Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice

Syed, Mohammed Iqbal; Ilan, Ophir; Nassar, Jihad

doi:10.1111/coa.12449

Cited by 40 publications

(32 citation statements)

References 47 publications

(94 reference statements)

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“…Barrs et al in their study reported reduction in the pain after adding 0.1 ml of lidocaine [11]. There is no consensus in the literature regarding appropriate dosing and duration of treatment [12]. Martin Sanz E et al compared the efficacy of daily and weekly intratympanic steroids and, found not many differences in the outcome [13].…”

Section: Discussionmentioning

confidence: 99%

Role of Intratympanic Steroids in the Management of Meniere’s Disease—A Review of 151 Cases

Deenadayal

Vidyasagar

Bommakanti

et al. 2016

IJOHNS

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Objective: To assess the outcomes of hearing and vertigo in patients with Meniere's disease who were treated with intratympanic methylprednisolone. Study Design: Retrospective study. Setting: Tertiary referral hospital. Methods: In our study with 151 patients [191 ears] were diagnosed as Menieres as per 1995 AAO-HNS guidelines. As an office based procedure these patients were treated with intratympanic methyl prednisolone. Results: There was a 98.6% improvement in the vertigo control rate, a 73.82% improvement in hearing and 29.31% had a definitive improvement in tinnitus. Conclusion: We conclude from our study that intratympanic steroid injection significantly controls vertigo, tinnitus and improves hearing in Meniere's disease with minimal complications. Hence, it can be tried as a first line treatment for patients with Meniere's disease.

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Section: Discussionmentioning

confidence: 99%

Role of Intratympanic Steroids in the Management of Meniere’s Disease—A Review of 151 Cases

Deenadayal

Vidyasagar

Bommakanti

et al. 2016

IJOHNS

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“…For those who do not experience improvement of their symptoms with conservative medical management (e.g., low salt diet, diuretics, betahistine), intratympanic injections of corticosteroids and aminoglycosides have been proven to provide benefit in reduction of vertigo frequency and other symptoms of Menière's disease. When dosed conservatively and using a titration schedule with infrequent dosing, IT gentamicin provides good control of vertiginous symptoms with minimal risk to hearing [69, 74–77]. Hearing loss and vestibular hypofunction, however, continue to be a risk of IT gentamicin due to its ablative nature and cocheotoxicity [69, 74–78•].…”

Section: Discussionmentioning

confidence: 99%

“…When dosed conservatively and using a titration schedule with infrequent dosing, IT gentamicin provides good control of vertiginous symptoms with minimal risk to hearing [69, 74–77]. Hearing loss and vestibular hypofunction, however, continue to be a risk of IT gentamicin due to its ablative nature and cocheotoxicity [69, 74–78•]. Vestibular hypofunction is often associated with imbalance during rapid ipsilateral head movements and other symptoms such as oscillopsia [106, 107].…”

Section: Discussionmentioning

confidence: 99%

“…Only two of these studies were randomized controlled trials (RCT's) and met all of their inclusion criteria to be accepted in their analysis. Similarly, in 2015, Syed and colleagues published a systematic review investigating randomized controlled trials of IT therapies for Menière's disease focusing on the same two randomized controlled trials [69]. In the first trial, Stokroos and Kingma (2004) reported results from their prospective randomized double-blind placebo-controlled trials establishing the efficacy of IT gentamicin compared to placebo in patients with active unilateral Menière's disease [70].…”

Section: Introductionmentioning

confidence: 99%

“…[69, 74–78•] In 2012, Houn et al [77] published a comprehensive systematic review with meta-analysis. Reviewing available studies through 2011, the authors focused on studies investigating the use of IT gentamicin in randomized controlled trials (n = 2) and prospective cohort studies with greater than 10 subjects (n = 12).…”

Section: Introductionmentioning

confidence: 99%

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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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Intratympanic corticosteroids for Ménière’s disease

Webster

Lee

Galbraith

et al. 2023

Cochrane Database of Systematic Reviews

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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 ...

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Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice

Cited by 40 publications

References 47 publications

Role of Intratympanic Steroids in the Management of Meniere’s Disease—A Review of 151 Cases

Role of Intratympanic Steroids in the Management of Meniere’s Disease—A Review of 151 Cases

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

Intratympanic corticosteroids for Ménière’s disease

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