Intratympanic Injections: An Unsolved Mystery

Kartik Parelkar,Mohan Jagade,Madhavi Pandare,Devkumar Rangaraja,Vandana Thorawade,Bandu Nagrale,Arpita Singhal,Rajanala Nataraj,Reshma Hanwate,Kiran Kulsange,Smita Nagle

doi:10.4236/ijohns.2015.42022

Kartik Parelkar, Mohan Jagade + Show 9 more

Open Access

https://doi.org/10.4236/ijohns.2015.42022

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Abstract

Aims: The aim of this study was to test the effectiveness of intratympanic dexamethasone injections as a treatment for severe disabling tinnitus and also observe its effect on hearing loss if any. Materials and Methods: Thirty patients with severe disabling tinnitus in the age group 20 to 60 years were selected and randomly assigned to receive intratympanic injections of a dexamethasone solution 4 mg/ml (0.5 ml) or isotonic saline (0.5 ml) solution under topical anaesthesia, once per week for 4 weeks using a zero degree endoscope. Improvement in tinnitus was assessed using a visual analog scale, considering 2-point improvement as significant and alteration in hearing if any was noted by pure tone audiometery before and after the therapy. Results: The improvement in tinnitus was not significant, with no alteration in audiometery reports. Conclusions: Intratympanic therapy is an attractive mode of treatment because of its highly targeted delivery, low concentration of the drugs required and a very good patient tolerance. Although there has been no breakthrough in intratympanic therapy for tinnitus or other otological conditions, accessibility to the inner ear through the semipermeable round window membrane holds many promises in the near future.

Highlights

One of the principal advantages of intratympanic (IT) therapy is the ability to deliver therapeutic concentrations of the drug in a highly targeted fashion to the inner ear, avoiding systemic side effects.How to cite this paper: Parelkar, K., Thorawade, V., Jagade, M., Nagle, S., Nataraj, R., Pandare, M., Hanwate, R., Nagrale, B., Kulsange, K., Rangaraja, D. and Singhal, A. (2015) Intratympanic Injections: An Unsolved Mystery
Diffusion occurs across the round window membrane (RWM) into the cochlea, driven by the concentration gradient between the middle ear and the perilymph-filled scala tympani
A cochleostomy for direct drug delivery entails a substantial risk of permanent damage, whereas RWM provides an attractive gateway to the inner ear

Summary

Introduction

One of the principal advantages of intratympanic (IT) therapy is the ability to deliver therapeutic concentrations of the drug in a highly targeted fashion to the inner ear, avoiding systemic side effects.How to cite this paper: Parelkar, K., Thorawade, V., Jagade, M., Nagle, S., Nataraj, R., Pandare, M., Hanwate, R., Nagrale, B., Kulsange, K., Rangaraja, D. and Singhal, A. (2015) Intratympanic Injections: An Unsolved Mystery. One of the principal advantages of intratympanic (IT) therapy is the ability to deliver therapeutic concentrations of the drug in a highly targeted fashion to the inner ear, avoiding systemic side effects. Diffusion occurs across the round window membrane (RWM) into the cochlea, driven by the concentration gradient between the middle ear and the perilymph-filled scala tympani. A cochleostomy for direct drug delivery entails a substantial risk of permanent damage, whereas RWM provides an attractive gateway to the inner ear. It consists of three layers: an outer epithelium facing the middle ear, a core of connective tissue, and an inner-ear epithelium bordering the inner ear [2]

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