"The use of intratympanic steroids is moderately uncomfortable, inconvenient, and more costly than oral steroids and is associated with several relatively minor adverse effects. Nevertheless, for patients with sudden hearing loss who are thought to be at too high a risk for systemic steroid usage, this study suggests a reasonable alternative in the setting of rapid specialty referral. Additional research should focus on identifying subgroups of patients for whom steroid treatment seems especially helpful and whether combination oral and intratympanic is better than single modality alone. However, the study by Rauch et al did not answer the lingering question of whether there is any benefit of steroids for the patient with sudden sensorineural hearing loss. A better understanding of the pathophysiology of hearing loss, identification of unique prognostic subgroups, and adherence to rigorous clinical research methods are required for the proper assessment of the therapeutic benefits of existing treatments and discovery of new treatments for this disorder."
This is a very important and much underestimated aspect in the management of Menieres disease. This can help minimize stressors which act as a trigger to acute attacks, and can also help in the management of underlying tinnitus, dizziness and imbalance. A syndrome labeled psychophysiologic dizziness plays a large role in many patients with Meniere’s Disease. This essentially where an insult to the vestibular system leaves a degree of nerve damage. The brain needs to compensate for this loss and anxiety, especially anxiety centred on the fear of further attacks or dizziness can further amplify the symptoms of instability.
The injections are performed with the patient lying down and using the office microscope. The ear is first cleaned of wax. A small area of the eardrum is numbed with a drop of medication. A small needle and syringe are then used and the needle is passed through the eardrum at the site that is numbed so that the tip is in the ear, near the round window. This is a membrane where drugs are absorbed in to the cochlea. The fluid is injected in to the middle ear and the patient stays lying down for 20-30 minutes during which he does not swallow or sniff. The drug sits against the round window and is absorbed in to the inner ear. The patient then sits up slowly and leaves the office. Patients should not drive for a few hours after this procedure. Water is kept out of the ear until it is confirmed that the tiny hole has healed.