Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Abstract

Objective-To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease.Study Design-Retrospective study. Setting-Tertiary referral neurotology clinic.Patients-One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy. Intervention-IT dexamethasone injections as needed to control vertigo attacks.Main Outcome Measure-A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment.Results-Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment.Conclusion-IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.

Intratympanic Steroids for Inner Ear Disorders: A Review

“…Three papers did not specify their diagnostic criteria for MD [13,19,22]. For follow-up length, the more recent papers ensured 2 years of follow-up [10,14,15,20]. The other papers ranged in follow-ups from as short as 1 month [19] to up to 20 months [16].…”

“…A negative study is one that concluded that steroids were not beneficial, but not harmful either, for the treatment of MD. Among the 13 MD studies, 8 were positive [10,12,13,14,18,20,21,22] and 5 were negative [11,15,16,17,19]. …”

“…Guidelines are also published by the AAO-HNS for vertigo and functional level. In reviewing table 1, the majority of papers used the 1995 AAO-HNS definition of MD as an inclusion criteria [10,11,14,15,16,17,20]. One paper used the Shea staging system [21].…”

Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere’s Disease Patients

“…Comparing the treatment group (dexamethasone) with the placebo group after 24 months demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in the class (82% versus 57% of patients achieving class A -complete con-trol) and a mean vertigo subjective improvement (90% versus 57%). Boleas-Aguirre [5] published a study in 2008 of 129 patients with MD receiving intratympanic treatment with 12 mg/mL of dexamethasone. Satisfactory vertigo control (meaning no further treatments were needed or asked for) was achieved in 117 (91%) of 129 cases.…”

Meniere’s Disease Treatment

“…Of these, 91% had control of dizziness with intratympanic dexamethasone, and some needed more injections of dexamethasone or associated intratympanic gentamicin [22].…”