Intratympanic steroid injection side effects

Managing an acute attack involves preparation. This includes consulting with a physician about any appropriate drugs that can be taken when an acute attack occurs, and deciding ahead of time when it is appropriate to go to a hospital. During an attack, it is helpful to lie down in a safe place with a firm surface, and avoid any head movement. Sometimes keeping the eyes open and fixed on a stationary object about 18 inches away is helpful. In order to control dehydration, a doctor should be called if fluid intake is not possible over time due to persistent vomiting.

This is a very important and much underestimated aspect in the management of Menieres disease. This can help minimize stressors which act as a trigger to acute attacks, and can also help in the management of underlying tinnitus, dizziness and imbalance. A syndrome labeled psychophysiologic dizziness plays a large role in many patients with Meniere’s Disease. This essentially where an insult to the vestibular system leaves a degree of nerve damage. The brain needs to compensate for this loss and anxiety, especially anxiety centred on the fear of further attacks or dizziness can further amplify the symptoms of instability.

Endolymphatic sac decompression has probably polarized the otolaryngology community more so than any other aspect of MD treatment. Following the publication of the Danish Sham study, 18 the procedure was largely abandoned in Europe. However, the study had methodological flaws leading many to question the validity of the results. The procedure remains popular in the United States at the present time. To do justice to this particular argument is well beyond the scope of this article. However, being Irish, I shall invoke an anecdote on the subject involving the consumption of alcohol. After a night with this author and another otolaryngologist of Polish extraction, one of the authors of the Danish Sham study conceded that the procedure might actually be effective in controlling vertigo symptoms. However, he felt that the improvement, rather than being mediated via decompression of the endolymphatic sac, was due to the surgery inflicting a degree of insult to the vestibular system, similar to the effect of low-dose gentamicin. I suspect that heated discussion on the subject of sac decompression will continue for some years to come.

Depending on timing, intra-tympanic steroid injection is also offered (dexamethasone 10-24mg/cc). Intra-typmpanic steroid injection is performed by inserting a needle through the eardrum and injecting about of highly concentrated steroids directly into the middle ear space. The patient is than instructed to keep the affected ear up for 30 minutes without swallowing, yawning, or popping the ear. After injection, the patient is allowed to immediately resume normal activities. This steroid injection has also been used to treat Meniere's Disease flare-ups.

Results  In the oral prednisone group, PTA improved by dB compared with a -dB improvement in the intratympanic treatment group. Mean pure tone average at 2 months was for the oral steroid treatment group and dB for the intratympanic treatment group. Recovery of hearing on oral treatment at 2 months by intention-to-treat analysis was dB greater than intratympanic treatment (% upper confidence interval, dB). Per-protocol analysis confirmed the intention-to-treat result. Thus, the hypothesis of inferiority of intratympanic methylprednisolone to oral prednisone for primary treatment of sudden sensorineural hearing loss was rejected.

Intratympanic steroid injection side effects

intratympanic steroid injection side effects

Depending on timing, intra-tympanic steroid injection is also offered (dexamethasone 10-24mg/cc). Intra-typmpanic steroid injection is performed by inserting a needle through the eardrum and injecting about of highly concentrated steroids directly into the middle ear space. The patient is than instructed to keep the affected ear up for 30 minutes without swallowing, yawning, or popping the ear. After injection, the patient is allowed to immediately resume normal activities. This steroid injection has also been used to treat Meniere's Disease flare-ups.

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