Optimal Head Position Following Intratympanic Injections of Steroids

Intratympanic drug applications may be performed for a number of reasons, including the treatment of Meniere's disease, sudden hearing loss, and tinnitus. In this study, the aim was to determine the optimal head position for steroid solutions to be absorbed through the round window after intratympanic injections.

The authors retrospectively reviewed the best head position where the level of steroid solution reaches the round window area behind the eardrum in video recordings of 20 Meniere's disease patients undergoing intratympanic steroid injections. The patients were positioned in the supine position, with the diseased ear pointing upward. Cotton wool soaked with 10% xylocaine was applied to the eardrum surface. After 2 or 3 swallows with the nose closed, dexamethasone (8.00 mg/2cc) was injected through the anterior quadrant using a syringe with a 25-gauge spinal needle, and the injection was continued until half of the middle ear was filled. Following injection, patients' heads were then tilted backward until the solution covered the round window area under microscopic view. The angle between the midsagittal plane of the head and the horizontal plane was noted when the best level of the solution covering the round window area was achieved.

The angleof the midsagittal head plane and horizontal plane for the optimum head position following injection were 90 degrees in 16 of 20 ears and 80 degrees in 4; in supine position.

The most appropriate head position for drug delivery after intratympanic injection was determined as the head looking directly upwards in the supine position.