How Painful Is Intratympanic Steroid Injection? An Overview for Patients

October 6, 2025 •

4 min read

Initial pain reports for intratympanic steroid injections are often mild, with most patients reporting a sensation of pressure or fullness rather than sharp pain. Understanding how painful is intratympanic steroid injection is key to managing expectations for this common inner ear procedure.

Quick Summary

The discomfort from an intratympanic steroid injection is generally mild and manageable, with local anesthetics minimizing pain. Patients typically feel pressure and fullness, and any post-injection ache is temporary.

Key Points

Mild Discomfort is Normal: Most patients report feeling pressure and fullness during the injection, not sharp pain, due to the use of a local anesthetic.
Local Anesthetics Minimize Pain: A numbing agent, such as a cream or spray, is applied to the eardrum beforehand to reduce discomfort from the needle.
Temporary Side Effects: Post-injection, temporary dizziness, ear fullness, or a mild ache are common but typically resolve quickly.
Manage Post-Procedure Aches: Any dull earache after the procedure can be effectively treated with over-the-counter pain medication like paracetamol or ibuprofen.
Targeted Treatment Reduces Systemic Side Effects: The intratympanic method avoids the more significant systemic side effects associated with oral steroids.
The Fullness Subsides: The sensation of pressure or fullness occurs as medication fills the middle ear but resolves as the fluid is absorbed.

What is an Intratympanic Steroid Injection?

An intratympanic steroid injection (ITS) is a procedure used to deliver medication directly into the middle ear, the space behind the eardrum. This method is primarily used to treat inner ear conditions such as Ménière's disease and sudden sensorineural hearing loss (SSNHL). By injecting the steroid directly, a higher concentration of the drug can reach the inner ear more effectively than with oral medication, often with fewer systemic side effects. The procedure is typically performed in a clinic setting by an ear, nose, and throat (ENT) specialist.

The Patient's Pain Experience: What to Expect

While the prospect of an injection into the ear can sound intimidating, most patients find the procedure tolerable and experience only mild discomfort, not severe pain. The sensation can be broken down into three phases: before, during, and after the injection.

1. Numbing the Eardrum: Before the injection, a local anesthetic is applied to the eardrum. This can be done via a topical cream, a spray, or drops.

Initial Sensation: Some patients report a mild stinging or burning sensation as the numbing agent is applied, similar to a bee sting, which subsides quickly as the area becomes numb.

2. The Injection Process: Once the eardrum is numb, the ENT specialist uses a fine needle to inject the steroid into the middle ear under microscopic guidance.

Pressure and Fullness: As the middle ear fills with the steroid solution, patients almost universally experience a feeling of pressure or fullness in the ear. This is a normal and expected sensation.
Fluid Irritation: Some patients, depending on the steroid used, might experience a temporary, burning sensation within the middle ear. Research indicates that different steroids can be associated with different pain intensities in the minutes following the injection.

3. The Recovery Period: After the injection, patients are typically asked to lie still for 15 to 30 minutes with the treated ear facing up to ensure the steroid is absorbed by the inner ear.

Dull Earache: When the local anesthetic wears off, a dull earache may occur for a short time. This is usually well-managed with simple over-the-counter pain medication.
Dizziness and Vertigo: A temporary feeling of dizziness or vertigo can happen, especially when sitting up after the procedure. This is often due to a caloric reaction from the liquid entering the ear, but it passes quickly.

Comparison: Intratympanic vs. Systemic Steroids

Intratympanic injections offer advantages over systemic oral or intravenous steroid treatments, particularly concerning side effects. The following table compares the typical side effects associated with each method:


Feature	Intratympanic Steroid Injection	Systemic (Oral) Steroid Treatment
Drug Delivery	Directly into the middle ear.	Absorbed into the bloodstream.
Side Effects	Localized side effects (mild pain, pressure, temporary dizziness, fullness, minimal systemic absorption).	Systemic side effects (mood changes, blood sugar problems, increased appetite, sleep changes).
Patient Safety	Avoids systemic side effects, beneficial for patients with conditions like diabetes or during pregnancy.	Higher risk of systemic side effects, potentially limiting use in some patients.
Targeted Approach	Delivers a high concentration of the drug to the target area (inner ear).	A portion of the drug reaches the inner ear after being distributed throughout the body.
Primary Concerns	Temporary pain, pressure, dizziness, rare tympanic membrane perforation.	Changes in mood, sleep, appetite, blood sugar, and immune function.

Factors Influencing the Pain Experience

Several factors can influence an individual's perception of pain during and after the procedure:

Individual Pain Tolerance: Every person has a different pain threshold, so what one patient describes as pressure, another might perceive as more intense discomfort.
Steroid Preparation: The specific steroid formulation (e.g., Dexamethasone vs. Methylprednisolone) and its temperature can affect pain levels. Warming the solution to body temperature can help prevent a temporary vertigo response.
ENT Surgeon's Technique: The skill and experience of the performing ENT can contribute to a smoother process and minimize discomfort.
Pre-Procedure Numbing: The effectiveness of the local anesthetic is paramount. While most are effective, some numbing techniques may feel more tolerable than others.

What to Do After the Injection

To ensure a smooth recovery and manage any residual discomfort, follow your ENT specialist's instructions. These typically include:

Taking Over-the-Counter Painkillers: Use paracetamol or ibuprofen as needed for a dull earache.
Keeping the Ear Dry: Avoid getting water in the ear for about a week to allow the small hole in the eardrum to heal properly.
Avoiding Strenuous Activity: Protecting the ear for a day or two can help recovery. Driving immediately after the first injection is generally not recommended due to the potential for temporary dizziness.
Monitoring for Complications: While rare, watch for signs of infection, such as increasing pain, redness, discharge, or continued dizziness, and contact your doctor if they occur.

Conclusion

In summary, the question of how painful is intratympanic steroid injection can be answered with reassurance. While you can expect some temporary sensations like pressure, fullness, and mild discomfort, severe pain is not the norm. The use of local anesthetics, combined with a precise procedure, makes this a well-tolerated treatment for many inner ear conditions. Most post-injection symptoms resolve quickly, and any lingering ache can be managed effectively with over-the-counter pain relievers.

For more detailed medical information, consult a resource like the Intratympanic Steroid Injection entry on NCBI Bookshelf.

Frequently Asked Questions

Some patients report a mild stinging or burning sensation when the numbing agent is applied, but this is brief and subsides as the anesthetic takes effect.

During the injection, most people feel a sense of pressure or fullness in their ear as the medication is delivered. Because the eardrum is numbed, the actual needle insertion is usually not painful.

Any dull earache that occurs after the numbing agent wears off is typically short-lived, often resolving within an hour or so. Simple painkillers can help manage this.

Yes, it is common to feel a little dizzy, disoriented, or to experience temporary vertigo immediately after the procedure. This usually passes quickly.

The type of steroid used can influence the level of discomfort. Some patients find certain preparations more irritating than others, but this can be discussed with your doctor.

It is generally recommended to have someone drive you home, especially after your first injection, in case you experience any temporary dizziness or disorientation.

The fullness is caused by the liquid medication temporarily filling the middle ear space. It feels similar to having water trapped in your ear after swimming and resolves as the body absorbs the fluid.