Intratympanic steroid versus gentamicin for treatment of refractory Meniere's disease: A meta-analysis

Lee, Sang Yeon; Kim, Young Seok; Jeong, Bola; Carandang, Marge; Koo, Ja Won; Oh, Seung Ha; Lee, Jun Ho

doi:10.1016/j.amjoto.2021.103086

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…The treatment is complicated since hearing, vertigo control, tinnitus, and suppression are all intertwined, and thus, are tricky to treat separately. Both pharmacologic and surgical treatment may be effective for some patients and ineffective for others [ 24 , 25 ]; however, there is no current cure for Meniere’s disease, which is especially crucial for sensorineural hearing loss. For surgical therapy, patients and doctors sometimes find a clinical course difficult to decide on.…”

Section: Discussionmentioning

confidence: 99%

Hearing Benefits of Clinical Management for Meniere’s Disease

Zhang

Wei

Sun

et al. 2022

JCM

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Meniere’s disease is a progressive hearing–disabling condition. Patients can benefit from strict clinical management, including lifestyle and dietary counseling, and medical treatment. A prospective cohort study was carried out with 154 patients with definite Meniere’s disease, with an average age of 43.53 ± 11.40, and a male to female ratio of 0.97:1. The pure-tone thresholds of all 165 affected ears, over a one-year clinical management period, were analyzed. After one year, 87.27% of patients had improved or preserved their hearing at a low frequency, and 71.51% at a high frequency. The hearing threshold at frequencies from 250 Hz to 2000 Hz had improved significantly (p < 0.001, p < 0.001, p < 0.001, p < 0.01), and deteriorated slightly at 8000 Hz (p < 0.05). Of all the patients, 40.00% had a hearing average threshold that reached ≤ 25 dB HL after the clinical management period, among whom 27.27% were patients in stage 3. The restoration time was 2.5 (1.0, 4.125) months, with a range of 0.5–11.0 months, and the restoration time was longer for stage 3 than for stages 1 and 2 (u = −2.542, p < 0.05). The rising curves improved the most (p < 0.05), with most becoming peaks, whereas most peaks and flats remained the same. Patients who were initially in the earlier stages (95% CI 1.710~4.717, OR 2.840, p < 0.001), have an increased odds ratio of hearing by an average of ≤25 dB HL. Age (95% CI 1.003~1.074, OR 1.038, p = 0.031), peak curve (95% CI 1.038~5.945, OR = 2.484, p = 0.041), and flat curve (95% CI 1.056~19.590, OR = 4.549, p = 0.042), compared with the rising curve, increase the odds ratio of hearing on average by > 25 dB HL. Most patients can have their hearing preserved or improved through strict clinical management, and sufficient follow-up is also essential. Stage 3 patients also have the potential for hearing improvement, although the restoration time is longer than in the early stages. The initial hearing stage, age, and audiogram pattern are related to the hearing benefits.

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Section: Discussionmentioning

confidence: 99%

Hearing Benefits of Clinical Management for Meniere’s Disease

Zhang

Wei

Sun

et al. 2022

JCM

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“…Previous studies have demonstrated the comparable efficacy of IT injections of dexamethasone or methyl prednisolone vs gentamicin in reducing the frequency of vertigo attacks in MD [ 5 , 7 ]. However, the length of time that such IT injections can control the patients’ symptoms has barely been examined.…”

Section: Discussionmentioning

confidence: 99%

“…We also recognise that a control group of placebo or gentamicin would be preferable; however, level 1 evidence has already been published [ 5 ]. Of note, our main scope was to determine for how long the injections provide adequate symptom-control and not just to show if they are effective, which has already been reported [ 7 ]. Finally, we recognise that only four patients did not respond to the treatment; thus it is a very small group; however, we felt that a direct comparison could highlight factors potentially linked to response/non-response (such as autoimmune background).…”

Section: Discussionmentioning

confidence: 99%

“…Patel et al ., where the first to perform a randomised double-blind trial comparing the reduction in frequency of vertigo attacks achieved by gentamicin vs methylprednisolone, finding them to be equally effective [ 5 ]. Subsequent similar studies have been performed leading to a recent meta-analysis that again supported the use of corticosteroids as an alternative to gentamicin [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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

Hilton

McClelland

McCallum

et al. 2022

Eur Arch Otorhinolaryngol

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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.

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“…Entretanto é importante ressaltar que ainda existe a necessidade de pesquisas nessa área, já que os estudos publicados até o presente momento não se mostram suficientes para um consenso sobre o assunto. 9,11…”

Section: Injeções Intratimpânicasunclassified

Tratamento da Doença de Menière

Venosa

2022

Preprint

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A Doença de Menière sempre foi considerada como uma doença heterogênea e sua abordagem atual leva em consideração a existência de diferentes tipos de apresentação, que podem estar ligados a determinados fatores como herança genética, estilo de vida e alimentação. Dessa forma, o tratamento deve ser direcionado para uma conduta individualizada que leve em consideração os subtipos de sintomas, suas possíveis causas e as respectivas consequências imediatas, a médio e longo prazo. Nesse artigo vamos abordar algumas opções terapêuticas atualmente utilizadas na prática otoneurológica para seu tratamento. Episódio agudo de vertigemA clássica crise vertiginosa, acompanhada de zumbido e plenitude aural, característica da Doença de Menière, deve ser abordada da mesma forma que outras vestibulopatias periféricas agudas, podendo ser utilizados, de forma racional, medicamentos depressores de função vestibular e sintomáticos para náuseas e vômitos. Medidas dietéticasAo longo dos anos diversas medidas dietéticas têm sido propostas para o tratamento da Doença de Menière e, dentre elas, se destacam as dietas com restrição de sal, cafeína, álcool e açúcar, que discutiremos a seguir. Publicação de revisão de literatura da Cochrane Library buscou evidências em ensaios clínicos randomizados a respeito do efeito das restrições de sal, cafeína, e álcool na Doença de Menière. A conclusão dos autores foi de que não há na literatura informações nem que suportem essas medidas, nem que as contraindiquem. 1 Do ponto de vista histórico é interessante notar que as dietas com restrição de sal sempre fizeram parte da primeira linha de tratamento da Doença de Menière e, até o presente momento, ainda existem publicações tanto a favor como contra tal tipo de abordagem. 2

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Intratympanic steroid versus gentamicin for treatment of refractory Meniere's disease: A meta-analysis

Cited by 15 publications

References 36 publications

Hearing Benefits of Clinical Management for Meniere’s Disease

Hearing Benefits of Clinical Management for Meniere’s Disease

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

Tratamento da Doença de Menière

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