Consensus on intratympanic drug delivery for Menière’s disease

Abstract

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.

Recent surgical advances and continued controversies in medically refractory Meniere's disease

“…A recent review of consensus statements and clinical practice guidelines from the USA, Europe, and China recommends the use of methylprednisolone over dexamethasone for intratympanic steroid administration. Within this review by Li et al [9 ▪ ] in 2022, an intratympanic gentamicin titration protocol is proposed that includes two injections 2 weeks apart with an end-point of vertigo cessation and/or unilateral vestibular loss on objective testing. When comparing intratympanic steroids versus gentamicin, a recent metanalysis by Lee et al (2021) [10] shows similar vertigo control rates, with better hearing outcomes for the steroid group.…”

A bibliometric and visualization study of Meniere’s disease: Current status and global hotspots and emerging trends

“…Intratympanic injection has long been one of the standard treatment methods for MD, and has been recognized and applied by most international scholars. [36] According to the 2018 international consensus [11] and European Position Statement on Diagnosis and Treatment, [37] intratympanic injection of steroids, such as dexamethasone and methylprednisolone, is proposed as the second-step treatment method, considering that they are not ototoxic. As the 4th step, ITG is likely the most effective nonsurgical treatment to eradicate vertigo in MD but is associated with the risk of hearing loss; there is a consensus that dexamethasone is more appropriate to use than methylprednisolone.…”

Editorial: Intratympanic and surgical treatment for Meniere's disease

“…They also suggested that the endpoint of treatment was a vestibulo-ocular reflex (VOR) gain reduction of >17.8%. The generally accepted treatment endpoint of ITG is when the patient does not have a vertigo attack over a 12-month period or a vestibular loss in objective tests in the affected ear ( 4 ). Guan et al completed a retrospective study on the effectiveness of ITG treatment and the value of the Halmagyi head thrust test (HTT) for predicting treatment durability.…”