Author(s)
Michael C. Topf, MD
David W. Hsu, MD
Douglas R. Adams, BS
Stanley Pelosi, MD
Thomas O. Willcox, MD
Kyle W. Fisher, MD
Affiliation(s)
Thomas Jefferson University Hospital
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to inform patients on the rate of persistent tympanic membrane perforation following intratympanic steroid injection and which comorbid conditions are associated with prolonged time to perforation closure. Objectives: To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection. Study Design: Retrospective chart review. Methods: Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Meniere's disease. Primary outcomes analysis included the rate of persistent tympanic membrane perforation, defined as perforation 90 days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent use of oral steroids, were analyzed as potential predictors of persistent tympanic membrane perforation. Results: 192 patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients with persistent tympanic membrane perforations received multiple injections. One patient underwent tympanoplasty for repair of the persistent tympanic membrane perforation. The median time to perforation healing was 18 days. When controlled for use of concurrent oral steroids, patients who received three or greater injections had a 33% increase in time to perforation healing. Conclusions: The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients who receive multiple injections may be at increased risk for prolonged time for closure of tympanic membrane perforation.