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Tympanic membrane perforation after intratympanic steroid injection with regard to local and systemic risk factors
18 April 2018 (online)
Intratympanic steroid injection is a frequent therapy modality of sensorineural hearing loss. Main complication is a persisting tympanic membrane perforation. As steroids affect wound healing, we evaluated the rate of perforations with regard to local and systemic risk factors.
Between 2013 and 2017, 77 patients were treated at the University Hospital of Regensburg with intratympanic steroids (0,5 ml of 10 mg/ml dexamethasone-phosphate until April 2016 and 50 mg/ml dexamethasone-phosphate since April 2016), among these the rate of perforations was determined and potential local (number and site of injections, appearance of otitis) and systemic risk factors (age, concomitant systemic steroid therapy, diabetes, smoking, vessel diseases, radiation/chemotherapy, immune suppression) were analyzed.
A total of 6 perforations was documented and each was closed operatively. The perforations occurred exclusively in patients with at least one risk factor while no risk factor was present in 21 of the 71 patients without a perforation. In the present sample of patients there was no significant difference between the groups with and without perforation with regard to the proportion showing a risk factor.
Intatympanic steroid therapy is a frequent therapy modality of hearing loss. In the presented collective of patients the risk of a persisting tympanic membrane perforation is 7.8% over all. The rate differs from some rates reported in the literature. This potential complication must be discussed thoroughly with the patient individually.