Intratympanic Injections — Various Study Results

I used scholar.google.com to look into Intratympanic injections as a treatment for tinnitus.

Some studies seem to have positive results, especially for patients treated within 2 weeks or 3 months of onset of T. Looks like it is too late for me. Too bad the ENT I saw two days after my onset had no idea about any of these studies......

You can use the studies below to determine whether this is a treatment you might be interested in. You can also print out some of these studies and show them to your doctor, as a way to get him or her to give you this treatment.

One thing you may want to do is look into how prestigious the different journals cited above are. My background is not in medicine, so it is difficult for me to tell whether any of these studies were published in predatory journals (that would publish anything for a fee).

Note, some of the studies don't have a control group. The finding where the success rate was higher for people who have had T for less than 2 weeks, could be explained by the fact that many who suffer from T for less than 2 weeks end up spontaneously recovering.

The Good News:
"We have demonstrated significant improvements in each of the above mentioned outcomes subsequent to treatment in both groups. However, patients in the IT dexamathazone and melatonin group attained statistically significant better outcomes. Besides, the differences in improvement rate and cure rate were highly significant between the two groups, favoring the IT dexamethazone and melatonin group."

"Tinnitus was cured in 43 of 114 patients (37.7%) within
3 months. The mean tinnitus loudness score, the mean tinnitus
awareness score, and the mean tinnitus handicap inventory score
were significantly reduced at 3 months after ITD. Audiometric
responses were detected in 12 of 43 patients (27.9%) who under-
went follow-up audiograms. The cure rate was significantly
greater in patients with symptoms lasting for 2 weeks or less than
in patients with symptoms lasting for more than 1 month (64.7% vs.
15.7%; p<0.05). The mean global improvement index for tin-
nitus was significantly greater in patients with unilateral tinnitus
than in patients with bilateral tinnitus. Among patients with unilateral tinnitus, the audiometric
response rate was significantly greater in patients with asym-
metric hearing threshold than in patients with symmetric hearing
threshold (48.8% vs. 4.8%; p<0.01). The cure rate was signifi-
cantly associated with the duration of symptoms."

"ITD injection may be a useful treatment option for acute tinnitus caused by noise trauma"

"Intratympanic (IT) steroid injection has been used increasingly in various inner ear diseases instead of systemic steroid, because of the higher concentration of the drug into the target organ and the lower risk of the systemic side effect. Although there were several trials applying IT steroid injection on tinnitus, most of them failed to demonstrate its therapeutic effect more than controls. However, a study has shown a meaningful outcome when the therapeutic target is limited to acute tinnitus developed within 3 months. Although IT steroid injection treatment in tinnitus requires more evidence, when the therapeutic target is limited to the acute phase, IT steroid injection could be a treatment option for tinnitus. Early intervention, asymmetric hearing loss and unilateral tinnitus seem to be favorable factors for outcome of IT steroid injection."

"Results
Pure-tone audiometry did not show significant improvement. However, there was a significant improvement in speech audiometry, tinnitus loudness, and Tinnitus Handicap Inventory after the end of the four injections and in the subsequent evaluations 1 and 3 months later.
Conclusion
IT dexamethasone injection could be a simple and effective method for controlling subjective idiopathic tinnitus. The tinnitus may not disappear, but will be alleviated, enabling the patient to cope more easily with the disease, and thus reducing their handicap."

"Carbamazepine is a medication routinely used to treat tinnitus.
Material and Method: Seventy-nine patients (84 ears) with subjective tinnitus which failed to respond to a minimum of four-week systemic medical therapy were assigned to a study group and a control group by a random, single-blind method. The study group was further randomly divided into two subgroups. The participants in the study group received either 0.5-ml intratympanic injections of prednisolone (study group 1) or dexamethasone (study group 2). The patients in the control group only took carbamazepine. The effective rates at the end of the therapy and the control rates at the end of a six-month follow-up were analyzed statistically.
Results: There were no statistical differences in the effective and control rates among the three groups.
Conclusions: Intratympanic steroid injection has positive effects similar to those of oral carbamazepine in subjective tinnitus. Intratympanic steroid injection may be considered an alternative treatment for subjective tinnitus."


The Bad News

"The results of this study indicate that intratympanic methylprednisolone has no benefit, compared with placebo"


"The improvement in tinnitus was not significant, with no alteration in audiometery reports."

 

A quick glance suggests these studies are poorly designed and don't convincingly demonstrate anything.

 

I don't see any problems with the design of the first two and the last study in the "good news" section. Both studies in the "bad news" section also look fine to me.

 

Let's take the second "good" study: there is no control group. That is a problem (as you yourself note), and it is impossible to know whether the treatment "worked".

From what I can tell of the abstracts, the two "bad" ones look better methodologically.

 

It can go very wrong as well.

http://www.curezone.org/forums/am.asp?i=1416252

 

The first study had a control group (taking melatonin is the same as not taking anything). According to
http://www.scimagojr.com/journalrank.php?category=2733
it was published in a good journal.


Study 2: I thought it was a good study, as the abstract stated "We report the better therapeutic efficacy of intratympanic dexamethasone injection (ITD) in patients with acute subjective tinnitus (AST) compared to alprazolam medication only."
Now I see that they compared the outcomes for patients in their study with the outcomes for patients in a study where alprazolam was used to treat the patients. It is not ideal, but it it not completely nonsense.

The last study in the "good news" group had a control group...

 

An oral drug is not a good control group for an IT drug.

These studies highlight the poor research design of most tinnitus studies.

 

The finding (injections better than the oral drug) would not imply that the injections are better than doing nothing only if the oral drug were to be worse than doing nothing. I imagine the drug was chosen because past studies had demonstrated that it was better than doing nothing. So if injections were better than a drug that previous studies showed to be an effective treatment, then injections are better than doing nothing.

 

if I understand well all those injection therapy are for Acute T only ?

 

The last study in the "bad news" section was concerned with chronic sufferers: "Patients having severe disabling tinnitus (SDT) for at least 6 months". One would have to get the full text of the studies where only the abstract is available, but it would appear that the rest of the studies focused on people in the acute stage...