(508) Treatment of Electronystagmography-proven Peripheral Vestibulopathy with Intratympanic Steroid Injections

Introduction: Intratympanic steroid (ITS) injections are a routine treatment option for patients with intractable Meniere’s disease, sudden sensorineural hearing loss (SSNHL), and autoimmune inner ear disease (AIED); however, patients with other otologic disorders are provided little interventional opportunities. We aim to determine the efficacy and safety of ITS injections for less common peripheral vestibulopathies.

Methods: We retrospectively reviewed 141 patients treated with ITS injections at the University of Florida between 2018-2022. Patients were stratified by a pre-injection diagnosis of Meniere’s (N=46), AIED (N=8), SSNHL (N=52), or other vestibulopathy (N=35). Criteria for the other vestibulopathy patients included either an ENG-proven peripheral vestibulopathy or a diagnosis of labyrinthitis or tinnitus. The review included self-reported improvement of vertigo or hearing loss, and comparative audiometric data or electronystagmography results.

Results: 60.3% of patients received 3 ITS injections and 83.3% received 3.2 mg of dexamethasone per injection. Vertigo improved in 69.6% of patients with Meniere’s and 62.9% of patients with other vestibulopathy. Subjective hearing improved in 44.2% of patients with SSNHL and 28.6% of patients with other vestibulopathy. 13 patients with Meniere’s pursued treatment after receiving ITS injections, most commonly endolymphatic sac decompression. 2 patients with other vestibulopathy pursued additional treatment. Only one patient experienced an adverse reaction of temporary facial weakness.

Conclusions: Our analysis confirms the utility of ITS injections for patients with non-diagnostic vertigo yet have ENG-proven peripheral vestibulopathy can benefit from ITS injections. Therefore, otolaryngologists should consider ITS injections as a potential treatment option for this challenging population. Of note, the degree of caloric weakness prior to ITS injection was not predictive of future subjective improvement in vertigo. A prospective, multicenter, clinical trial is needed to further characterize the effect of this therapy on these patients.