Duration of symptom control following intratympanic dexamethasone injections in Meniere’s disease

Abstract

Purpose Intratympanic (IT) injections of corticosteroids have emerged as a non-ablative alternative to gentamicin in the management of refractory Meniere’s disease. However, currently, the duration of the symptom control achieved via intratympanic corticosteroids is under reported. Methods We retrospectively reviewed the notes of all patients who underwent IT injections of dexamethasone for the treatment of definite Meniere’s disease at a single tertiary referral university centre over a 6-year period. We included demographic information, the number of procedures patients required, duration of symptom-control achieved (time interval between repeat IT injections), and the presence of co-morbidities, with a focus on the presence of autoimmune disease. Results We identified 27 patients who underwent a total of 42 procedures; 23/27 (85.2%) patients demonstrated clinical response with a median period of symptom control of 14.5 months (range 1–64, IQR 10.25). The median longest asymptomatic period per patient was 19 months (range 11–64, IQR: 18). Interestingly, all patients with autoimmune disease (7/27) demonstrated a clinical response; autoimmune disease was found to be a statistically significant predictor of response to treatment (p = 0.002). In patients who received repeated treatment following disease relapse, there was no difference in duration of symptom-control achieved. Conclusions IT steroids can provide an effective alternative to gentamicin ablation. Symptom control is achieved for a median of 14.5 months, and treatment can be repeated with no loss of efficacy. Those patients who have an underlying autoimmune co-morbidity are more likely to demonstrate a clinical response to therapy, which may provide insight into the underlying pathophysiology of Meniere’s disease.

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

“…ITG even though reserved for MD patients with refractory vertigo and with considerable hearing loss, is still more widely used than ITC because of two reasons: ‘chemical labyrinthectomy’ with aminoglycosides is a well-known concept since introduced in 1948 by fowler [ 11 ] whereas ITC is a recent treatment method introduced in 2007 [ 3 ]. The second reason is that the evidence of disease control for ITC in MD patients is still rather questionable as shown in the Cochrane and systematic reviews [ 9 , 45 , 47 ] with very few studies showing control of disease symptoms [ 18 , 21 ]. What needs to be considered here is that when ITG might be better at controlling vertigo, ITC has been shown to be better at hearing preservation but not effective in controlling vertigo.…”

Long-term efficacy of dexamethasone treatment via tympanic antrum catheterization for intractable Meniere's disease

“…Intratympanic gentamicin (ITG), is known as chemical labyrinthectomy, with a vertigo control rate up 96.8% but accompanied by 0-75% hearing impairment (9, 10). Growing evidence has indicated intratympanic steroids (ITS) provide an effective alternative to ITG in symptom control, especially multi-session ITS (11,12). However, repeated injections via tympanic puncture can cause burning and painful sensation (8).…”