Intratympanic Steroid Perfusion for the Treatment of Ménière's Disease: A Retrospective Study

Abstract

Weconducted a retrospective outcomes review ofthe charts of 22 patients with Meniere s disease who were treated with intratympanicperf usion ofmethylprednisolone and/or dexamethasone. Outcomes were determined by subjective assessment ofvertigo control and by objective changes in audiometricpure-tone average (PTA) and speech discrim ination sco re (SDS). These evaluations were made at the jirstp ostperfusion visit (short term) andat least 12 months later (long term). In the short term, 12 patients (54.5%) achievedvertigo control, 4 pa tients (18.2 %) demonstrated a greater than 10-dB improvement in PTA, and 1patient (4.5%) experienced an increase in SDS of at least 15%. In the long term, the correspo nding numbers ofpatients were 4 (18.2%) , 2 (9.1%), and 1 (4.5%) . The level of hearing ultimately deteriorated in 9 patients (40.9%). These fi ndings sugges t that intratympanic stero id pe rfus ion does not result in any long-t erm alleviation of vertigo or hearing loss. However; the short-term alleviation of vertigo seen in approximately half ofthese pa tients suggests that this treatment may be useful f or the temp orary reliefofsymptoms ofMeniere s disease.

Factors influencing the efficacy of round window dexamethasone protection of residual hearing post-cochlear implant surgery

“…Seprapack TM (Genzyme, Cambridge, MA, USA), a carboxymethylcellulose hyaluronic acid polymer was chosen, as it allowed for an extended delivery of the drug. Dexamethasone delivered via a Seprapack sponge was as still detectable within the cochlea 24 h after the initial round window application (James et al, 2008) Local delivery also has the advantage of avoiding the potential risk of systemic complications associated with the parenteral administration of steroids, and there is a clinical precedent for its use in the treatment of sudden sensorineural hearing loss, intractable tinnitus and Meniere's disease (Chandrasekhar, 2001;Dodson et al, 2004;Gouveris et al, 2005;Silverstein et al, 1996).…”

Circadian changes in serum corticosterone levels affect hearing in mice exposed to noise

“…Steroids are frequently used to restore hearing in patients with rapidly progressing bilateral inner ear disorders, such as sudden hearing loss, tinnitus, Ménière's disease, or autoimmune sensorineural hearing loss [1][2][3][4][5]. Glucocorticoid receptors are distributed throughout the cochlea with higher expression in spiral ganglion neurons and the spiral ligament, and lower expression in the stria vascularis and the organ of Corti [6,7].…”

The role of glucocorticoids for spiral ganglion neuron survival

“…In humans and other vertebrates, the adrenal steroid glucocorticoids (GCs) modulate and control this system at multiple levels (see recent reviews, Kino, 2007; Viegas et al, 2008). Synthetic GCs are currently widely used to treat allergic, inflammatory, and lymphoproliferative disorders as well as hearing loss in a variety of inner ear diseases such as Meniere’s disease, sudden or idiopathic hearing loss, endolymphatic hydrops and autoimmune inner ear disease (Dodson and Sismanis, 2004; Dodson et al, 2004; McCabe, 1979; Trune et al, 2007; Wei et al, 2006). Despite their wide use, the role of GC signaling pathways in the inner ear is poorly understood.…”