title: Rate of tympanic membrane perforation after intratympanic steroid injection.
abstract: OBJECTIVE
  To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection.
  
  
  METHODS
  Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation.
  
  
  RESULTS
  One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078).
  
  
  CONCLUSIONS
  The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA. Electronic address: michael.topf@jefferson.edu.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Topf
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
authors.forename: David W
authors.initials: DW
authors.lastname: Hsu
authors.affiliation: Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut Street #100, Philadelphia, PA.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Adams
authors.affiliation: Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, 132 South 10th Street, 1170 Main Building, Philadelphia, PA.
authors.forename: Tingting
authors.initials: T
authors.lastname: Zhan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Pelosi
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
authors.forename: Thomas O
authors.initials: TO
authors.lastname: Willcox
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
authors.forename: Brian
authors.initials: B
authors.lastname: McGettigan
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut Street, 6th Floor, Philadelphia, PA.
authors.forename: Kyle W
authors.initials: KW
authors.lastname: Fisher
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001299:Audiometry / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000175:diagnosis / Q000188:drug therapy*; D003639:Hearing Loss, Sudden / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D015552:Injections, Intralesional / Q000009:adverse effects*; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013256:Steroids / Q000008:administration & dosage*; D013997:Time Factors; D014432:Tympanic Membrane / Q000187:drug effects; D018058:Tympanic Membrane Perforation / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014945:Wound Healing / Q000502:physiology
chemical_list: D013256:Steroids