Intratympanic Dexamethasone

Your doctor has recommended intratympanic  Dexamethasone procedure for you. Below are some common questions and answers about this procedure. 

What is intratympanic dexamethasone?

Dexamethasone is a steroid that we usually give intravenously (through the vein) or intramusculary. Steroids are typcially given for conditions when we want to reduce inflammation, swelling or scar tissue formation.

Intratympanic means through the ear drum into the middle ear.  Medicines that are placed into the middle ear space can be absorbed into the inner ear structures such as the cochlear or balance organ.

So we can give dexamethasone through the ear drum, to specifically allow it to get into the inner ear at a much higher concentration than if it was given by any other route.

Why have you been offered intratympanic dexamethasone?

You have been offered intratympanic dexamethasone so we can get a large concentration of steroid into the inner ear. Typically we offer this for conditions such as sudden sensorineural hearing loss when patients can’t have oral steroids, and/or have not had any improvement in their hearing with the oral steroids.   It is also offered for patients with Meniere’s Disease.

What to expect during the procedure

Local anaesthetic is injected into the ear. It feels like a bee-sting lasting a few seconds.

Dexamethasone is then injected through the drum into the middle ear, filling it entirely. You may feel pressure and the hearing will decrease temporarily.  You may also feel some medicine going down the back of the nose/ throat area as it drains down the Eustachian tube.

At this point, it is important that you try not to swallow or talk; each time you do this, some of the dexamethasone drains down the Eustachian tube.

You will be asked to lie for 15-20 minutes with the injected ear facing the ceiling.

The intention is to allow the dexamethasone to be in the middle ear so it gets absorbed as much as possible into the inner ear.

What to expect after the procedure

Most patients feel very little difference after the injection other than a numb and blocked ear that resolves after 24 hours. However, some patients may have some burning or stinging sensation for 1-2 days after. Paracetamol or simple non-steroidals are usually enough.

Most people are well enough to drive afterwards, although occasionally patients can have no more than a few hours of bad spinning vertigo. It is best to have a driver with you at least for your first injection.

Why does it sometimes hurt?

We cannot inject local anaesthetic directly into the ear drum, so we rely on the local to trickle down towards the ear drum. You won’t feel a sharp pain, but you may still feel pressure and some discomfort.  Also not commonly, some people do experience some pain from the dexamethasone itself in the middle ear or down the Eustachian tube.

Why have I been offered a grommet?

Very occasionally we offer patients grommet insertion so that the patient can place steroid drops into the middle ear themselves.