Department of Otolaryngology, JR Tokyo General Hospital, Japan.
Department of Otolaryngology, JR Tokyo General Hospital, Japan; Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, University of Tokyo, Japan.
Auris Nasus Larynx. 2023 Oct;50(5):714-719. doi: 10.1016/j.anl.2023.01.012. Epub 2023 Feb 10.
Intratympanic steroid injection (ITSI) can be an effective treatment for sudden sensorineural hearing loss or Meniere's disease. Tympanic membrane (TM) perforation after ITSI is a major complication which needs additional treatment. The purpose of this study is to assess the factors associated with TM perforation after ITSI.
We obtained the clinical data of patients who underwent ITSI treatment at the Department of Otolaryngology JR Tokyo General Hospital from April 2013 to March 2021. The data included age, sex, treated side, number of injections, average interval between injections, TM anesthesia with Zentöl solution, which contains phenol, any history of diabetes and any concurrent use of oral or intravenous steroids. We evaluated the association between these variables and TM perforation after ITSI using the Student's t-test, the chi-squared test, univariate logistic regression analysis and multivariate logistic regression analysis. TM perforation was defined as a case in which perforation was observed at least once during outpatient visits.
Records of 205 ears in 190 patients were analyzed. The overall proportion of TM perforation in the early period after ITSI was 12.7% (26 out of 205 ears), which decreased to 9.3% (19 out of 205 ears) and 5.9% (12 out of 205 ears) at the 1- and 3-month follow-ups, respectively. The proportion of TM perforation in the early period after ITSI without TM anesthesia was 3.5% (5 ears out of 145 ears), which decreased to 1.4% (2 ears) or 0% at the 1- or 3- month follow-ups, respectively. The use of tympanic anesthetics which contain phenol was significantly associated with TM perforation in univariate logistic regression analysis (odds ratio: 15.08, 95% confidence interval: 5.34-42.56, p < 0.001) and in multivariate analysis (odds ratio: 20.76, 95% confidence interval: 6.31-68.3, p < 0.001). All TM perforation cases without TM anesthesia healed spontaneously or with paper tympanic closure treatment. TM perforation in 6 ears out of 21 ears with TM anesthesia did not heal during the follow-up.
The overall proportion of TM perforations from the early period after ITSI was 12.7%, 9.3% at the 1-month post-ITSI outpatient follow-up, 5.9% at the 3-month post-ITSI outpatient follow-up. Tympanic anesthesia was significantly associated with TM perforation after ITSI, which indicated that TM anesthesia with solutions containing phenol is not recommended for ITSI.
鼓室内类固醇注射（ITSI）可以是治疗突发性聋或梅尼埃病的有效方法。鼓室鼓膜（TM）穿孔是 ITSI 后的主要并发症，需要额外的治疗。本研究的目的是评估与 ITSI 后 TM 穿孔相关的因素。
我们从 2013 年 4 月至 2021 年 3 月从 JR 东京综合医院耳鼻喉科接受 ITSI 治疗的患者中获得了临床数据。数据包括年龄、性别、治疗侧、注射次数、注射间隔的平均值、用 Zentöl 溶液进行的 TM 麻醉，该溶液含有苯酚、任何糖尿病史和任何同时使用口服或静脉内类固醇。我们使用学生 t 检验、卡方检验、单变量逻辑回归分析和多变量逻辑回归分析评估这些变量与 ITSI 后 TM 穿孔之间的关联。TM 穿孔定义为至少在门诊就诊期间观察到穿孔的病例。
对 190 名患者的 205 只耳朵的记录进行了分析。ITS 后早期 TM 穿孔的总体比例为 12.7%（26 只耳朵），1 个月和 3 个月随访时分别降至 9.3%（19 只耳朵）和 5.9%（12 只耳朵）。ITS 后早期无 TM 麻醉的 TM 穿孔比例为 3.5%（145 只耳朵中的 5 只），分别降至 1 个月或 3 个月随访时的 1.4%（2 只）或 0%。使用含有苯酚的鼓室麻醉剂与 TM 穿孔在单变量逻辑回归分析（优势比：15.08，95%置信区间：5.34-42.56，p<0.001）和多变量分析（优势比：20.76，95%置信区间：6.31-68.3，p<0.001）中显著相关。所有无 TM 麻醉的 TM 穿孔病例均自发愈合或经纸鼓膜封闭治疗愈合。21 只接受 TM 麻醉的耳朵中有 6 只耳朵的 TM 穿孔在随访期间未愈合。
ITS 后早期 TM 穿孔的总体比例为 12.7%，1 个月 ITSI 门诊随访时为 9.3%，3 个月 ITSI 门诊随访时为 5.9%。鼓室麻醉与 ITSI 后 TM 穿孔显著相关，这表明不建议使用含有苯酚的溶液进行 TM 麻醉。
