J Korean Med Assoc.  2023 Oct;66(10):589-596. 10.5124/jkma.2023.66.10.589.

Intratympanic injection for treatment of inner ear diseases

• Lee HJ
• Chang M
• Mun SK

• KMID: 2547248
• DOI: http://doi.org/10.5124/jkma.2023.66.10.589

Abstract

Background
Intratympanic injection has emerged as a novel approach to bypass the blood-labyrinth barrier and effectively deliver drugs into the inner ear. This technique is used for treatment of various inner ear diseases and overcomes the limitations of systemic drug therapy. In this paper, we provide an overview of the application of intratympanic injection using steroids and gentamicin and highlight the major diseases and summarize the reported efficacy of this approach.
Current Concepts
Intratympanic steroid injections have been used for treatment of various inner ear diseases, including sudden sensorineural hearing loss, Ménière disease, and tinnitus. Therapeutic effects of steroids include reducing inflammation, modulating the immune response, improving cochlear blood flow, and maintaining ion homeostasis. Intratympanic gentamicin injections are primarily used to minimize hearing loss and control vertigo symptoms in patients with Ménière disease. Gentamicin selectively injures vestibular hair cells with minimal ototoxicity compared with other aminoglycoside antibiotics.
Discussion and Conclusion
Intratympanic injections offer several advantages, including targeted drug delivery, minimal systemic adverse effects, and rapid action. Reportedly, intratympanic steroid injections used as primary or salvage treatment are associated with positive outcomes in patients with sudden sensorineural hearing loss. Ménière disease also shows positive outcomes following intratympanic steroid and gentamicin injections. However, studies have reported conflicting results, and further research is required to standardize dosing and administration protocols. Intratympanic injections are a promising therapeutic option, and ongoing research is essential to optimize their efficacy and safety.

Keyword

Intratympanic injection; Steroids; Gentamicins; Sudden hearing loss; Meniere disease; 고실 내 주사; 스테로이드; 젠타마이신; 돌발난청; 메니에르병