ITSI Effective for Some Cases of Idiopathic Tinnitus

How effective is intratympanic steroid injection (ITSI) in treating idiopathic tinnitus?

Background: Subjective tinnitus is a conscious perception of a phantom sound that is audible only by the patient. The pathophysiology is still obscure. ITSI has been used frequently to treat various inner ear diseases, as well as idiopathic tinnitus; however, previous studies have not proven its effectiveness.

Study design: A prospective, placebo-controlled, randomized, double-blind study of 30 patients with refractory tinnitus, treated between 2006 and 2007.

Setting: Department of Otolaryngology, Ajou University Hospital, Suwon, Republic of Korea.

Synopsis: Enrolled patients were randomly assigned to receive 0.3 ml to 0.4 ml intratympanic injections of either dexamethasone solution or isotonic sodium chloride solution. Intratympanic injections were performed twice a week for two weeks. ITSI efficacy was determined by comparing a tinnitus questionnaire, tinnitus handicaps index (THI) and tinnitus loudness scale at baseline and at four weeks after the last injection. Thirty patients (15 steroid, 15 saline) with refractory tinnitus completed the therapy, audiometry, tinnitogram, tinnitus questionnaire and THI. There were no differences between the steroid and the saline groups. Overall, ITSI treatment on refractory tinnitus appeared to be slightly more effective than saline injection, but there was no statistical difference between the steroid and saline groups. Side effects such as hearing loss, dizziness or eardrum perforation, or a hearing level change were not found in any patients during therapy and follow-up. Effective results, which were shown for patients with low-frequency compared with high-frequency tinnitus, had no statistical significance.

Bottom line: ITSI may not be effective for refractory tinnitus, so ITSI indication for tinnitus should be limited to specific cases.

Citation: Choi SJ, Lee JB, Lim JH, et al. Intratympanic dexamethasone injection for refractory tinnitus: prospective placebo-

controlled study. Laryngoscope. 2013;123:2817-2822.

—Reviewed by Amy Eckner