Operative technique The drum was anaesthetized locally by cotton soaked with Xylocaine 10%. The patient was kept in supine position and his head turned about 45°away from the surgeon. All patients were injected by a single surgeon (dr saad elzayat,MD, consultant of ORL). The assigned solution was injected under direct vision through an operating microscope at the anterosuperior quadrant of the tympanic membrane using a 27-gauge needle. About one ml of the drug was injected in the diseased ear. In group A, the investigators used combined Lidocaine 2% and dexamethasone (8mg/2ml) with ratio (1:1). In group B, the investigators used dexamethasone only for injection 8mg/2ml. The patients would remain in the supine position for about 30 minutes and avoid swallowing after the injection to keep the Eustachian tube closed and give the drug maximal time of contact with the round window. The patients were kept in our department for six hours for observation of any complications. This procedure was repeated for three times at weekly interval.