A dural puncture, or "wet tap," is perhaps the most common complication from an ESI. This complication only occurs in to 5 percent of all injections. The result of a dural puncture is usually a spinal headache and nausea. A spinal headache occurs when the puncture in the spinal sac fails to seal itself off. This allows the spinal fluid to continue to leak out and lowers the spinal fluid pressure in the brain. When sitting or standing, the headache and nausea are much worse because the spinal fluid pressure is lower at the top (near your head) than at the bottom of the spine. The headache usually goes away when you lie down with your feet higher than your head.
Recently, doctors have started injecting steroids directly into the middle ear — a procedure called intratympanic treatment. This technique is thought to deliver more of the drug to the ear and to avoid some of the side effects that can come along with oral steroids. The side effects of oral therapy can be mild, like weight gain, mood changes and sleep disruption, or more serious, like high blood pressure and elevated blood sugar. Side effects of injected steroids are usually local, such as ear infection and vertigo. However, up until now, no study had compared the 2 treatments to see whether direct injection worked as well as oral steroids.