Background: Intratympanic therapy for tinnitus, first described in 1940, is now re-emerging as a treatment option, particularly in those who fail conventional treatment and find tinnitus disabling.

Objective: To critically evaluate the current evidence on the efficacy of intratympanic therapies on tinnitus using the tinnitus handicap inventory, tinnitus loudness scale, tinnitus awareness score, tinnitus loudness matching, minimum masking level and visual analogue scales.

Search strategy: An electronic literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders group trials register using various MeSH. The search was restricted to English-language and human subjects. The last date of search was February 2016.

Selection criteria: Randomised controlled trials [RCT's] of intratympanic therapies [steroids, AM-101, AM-111, gentamicin and latanoprost] versus a placebo or alternate therapy.

Results: Our search identified 17 relevant RCT's, of which 15 RCT's [1144 patients] comparing intratympanic steroids, AM-101, AM-111, gentamicin or latanoprost to another form of treatment or placebo were analysed.

Conclusions: On the basis of 3 RCT's (n = 357) for intratympanic AM-101 there is limited evidence to support its effectiveness, and based on 8 RCT's (n = 425) for intratympanic steroids we found contradictory evidence of its benefit in changing the audiometric quality and improving the impact on tinnitus on the patient. Results from ongoing multi-centre RCT's on AM-101 and intratympanic steroids will help to hopefully clarify their efficacy but there is a need for further targeted RCT's to determine which subgroups of patients are likely to benefit most from intratympanic therapy of steroids or AM-101. There is no evidence to support the use of other forms of intratympanic therapies including AM-111, gentamicin and latanoprost for refractory tinnitus.