Intratympanic Steroid Treatment in Otitis Media with Effusion Resistant to Conventional Therapy in Children

Abstract

Background: Children's hearing impairment is primarily caused by otitis media with effusion (OME). OME may be linked to developmental delays, thus early and appropriate therapy of OME avoids hearing and speech impairment in children. Treatment is still a contentious topic, though. Objectives: We aimed to assess the efficacy of Intratympanic (IT) steroids for the management of OME resistant to traditional medical Therapy. Patients and methods: The study was conducted on 40 patients who had complaints of hearing loss and bilateral OME that resisted medical treatment lasting at least three months. Under general anesthesia, we performed myringotomy and ventilation tube (VT) was inserted bilaterally on each patient Then we injected steroid (.5 ml methylprednisolone 40 mg/mL) into the right middle ear. During the operation and in follow-up visits, once a week for three weeks in a row. Results: Resolved OME was 32 (80%) ears with ventilation tube (VT) alone and 38 (95%) ears with ventilation tube (VT) and steroid injection. This difference was significant (p = 0.043). As regard postoperative complication, tympanosclerosis was noted in 6 (15%) non-injected ears and one injected ear (2.5%) and the difference was statistically significant (p<0.05). Also, permanent perforation occurred in two (5%) non-injected ears and one (2.5%) injected ears, with statistically non-significant difference (p =1.000). While Otorrhea occurred in 4 (10%) non-injected ears and 5 (12.5%) injected ears, with statistically non-significant difference (p =1.000). Conclusion: IT steroid injections have been shown to be effective in treating OME resistant to pharmaceutical and surgical interventions, with a little risk of recurrence and surgical side effects. The best well-known therapeutic method combines IT steroid injection with ventilation tubes.