Intratympanic (IT) Therapies for Menière’s Disease: Some Consensus Among the Confusion

Abstract

Purpose of Review Aminoglycosides and corticosteroids are commonly used to treat Menière's disease. Intratympanic (IT) administration of these medications allows high inner ear concentrations without significant adverse systemic effects. As a direct result, IT therapy has grown in popularity. Recent studies have compared patient outcomes between IT aminoglycosides and corticosteroids. This review summarizes these findings. Recent Findings Trials comparing IT corticosteroids to IT placebo or oral therapy have had conflicting results. Most recently, Lambert et al. investigated the effect of IT dexamethasone in a sustained-release formulation compared to placebo. Their findings demonstrated improvement in some secondary measures of vertigo with the sustained-release formulation. IT gentamicin is known to be effective in controlling vertigo in Menière's disease. In a recent study from 2016, Patel et al compared IT gentamicin and IT methylprednisolone in a double-blind, randomized controlled trial and identified no significant differences between the two in vertigo control. Summary IT injections of aminoglycosides and corticosteroids can improve vertigo control. Hearing and vestibular loss however may result with IT aminoglycosides. Corticosteroids demonstrate limited hearing loss but may not have the same efficacy in controlling vertigo. Further investigation in the etiology of Menière's disease is needed to tailor the proposed treatment to suit the disease mechanism.

Current Understanding and Clinical Management of Meniere's Disease: A Systematic Review

“…Lifestyle adjustments like rest, avoiding sudden position changes, and hydration have been recommended. 84,86 During acute vertigo attacks, patients can benefit from vestibular suppressants. The most frequently used drugs are benzodiazepines (diazepam, lorazepam, clonazepam), H1 antihistamines receptor (meclizine, diphenhydrinate, promethazine), antidopaminergic agents (metoclopramide), anticholinergics (diphenhydramine), and antiemetic 5-HT 3 antagonists (ondansetron).…”

“…[93][94][95] Finally, in case of failure of conservative therapies, intratympanic gentamicin could be proposed to induce a partial chemical labyrinthectomy. 86,[96][97][98][99][100][101][102][103] Several reviews have evaluated the effectiveness of intratympanic therapies, supporting their use in MD. 104,105 -Surgery: This must be considered with caution, since MD may become bilateral after surgery.…”

Dexamethasone and Dexamethasone Phosphate Entry into Perilymph Compared for Middle Ear Applications in Guinea Pigs

“…When applied systemically, the phosphate is cleaved by phosphatases in the liver, by which time the drug is diluted to a degree that the dexamethasone remains in solution. Intratympanically-administered dexamethasone-phosphate is used clinically to treat Meniere’s disease and idiopathic sudden sensorineural hearing loss [Schoo et al, 2017; Plontke et al, 2009]. It is usually injected at concentrations of 4 – 12 mg/mL [review and meta-analysis by Liebau et al, 2017].…”

Pharmacological, surgical and diagnostic innovations in Meniere’s disease: a review

“…First-line treatment includes dietary restrictions for salt, caffeine, and alcohol associated to drugs both for acute attacks (dimenhydrinate, benzodiazepines) 12 , and as prophylactic therapy (betahistine, β-blockers, diuretics) 13 . When first-line treatment does not offer satisfactory symptom control, intratympanic (IT) administration of gentamicin or corticosteroids can be performed 14 ; however, many studies showed that IT gentamicin may expose the patients to a risk of hearing loss, depending on dosage and intervals between administrations 15 . Labyrinthectomy or other surgical procedures can be suggested for intractable MD 16 .…”