Effects of an Intratympanic Injection of Dexamethasone Combined with Gentamicin on the Expression Level of Serum P0 Protein Antibodies in Patients with Meniere's Disease

Geng, Yang; Cao, Wenping; Xu, Huji; Wu, Fengfang; Feng, Tao

doi:10.6061/clinics/2020/e1622

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…This study gives credibility to the immune complex-mediated theory of Meniere's disease. 17 Immune-mediated disease process thus has a favourable outcome with steroids. The use of steroids in Meniere's disease not only alleviates vestibular symptoms but have a protective effect on the cochlea.…”

Section: Discussionmentioning

confidence: 99%

Vestibular Rehabilitation with Intratympanic Drug Therapy in Meniere's Disease

Ayub

Ashfaq²,

Khan³

et al. 2022

PAFMJ

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Objective: To evaluate vertigo control and auditory rescue in patients with Meniere's disease treated with intratympanic Gentamicin and Dexamethasone. Study Design: Randomized Control Trial (Clinical Trials. gov Identifier: NCT05355610).Place and Duration of Study: ENT Departments CMH Quetta and Benazir Bhutto Hospital Rawalpindi Pakistan from Apr 2020 to Mar 2022. Methodology: Ninety-three cases of unilateral Meniere's disease meeting the inclusion criteria were treated with intratym-panic Gentamicin and Dexamethasone. Pre and post-treatment vertigo was assessed on Vestibular Deficit Index. Speech discrimination scores for auditory impact were also recorded pre and post-treatment. Results: In the Ninety-three treated cases, there was a statistically significant improvement in the Vestibular Deficit Index (with a p-value of 0.001). Although all patients had a reduced speech discrimination score, it was not statistically significant (p value=0.08). Conclusion: Control of vestibular symptoms can be achieved with intratympanic Gentamicin, and at the same time, the auditory system can be rescued with Dexamethasone.

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Section: Discussionmentioning

confidence: 99%

Vestibular Rehabilitation with Intratympanic Drug Therapy in Meniere's Disease

Ayub

Ashfaq²,

Khan³

et al. 2022

PAFMJ

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“…Current strategies for treatment of MD as shown in Figure 4 include lifestyle changes (low‐sodium diet, good hydration, caffeine restriction), medication trial (betahistine and diuretics), 118,119 and intratympanic steroid injection. Surgical or ablative therapies include endolymphatic sac surgery, intratympanic gentamicin, labyrinthectomy, and vestibular neurectomy, as detailed in Figure 4 118–121 …”

Section: Vestibular Migraine Treatmentmentioning

confidence: 99%

“…Surgical or ablative therapies include endolymphatic sac surgery, intratympanic gentamicin, labyrinthectomy, and vestibular neurectomy, as detailed in Figure 4. [118][119][120][121] Migraine diet and lifestyle modifications and medications as treatment for MD patients have sparked a debate among otolaryngologists.…”

Section: Treatment Of MD As a Migraine Variantmentioning

confidence: 99%

Migraine management for the otolaryngologist

Brooks

Tawk

Djalilian

et al. 2023

Laryngoscope Investig Oto

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ObjectiveTo characterize migraine pathophysiology, presentation, and current treatment strategies, specifically in regard to vestibulocochlear manifestations of migraine.MethodsNarrative review of available literature.ResultsMigraine disorder can be described as a spectrum of otologic manifestations, with vestibular migraine now recognized with fully‐fledged diagnostic criteria. Otologic manifestations are theorized to be due, in part, to trigeminal innervation of the inner ear structures and calcitonin gene‐related peptide (CGRP) expression within the labyrinth. Patients can experience vertigo, aural fullness, enhanced tinnitus, and hearing loss without the characteristic migraine headache, leading to under recognition of these symptoms as migraine‐related. Meniere's disease, mal de débarquement syndrome, persistent postural perceptual dizziness, and recurrent benign paroxysmal positional vertigo have close associations to migraine and may exist on the migraine spectrum. Migraine treatment consists of two goals: halting acute attacks (abortive therapy) and preventing attacks (prophylactic therapy). Abortive medications include triptans, corticosteroids, anti‐histamines, and anti‐emetics. Pharmacologic prophylaxis in conjunction with lifestyle modifications can decrease frequency and severity of symptoms and include tricyclic antidepressants, calcium channel blockers, anti‐epileptic medications, selective serotonin reuptake inhibitors, serotonin‐norepinephrine reuptake inhibitors, beta‐blockers, gepants, and monoclonal antibodies to CGRP. Promising evidence is emerging regarding the ability of migraine medications to positively treat the various otologic symptoms of migraine.ConclusionMigraine disorder manifesting with primarily cochleovestibular symptoms can be challenging to diagnose and manage for practicing clinicians. Patients with various vestibulopathies that are closely related to migraine may benefit from migraine treatment. Lifestyle choices and prophylactic medications are key to satisfactorily preventing acute migrainous attacks and improve function.

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“…There were also a few articles revealed that IT injection of a mixture of gentamicin and dexamethasone (ITG + D) in intractable Meniere’s disease cases was more effective than dexamethasone or gentamicin alone for vertigo control [ 29 , 30 ]. Two years after treatment there was better control of vertigo in mixture group (ITG + D) than in ITD alone (Table 2 ).…”

Section: Intratympanic Corticosteroidsmentioning

confidence: 99%

Consensus on intratympanic drug delivery for Menière’s disease

Pyykkö

Zhang

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière’s disease (MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. Methods The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus (ICON) on treatment of Menière’s disease (2018), Clinical Practice Guideline (2020) and European Position statement on Diagnosis and Treatment of Meniere’s Disease (2018) are taken into account for reference, and follow advice from experts from Europe, USA and China. Results Experts agree on the following: (1) The effectiveness of IT methylprednisolone (ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone (ITD), and ITM can restore hearing in some cases. (2) Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin (ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. (3) Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. Conclusion More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.

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Effects of an Intratympanic Injection of Dexamethasone Combined with Gentamicin on the Expression Level of Serum P0 Protein Antibodies in Patients with Meniere's Disease

Cited by 4 publications

References 22 publications

Vestibular Rehabilitation with Intratympanic Drug Therapy in Meniere's Disease

Vestibular Rehabilitation with Intratympanic Drug Therapy in Meniere's Disease

Migraine management for the otolaryngologist

Consensus on intratympanic drug delivery for Menière’s disease

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