is also used in selected cases of Ménière's disease, to control attacks of vertigo. The indication is individual and discussed in consultation, with the test results to hand.
How many injections are needed?
It varies with the indication and with each patient's response. It is common for several injections to be given a few days apart, with follow-up audiometry in between. The number is not fixed in advance: it is adjusted over the course of follow-up.
What are the precautions afterwards?
Lying with the treated ear uppermost for a few minutes after the injection, avoiding swallowing and speaking during that time, and keeping the ear dry for the period advised. The small opening made in the eardrum usually closes on its own.
Sudden hearing loss calls for prompt assessment
If you have lost hearing in one ear from one hour to the next, do not wait for a routine appointment. Call the clinic on +55 98 3199-1706 or +55 98 3015-1537. The phone is the fastest way to have an assessment fitted in.