Systemic side effects of transtympanic steroids

Objective: Review largest series of patients treated with transtympanic steroids, including outcomes, steroid dosing and adverse outcomes. Review first reported cases of systemic side effects from transtympanic steroids. Methods: A retrospective case series of 166 patients who underwent placement of transtympanic Silverstein tube with microwick for steroid administration was reviewed. Results: 5/166 patients developed systemic side effects, 9/166 patients developed local side effects. 48/166 (29%) of patients had a persistent perforation after therapy. The percent of patients with improvement as a function of symptoms: hearing loss 42%, tinnitus 56%, vertigo 68%, aural fullness 25% and dysequilibrium 66%. Conclusions: While our study revealed a significant risk of persistent tympanic membrane perforation, the incidence of systemic and local side effects from transtympanic steroid administration is low.