Consensus on intratympanic drug delivery for Menière’s disease

Abstract

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.

Role of prior intratympanic gentamicin and corticosteroids therapy on speech understanding in patients with Menière's disease after cochlear implantation

“…This fluctuation occurring only in ITG group and not in ITC group in our study is still harder to explain. We can only speculate that the ITC group as suggested by the prior pathogenesis plays a hearing protective role, which the ITG group lacks [ 14 , 22 , 32 ]. There has also been increased discussion in the last years suggesting that ITG might be more effective in controlling vertigo episodes than ITC with negligible hearing loss when used in low doses [ 6 , 33 ].…”

Effects of Nutraceuticals on Cisplatin-Induced Cytotoxicity in HEI-OC1 Cells

“…Much effort is being dedicated to optimize drug delivery through the intratympanic administration of hydrogels and nanoparticles. Intratympanic drug delivery has already been used in humans for intractable Menière's disease [62], for idiopathic sudden hearing loss [63,64], and recently, for cisplatin-induced ototoxicity [65,66]. The last studies have demonstrated that intratympanic injection of thiosulfate is feasible and safe, but the number of patients was very small, and more work is necessary to establish whether and in which conditions (such as time of injection relative to cisplatin infusion) it is possible to obtain otoprotection.…”

Recent surgical advances and continued controversies in medically refractory Meniere's disease

“…A recent review of consensus statements and clinical practice guidelines from the USA, Europe, and China recommends the use of methylprednisolone over dexamethasone for intratympanic steroid administration. Within this review by Li et al [9 ▪ ] in 2022, an intratympanic gentamicin titration protocol is proposed that includes two injections 2 weeks apart with an end-point of vertigo cessation and/or unilateral vestibular loss on objective testing. When comparing intratympanic steroids versus gentamicin, a recent metanalysis by Lee et al (2021) [10] shows similar vertigo control rates, with better hearing outcomes for the steroid group.…”