Intratympanic methylprednisolone versus gentamicin in patients with unilateral Ménière's disease: a randomised, double-blind, comparative effectiveness trial

Patel, Mitesh; Agarwal, Krishna; Arshad, Qadeer; Hariri, M. A.; Rea, Peter; Seemungal, Barry M.; Golding, John F.; Harcourt, Jonny; Bronstein, Adolfo M.

doi:10.1016/s0140-6736(16)31461-1

Cited by 134 publications

(125 citation statements)

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“…Early protocols for IT administration of gentamicin had an expected risk of hearing loss . More recent protocols have demonstrated little effect on hearing outcomes, although hearing outcomes may be technique‐ and dose‐dependent . Currently, IT corticosteroids have gained popularity as data has emerged regarding its utility in controlling vertigo symptoms with less risk to hearing …”

Section: Introductionmentioning

confidence: 99%

“…As a result, MD is known to be associated with a number of anxiety‐related disorders . Almost all studies that adhere to the 24‐month criteria defined by the AAO–CHE demonstrate long‐term efficacy from IT corticosteroids or gentamicin . Whereas the outcomes are promising at this extended timeframe, it is unclear whether these results represent long‐term efficacy of the treatment or simply the natural history of the disease .…”

Section: Introductionmentioning

confidence: 99%

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Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control

et al. 2018

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Objective To evaluate outcomes of intratympanic (IT) dexamethasone and gentamicin in Ménière Disease (MD). Methods Charts of adult patients with unilateral definite MD receiving IT gentamicin or dexamethasone from 2005 to 2017 were retrospectively reviewed. All patients had at least 6 months follow‐up. Failure in each group was defined as the need for more aggressive therapy. Prior to 2011, all patient received IT gentamicin, administered as primary therapy after failure of conservative treatment measures. Gentamicin was administered every 2 weeks, up to three injections, until vertigo control was achieved. Beginning in 2011, the treatment protocol shifted to IT dexamethasone as initial treatment, with gentamicin used for dexamethasone failures. Dexamethasone was administered weekly for up to three injections. Treatments could be repeated if symptoms recurred. Results Thirty‐three patients received IT dexamethasone, and 70 patients received IT gentamicin. Dexamethasone patients received a mean of 3.3 injections compared to 2.7 in the gentamicin group (P = 0.011). There were 12 (38%) failures in the dexamethasone group and only seven (10%) gentamicin failures (P = 0.025). No patients failed both treatments. The mean time to failure in the dexamethasone group was 5 months, whereas in the gentamicin group it was 27 months. Change in pure tone audiometry from baseline was not different between treatment groups (P = 0.30). Conclusion Subjects receiving IT gentamicin required fewer injections and had a significantly longer time to failure than IT dexamethasone. Audiometric outcomes were similar between the groups. The use of IT gentamicin as initial therapy for early and long‐term control of MD is safe and effective. Level of Evidence 3 Laryngoscope, 129:216–221, 2019

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control

et al. 2018

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“…When comparing IT to intravenous (IV) corticosteroid administration in humans both IT methylprednisolone and dexamethasone reached perilymph concentrations more than 200 times higher compared to IV administration [86]. As high dose dexamethasone is not commonly available in many European countries, methylprednisolone (62.5mg/ml) injections are often used instead [87••]. It should be noted that methylprednisolone is not favored by some authors due to burning discomfort often associated with application to the middle ear.…”

Section: Introductionmentioning

confidence: 99%

“…In 2016, Patel and colleagues published a randomized, double-blind comparative effectiveness trial for 60 adults with refractory unilateral Menière's disease comparing 2 doses of IT 62.5 mg/ml methylprednisolone to IT 40 mg/ml gentamicin given 2 weeks apart [87••]. Their main outcome measure was vertigo frequency during months 18-24 after starting treatment compared to vertigo frequency during the 6 months prior to starting therapy.…”

Section: Introductionmentioning

confidence: 99%

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

Schoo

Tan

Ehrenburg

et al. 2017

Curr Otorhinolaryngol Rep

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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.

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“…In the basic research field of sensorineural hearing loss, significant advances include: the discovery of numerous inherited deafness-associated genes [1], progress in cochlear cell development and regeneration [2], new insights on acquired hearing loss and its prevention [3], as well as auditory central physiological and pathological mechanisms [4]. The pathogenesis of otogenic vertigo, and comprehensive individualized and procedural treatment programs are becoming well-established [5]. The diagnosis and retraining therapy for tinnitus have also seen breakthroughs [6].…”

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confidence: 99%

Welcome to Journal of Otorhinolaryngology, Hearing and Balance Medicine

Kong

Salvi²,

Schacht

2017

JOHBM

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To date, much progress has been achieved in the field of Otorhinolaryngology-Head and Neck surgery, as well as hearing and balance science and medicine. A large number of new techniques and methods have also recently been established. In the basic research field of sensorineural hearing loss, significant advances include: the discovery of numerous inherited deafness-associated genes [1], progress in cochlear cell development and regeneration [2], new insights on acquired hearing loss and its prevention [3], as well as auditory central physiological and pathological mechanisms [4]. The pathogenesis of otogenic vertigo, and comprehensive individualized and procedural treatment programs are becoming well-established [5]. The diagnosis and retraining therapy for tinnitus have also seen breakthroughs [6]. Advances have been made in assessment of otitis media, and its classification and treatment [7]. A groundbreaking discovery in the pathogenesis of allergic rhinitis-allergic rhinitis and its impact on asthma (ARIA)-has redefined the classification of rhinitis and allergic rhinitis [8], and the mechanism and treatment of sinusitis [9]. In addition, there have been fruitful results in research related to the pathogenesis and treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS) [10], the pathogenesis of head and neck neoplasms, and molecular epidemiology [11], as well as their comprehensive treatment.In order to provide a forum for this broad clinical and scientific field, we have established a multidisciplinary publication, the Journal of Otorhinolaryngology, Hearing and Balance Medicine (OHBM). We aim to publish original research articles (including basic research, translational research as well as clinical studies), review articles and case reports in all areas of Otorhinolaryngology-Head and Neck medicine including hearing and balance science, otology, neurotology, rhinology, laryngology, head and neck surgery, bronchoesophagology, maxillofacial and plastic surgery, audiology and speech science and medicine, oncologic medicine and pediatric otorhinolaryngology, but also the quickly developing fields of allergology, skull base surgery, and sleep medicine.We are very proud to welcome our founding Editorial Board Members, a group of more than 50 established academics and clinicians from all over the world. On behalf of the Editorial Board, we invite you to submit your manuscripts to and suggestions for OHBM and other interesting ideas for this discipline. Please see the Appendix A for the current Editorial Board leadership of the Journal of Otorhinolaryngology, Hearing and Balance Medicine (OHBM).

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Intratympanic methylprednisolone versus gentamicin in patients with unilateral Ménière's disease: a randomised, double-blind, comparative effectiveness trial

Abstract: Ménière's Society and National Institute for Health Research Imperial Biomedical Research Centre.

Cited by 134 publications

References 40 publications

Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control

Intratympanic Therapies in Ménière Disease: Evaluation of Outcomes and Early Vertigo Control

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

Welcome to Journal of Otorhinolaryngology, Hearing and Balance Medicine

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