INTRATYMPANIC INJECTION 

By definition an intratympanic injection is when we inject something directly into the middle ear- through the Tympanic Membrane. In certain Ear disorders important medication in sufficient concentration has to reach some parts of the inner ear for relief. The concept of injecting drugs into the ear is not very old but has stood the test of time and is being practiced more frequently now, as the medication as well as the dosage schedule get formalized.

INDICATIONS FOR INTRATYMPANIC STEROID SUDDEN SNHL- Sudden idiopathic loss of hearing in one ear is a catastrophic event for the sufferer. Though the mainstream medication continues to be oral/ systemic steroids along with other supportive medication, there are some indications for an intratympanic injection-  Patient cannot tolerate oral steroids- uncontrolled diabetes, other contraindications As a salvage therapy where full dose oral steroid has not helped As part of a research project for thesis etc. 

MENIERE’S DISEASE – Though Gentamycin is the preferred drug, sometimes a steroid may be used, specially when hearing needs to be preserved.

TINNITUS MANAGEMENT – In some cases of intractable Tinnitus when no other therapy works- early treatment, unilateral tinnitus, asymmetric hearing loss are situations where the drug works.

AUTO IMMUNE INNER EAR DISEASE – a rare disorder of the inner ear 

INDICATIONS FOR INTRATYMPANIC GENTAMYCIN- Meniere’s disease not responding to mainstream medication with debilitating giddiness and Tinnitus 

HOW DOES IT WORK? The rationale is simple – instead of giving an oral/ systemic drug in higher concentrations with its attendant side effect profile, it is safer and more effective to give a smaller dose straight into the middle ear.  The middle ear has two membranes through which it connects with the inner ear – the oval window and the round window membranes. It is through the Round Window Membrane that the injectable chemical percolates through to reach the inner ear. 

PROCEDURE : 

Though a simple procedure it has to be done with full aseptic precautions and under Local Anaesthesia. The patient is kept on the OT table, part is cleaned and draped and 2 % xylocaine with adrenaline is infiltrated to achieve anaesthesia. A thin syringe with a very thin needle is taken and filled with the steroid/ Gentamycin.  Under microscopic guidance this is then injected into the ear through the eardrum.  The patient is made to lie down on that side for a few minutes.  Intratympanic injections are currently gaining favour amongst Otologists and their applications are likely to expand in the future. 

For more information : https://entdelhi.com/intratympanic-steroid-injection/

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