Can Steroid Injections Make Tinnitus Worse? Understanding a Temporary Risk

October 6, 2025 •

4 min read

According to a 2016 study, a temporary increase in tinnitus occurred in approximately 5.4% of intratympanic steroid injections performed for sudden sensorineural hearing loss. This initial, transient risk is an important consideration when assessing if a steroid injection can make tinnitus worse for individuals undergoing treatment for inner ear disorders.

Quick Summary

A temporary increase in tinnitus is a known side effect of intratympanic steroid injections for inner ear conditions. While this initial worsening is typically short-lived, the risk can vary based on the underlying condition and individual patient factors. Long-term outcomes often show improvement in symptoms, but proper patient selection is crucial.

Key Points

Temporary worsening is a possibility: A temporary increase in tinnitus is a documented, though not common, side effect of intratympanic steroid injections, particularly in the hours immediately following the procedure.
Fluid in the middle ear is a factor: The introduction of fluid into the middle ear during the injection can cause temporary ear fullness, which may lead to a transient change in tinnitus perception.
Risk varies by condition: Studies suggest the risk of worsening tinnitus may depend on the underlying cause, with some patient groups being more susceptible than others.
Long-term goal is improvement: The treatment aims for a long-term anti-inflammatory effect that can ultimately reduce tinnitus and other symptoms related to inner ear conditions like Meniere's disease.
Systemic vs. Intratympanic: Intratympanic injections deliver the steroid directly to the inner ear, reducing the systemic side effects that come with oral steroid administration.
Expert consultation is essential: It is crucial to discuss the specific risks and benefits with an otolaryngologist, as outcomes are highly individual.

What are Intratympanic Steroid Injections?

Intratympanic steroid injections (ITSIs) are a medical procedure used to deliver a corticosteroid directly into the middle ear space. The goal is to allow the medication to diffuse into the inner ear through the round window membrane, bypassing the systemic circulation and minimizing side effects associated with oral steroids. This localized approach is used for treating various inner ear conditions, including:

Sudden sensorineural hearing loss (SSNHL)
Meniere's disease, which causes episodes of vertigo, hearing loss, and tinnitus
Certain autoimmune inner ear diseases (AIED)
Refractory or persistent tinnitus

Steroids work by exerting powerful anti-inflammatory effects, which can help reduce swelling and inflammation in the sensitive structures of the inner ear. For many patients, ITSIs offer a therapeutic benefit, particularly for acute conditions.

The Potential for Worsening Tinnitus

One of the temporary side effects associated with intratympanic steroid injections is an increase in tinnitus intensity or the perception of new tinnitus. This initial exacerbation is often due to the fluid introduced into the middle ear during the procedure and typically resolves within a few hours.

Documented Instances of Increased Tinnitus

Clinical studies have quantified the risk of this temporary side effect. A retrospective review published in 2016 found that, out of 278 intratympanic steroid injections for sudden hearing loss, increasing tinnitus was noted in 15 instances (about 5.4%). The study noted that this, like other post-injection complications such as dizziness, was temporary. For patients with temporomandibular disorders treated with local steroids, one study found that up to 11% reported an increase in tinnitus intensity.

What Influences the Risk?

The risk of experiencing increased tinnitus is not uniform and can depend on several factors, including:

Underlying Condition: The cause of the tinnitus plays a significant role. For example, patients with tinnitus related to temporomandibular disorders may respond differently than those with Meniere's disease.
Type of Injection: The exact location and nature of the injection can matter. Some studies, for instance, have examined intratympanic injections versus steroids targeting the temporomandibular joint for related tinnitus.
Fluid in Middle Ear: The temporary presence of fluid in the middle ear post-injection can cause a feeling of ear fullness or pressure, which can in turn alter tinnitus perception. This effect is short-lived as the fluid is absorbed.
Patient Specificity: Each patient's auditory system and perception of tinnitus are unique, meaning responses to treatment can vary.

Long-Term vs. Short-Term Effects on Tinnitus

It is crucial to distinguish between the immediate, temporary increase in tinnitus and the potential for long-term improvement. For many patients with inner ear conditions like Meniere's disease, the long-term goal of the injection is to reduce symptoms, including tinnitus. Numerous studies have explored the efficacy of ITSIs for tinnitus and related conditions, with varying results. Some show benefit, particularly for acute tinnitus, while others find no significant advantage over a placebo.

Immediate Post-Injection: A few hours of increased tinnitus, ear fullness, or dizziness is a common and usually transient side effect.
Long-Term (Weeks to Months): The anti-inflammatory effect of the steroid sets in, potentially reducing the underlying inflammation causing the tinnitus. For some patients, this leads to a reduction in the severity of their symptoms. However, the response is not guaranteed and can depend on the nature of the tinnitus.

Comparison: Steroid Injections vs. Other Tinnitus Treatments


Treatment Method	Mechanism of Action	Effectiveness for Tinnitus	Risk of Worsening Tinnitus	Side Effects	Notes
Intratympanic Steroid Injection	Localized anti-inflammatory effect in inner ear.	Varied, potentially more effective for acute cases.	Small, temporary risk due to fluid in middle ear.	Temporary dizziness, ear fullness, minor pain, potential for eardrum perforation.	Avoids systemic side effects of oral steroids.
Oral Steroids	Systemic anti-inflammatory effect throughout the body.	Often used for sudden hearing loss, with a less direct effect on the inner ear compared to intratympanic delivery.	Minimal reported risk of worsening tinnitus directly; high doses can cause systemic effects.	High blood sugar, mood changes, sleep problems, increased appetite, and others.	Involves higher doses to reach inner ear, increasing systemic risk.
Sound Therapy / Tinnitus Maskers	Auditory distraction or habituation to lessen the perception of tinnitus.	Often effective in managing and masking tinnitus, though not a cure.	Very low to non-existent.	Non-invasive, few to no physical side effects.	A management strategy rather than a disease-modifying treatment.
Cognitive Behavioral Therapy (CBT)	Helps patients change their reaction to and perception of tinnitus.	Highly effective for reducing the psychological distress caused by chronic tinnitus.	None.	None.	Focuses on coping mechanisms and quality of life improvement.

Conclusion

While the prospect of a steroid injection potentially worsening tinnitus is a valid concern, it is a risk that is often temporary and relatively low. For patients with specific inner ear conditions like sudden hearing loss or Meniere's disease, the short-term inconvenience of a potential tinnitus flare-up is often outweighed by the potential for significant long-term symptom relief. The key takeaway is the importance of a thorough consultation with an otolaryngologist, who can assess the specific cause of your tinnitus and determine if an intratympanic steroid injection is the right course of action for your situation. Discussion about the potential for a temporary increase in tinnitus and other short-lived side effects should be part of this conversation, allowing you to make an informed decision.

For more information on the safety and efficacy of treatments for Meniere's disease, a condition often involving tinnitus, review the available evidence, such as the Cochrane review titled "What are the benefits and risks of corticosteroids given directly into the ear (intratympanic corticosteroids) for Ménière's disease?".

Frequently Asked Questions

Yes, the initial increase in tinnitus immediately following an intratympanic injection is typically temporary and subsides within several hours. The ultimate goal of the treatment is to provide long-term relief by addressing underlying inner ear inflammation.

The initial worsening is often caused by the physical presence of fluid from the injection filling the middle ear, which can alter pressure and auditory perception. As the fluid is absorbed, this effect typically resolves.

It is not a very common side effect. One study on intratympanic injections for sudden hearing loss reported that an increase in tinnitus occurred in about 5.4% of injection procedures. Another noted a higher percentage in patients with specific temporomandibular-related tinnitus.

Intratympanic steroid injections are often considered for refractory (persistent) tinnitus, especially in the acute phase. Your ENT specialist will evaluate your specific case to determine if it's an appropriate treatment option.

Intratympanic injections are often preferred for diabetic patients over oral steroids because they deliver the medication directly to the inner ear, avoiding the systemic side effects like increased blood sugar that can occur with high doses of oral steroids.

Common temporary side effects include temporary dizziness, a feeling of ear fullness, and minor pain at the injection site. In rare cases, a persistent tympanic membrane perforation or infection can occur.

Yes, patient selection is vital. Research has shown that the best candidates are often those with acute, unilateral tinnitus and certain underlying conditions, while others may not experience as much benefit and could risk worsening their symptoms.