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Ménière's Syndrome treatment with Steroid Injections in the Ear

What is Ménière’s syndrome?

Ménière’s syndrome (also known as endolymphatic hydrops) is the result of a fluid imbalance in the inner ear. Symptoms of Ménière’s syndrome include vertigo (spinning sensation), sensitivity to loud sounds, tinnitus (ringing in the ears), temporary or permanent hearing loss, and fullness/pressure in the ears. Severe attacks can include nausea, vomiting, and an increased risk for falls. Attacks can be sudden and last for several hours.

What is the purpose of a steroid injection for Ménière’s syndrome?

Steroids are a powerful anti-inflammatory medication when placed in the ear in small doses. When used in Ménière’s syndrome, a steroid injection reduces the frequency and severity of vertigo attacks. Approximately 87% of patients experience such improvements according to the results of medical studies.

What are the risks of a steroid injection?

The steroid is injected directly through the eardrum (also called the tympanic membrane; see illustration). This can cause such events as temporary dizziness, pain and bleeding. Rare risks include damage to ear bones (ossicles) and middle ear infections. There is also about a one percent chance that the hole will remain in the eardrum, which could require surgery to correct.

What is the procedure for receiving a steroid injection?

The procedure takes approximately 30 minutes. First, patients lie down flat on their back on the examining table with head turned so that the affected ear is facing up. The physician performs the procedure with the aid of a special type of microscope. Some physicians apply a medicine directly on the eardrum to numb it before the procedure. Next, a needle is inserted through the eardrum into the middle ear (see illustration). The needle contains a small amount of a steroid (dexamethasone is commonly used) sometimes mixed with a very small amount of another ‘numbing’ drug (lidocaine is commonly used). The medicine(s) fill the middle ear.

What happens after the procedure?

After the procedure, patients will lie down flat on their back on the examining table with head turned so that the treated ear is facing up. Typically, patients remain in this position for 15 to 30 minutes. (This time varies based on physician preference.) Finally, a cotton ball is placed in the treated ear.

The ear should be kept dry for 24 hours (no swimming or direct shower spray to the head or ear). Mild discomfort, gurgling, popping, and moisture in the ear canal following the injection are common, temporary sensations.

Common Questions:

How long should I keep the cotton ball in my ear?

The cotton ball absorbs extra solution and can be removed at any time.

Are there any dietary or drink restrictions after the injection (besides existing restrictions – what restrictions already exist?)?

No. Drinking flavored beverages helps remove the taste of the medication, which drains from the ear down into the mouth then down the throat.

How long until I notice a change in my symptoms?

You should notices changes in approximately two to three days.

Are there any complications that I should watch for?

You should watch for severe pain, fever, or foul smelling drainage from the ear. If you experience any of these symptoms or are unsure of the importance of a symptom, contact your physician’s office.

Contact your physician with any additional concerns or questions.

References:
  • Phillips JS et al. Intratympanic steroids for Ménière’s disease or syndrome. Cochrane Database Syst Rev. 2011 Jul 6;(7):CD008514.
  • Lambert PR et al. A randomized, double-blind, placebo-controlled clinical study to assess safety and clinical activity of OTO-104 given as a single intratympanic injection in patients with unilateral Ménière’s disease. Otol Neurotol 2012 Sep;33(7):1257-65.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 8/6/2013…#15228

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