Intratympanic corticosteroids for Ménière’s disease

Abstract

Background Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. Corticosteroids are sometimes administered directly into the middle ear to treat this condition (through the tympanic membrane). The underlying cause of Ménière's disease is unknown, as is the way in which this treatment may work. The efficacy of this intervention in preventing vertigo attacks, and their associated symptoms, is currently unclear. Objectives To evaluate the benefits and harms of intratympanic corticosteroids versus placebo or no treatment in people with Ménière's disease. Search methods The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022. Selection criteria We included randomised controlled trials (RCTs) and quasi‐RCTs in adults with a diagnosis of Ménière's disease comparing intratympanic corticosteroids with either placebo or no treatment. We excluded studies with follow‐up of less than three months, or with a cross‐over design (unless data from the first phase of the study could be identified). Data collection and analysis We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome ‐ improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease‐specific health‐related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects (including tympanic membrane perforation). We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome. Main results We included 10 studies with a total of 952 participants. All studies used the corticosteroid dexamethasone, with doses ranging from approximately 2 mg to 12 mg. Improvement in vertigo Intratympanic corticosteroids may make little or no difference to the number of people who report an improvement in their vertigo at 6 to ≤ 12 months follow‐up (intratympanic corticosteroids 96.8%, placebo 96.6%, risk ratio (RR) 1.00, 95% confidence interval (CI) 0.92 to 1.10; 2 studies; 60 participants; low‐certainty evidence) or at more than 12 months follow‐up (intratympanic corticosteroids 100%, placebo 96.3%; RR 1.03, 95% CI 0.87 to 1.23; 2 studies; 58 participants; low‐certainty evidence). However, we note the large improvement in the placebo group for these trials, which causes challenges in interpreting these results. Change in vertigo ...

Role of prior intratympanic gentamicin and corticosteroids therapy on speech understanding in patients with Menière's disease after cochlear implantation

“…ITG even though reserved for MD patients with refractory vertigo and with considerable hearing loss, is still more widely used than ITC because of two reasons: ‘chemical labyrinthectomy’ with aminoglycosides is a well-known concept since introduced in 1948 by fowler [ 11 ] whereas ITC is a recent treatment method introduced in 2007 [ 3 ]. The second reason is that the evidence of disease control for ITC in MD patients is still rather questionable as shown in the Cochrane and systematic reviews [ 9 , 45 , 47 ] with very few studies showing control of disease symptoms [ 18 , 21 ]. What needs to be considered here is that when ITG might be better at controlling vertigo, ITC has been shown to be better at hearing preservation but not effective in controlling vertigo.…”

Examination of betahistine bioavailability in combination with the monoamine oxidase B inhibitor, selegiline, in humans—a non-randomized, single-sequence, two-period titration, open label single-center phase 1 study (PK-BeST)

“…c) There is insufficient evidence for the effectiveness of many other measures that have been recommended, such as life-style changes, e.g., low salt diet ( 19 ), diuretics ( 4 ), pulsed low-pressure delivery ( 20 ), surgical interventions ( 21 ), intratympanic steroids ( 22 ), and intratympanic gentamicin ( 23 ). All in all, there is very limited evidence for the efficacy of any prophylactic therapy in MD that does not impair vestibular function.…”

Stratification of patients with Menière’s disease based on eye movement videos recorded from the beginning of vertigo attacks and contrast-enhanced MRI findings

“…Some patients with MD have EH on CE-MRI, but others do not ( 7 ). Many therapies for MD exist, for example, oral administration of diuretics ( 8 ), intratympanic administration of steroids ( 9 ), intratympanic administration of gentamicin ( 10 ), endolymphatic sac decompression surgery ( 11 ), and vestibular neurectomy ( 12 ). However, there is no evidence for the effectiveness of any of these treatments.…”