Oral Steroid Treatment for Hearing Improvement in Ménière’s Disease and Endolymphatic Hydrops

Abstract

The results of this and other studies would indicate that a Ménière's disease or endolymphatic hydrops patient is unlikely to experience an improvement in hearing from a short course of oral steroid. Clinically observed temporary improvement did not sustain over several months. Further work to elucidate the mechanisms underlying hearing loss in hydrops, perhaps focusing on the dendrite damage noted in animal models of hydrops, is warranted.

Clinical Practice Guideline: Ménière’s Disease

“…Oral steroids showed an overall improvement in vertigo in one small pilot study, 258 while another cited no hearing improvement with oral steroids. 259 A small prospective cohort study was conducted comparing 2 antiviral treatments in MD (n = 31), and only 39% showed improvement in hearing within 2 months and complete vertigo control (n = 12 of 31). 260 Given the limited amount of high-quality studies looking at the role of these alternative agents as maintenance therapy for chronic MD, this GDG cannot currently make a recommendation on their use.…”

Efficacy and safety of betahistine treatment in patients with Meniere’s disease: primary results of a long term, multicentre, double blind, randomised, placebo controlled, dose defining trial (BEMED trial)

“…Many therapeutic approaches to Meniere’s disease have been studied. These include a low salt diet and diuretics,8 intratympanic steroid application,9 10 or minimal invasive interventions (such as insertion of a ventilation tube into the tympanic membrane,11 12 endolymphatic sac surgery,13 or pulsed low pressure delivery (using Meniett devices)) 1415 16 17 For patients who do not respond to these treatments, more aggressive procedures can be considered, such as intratympanic application of gentamycin,18 19 plugging of the semicircular canal, labyrinthectomy, or neurectomy 20…”

Prognostic implications of and audiometric evidence for hearing fluctuation in Meniere's disease

“…Current treatment strategies are directed primarily toward controlling vertigo in these patients given its great impact on daily living. Although hearing does not typically progress to a profound hearing loss, current treatments are largely ineffective against the overall progression of hearing loss in these patients . Furthermore, there appears to be an understanding communicated to the patients, whether through misinterpretation of counseling efforts from those within the field of otolaryngology or gleaned by patients' interpretation of materials that they obtain on their own, that they will progress to deafness with a diagnosis of Meniere's disease.…”

“…Although hearing does not typically progress to a profound hearing loss, 3 current treatments are largely ineffective against the overall progression of hearing loss in these patients. [4][5][6][7] Furthermore, there appears to be an understanding communicated to the patients, whether through misinterpretation of counseling efforts from those within the field of otolaryngology or gleaned by patients' interpretation of materials that they obtain on their own, that they will progress to deafness with a diagnosis of Meniere's disease. Finally, the fluctuating nature of hearing loss in Meniere's disease impacts the interpretation of hearing improvement in treatment study methodology.…”