Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Menière's Disease

Harcourt, Jonny; Lambert, Aileen L.; Wong, Phui Yee; Patel, Mitesh; Agarwal, Krishna; Golding, John F.; Bronstein, Adolfo M.

doi:10.1097/mao.0000000000002108

Cited by 15 publications

(3 citation statements)

References 31 publications

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“…36,37 However, the data in the literature are inconsistent as to its efficacy at 5 years, which varies from 70% to 81%. 38,39 In comparison to VN its efficacy rate always seems lower, whether it is at 2 years (75% in the case of ITG vs 95.8% in the case of VN for Colletti et al 40 ) or at more than 2 years (81% at 2.7 years in the case of ITG vs 93% at 4.9 years in the case of VN for Morel et al 15 ).…”

Section: Discussionmentioning

confidence: 98%

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Véleine¹,

Brenet²,

Labrousse³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE When Ménière’s disease (MD) becomes disabling due to the frequency of attacks or the appearance of drop attacks (i.e., Tumarkin otolithic crisis) despite "conservative" medical and surgical treatments, a radical treatment like vestibular neurotomy (VN) is possible. An ideal MD treatment would relieve symptoms immediately and persist after the therapy. The aim of this study was to identify if VN was effective after 10 years of follow-up regarding vertigo and drop attacks, and to collect the immediate complications. METHODS The authors report a retrospective, single-center (i.e., in a single tertiary referral center with otoneurological surgery activity) cohort study conducted from January 2003 to April 2020. All patients with unilateral disabling MD who had received a VN with at least 10 years of follow-up were included. The therapeutic efficacy was defined by complete disappearance of vertigo and drop attacks. The postoperative complications (CSF leak, total deafness, meningitis, death) were determined immediately after the surgery, and the hearing thresholds were determined during the patient follow-up with the pure tone average (PTA). RESULTS A total of 74 patients (of 85 who were eligible), average age 51.9 ± 11.1 years, including 38 men (51.4%), with disabling MD and/or Tumarkin drop attacks (24.3%) received VN, with at least 10 years of follow-up after surgery. After an average follow-up of 12.4 ± 1.7 years (range 10.0–16.3 years), 67 patients (90.5%) no longer presented any vertiginous attacks, and no patient experienced drop attack. The mean variation in early pre- and postoperative PTA was not statistically significant (n = 64, 2.2 ± 10.3 decibels hearing level [range −18 to 29], 95% CI [−0.4 to 4.37]; p = 0.096), and 84.4% of the patients evaluated had unchanged or improved postoperative PTA. Three significant complications were noted, including two surgical revisions for CSF leak. There was no permanent facial paralysis, meningitis, or death. CONCLUSIONS In case of disabling MD (disabling vertigo refractory to conservative vestibular treatments—Tumarkin drop attacks), VN via the retrosigmoid approach must be the prioritized proposal in comparison to intratympanic gentamicin injections, because of the extremely low complication rate and the immediate and long-lasting effect of this treatment on vertigo and falls.

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Section: Discussionmentioning

confidence: 98%

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Véleine¹,

Brenet²,

Labrousse³

et al. 2022

Journal of Neurosurgery

View full text Add to dashboard Cite

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“…These results are in accordance with those from Weckel et al 23 who retrospectively evaluated 25 patients treated with IT dexamethasone; they reported a satisfactory control of vertigo in 92% of the patients, and this protocol achieved control of vertigo in 70% of patients at 2 years. Harcourt et al 24 suggested IT methylprednisolone as an effective treatment for the long-term control of vertigo attacks, without he known inner-ear toxicity associated with gentamicin.…”

Section: Discussionmentioning

confidence: 99%

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

Scarpa

Ralli²,

Bonis

et al. 2020

Translational Medicine @ UniSa

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Meniere's disease is an inner ear disorder characterized by the presence of endolymphatic hydrops in the inner ear and symptomatology of recurrent and debilitating vertigo attacks, tinnitus, aural fullness, and fluctuating sensorineural hearing loss. Although many therapeutic options for MD have been proposed during years, no consensus has been reached by the scientific community. In the last decade, many therapeutic options have been proposed, as intratympanic steroid, intratympanic gentamicin, and intravenous glycerol. Recently, the role of the antisecretory factor in the diet of MD patients have been investigated. Surgery is recommended for intractable MD; some authors proposed new approaches including transcanal endoscopic infracochlear vestibular neurectomy, new marsupiliazation technique in sac surgery, and tenotomy of the stapedius and tensor tympani muscles.

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“…The concentration of dexamethasone ranged from 10 mg/dl to 40 mg/ml and frequency from 3 times one week to 2 times one month apart [ 9 , 12 – 15 ]. The concentration of methylprednisolone ranged from 40 mg/dl to 62.5 mg/ml and frequency from once a day to 2 times two weeks apart [ 9 , 10 , 16 – 18 ]. Thus, the IT delivery schedule is not settled so far, but it seems that more than one IT-injection should be delivered and is recommended.…”

Section: Intratympanic Corticosteroidsmentioning

confidence: 99%

Consensus on intratympanic drug delivery for Menière’s disease

Pyykkö

Zhang

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière’s disease (MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. Methods The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus (ICON) on treatment of Menière’s disease (2018), Clinical Practice Guideline (2020) and European Position statement on Diagnosis and Treatment of Meniere’s Disease (2018) are taken into account for reference, and follow advice from experts from Europe, USA and China. Results Experts agree on the following: (1) The effectiveness of IT methylprednisolone (ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone (ITD), and ITM can restore hearing in some cases. (2) Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin (ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. (3) Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. Conclusion More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.

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Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Menière's Disease

Cited by 15 publications

References 31 publications

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

Long-term efficacy of vestibular neurotomy in disabling Ménière’s disease and Tumarkin drop attacks

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

Consensus on intratympanic drug delivery for Menière’s disease

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