Intratympanic Dexamethasone Delivery versus Placebo in Intractable Meniere Disease
Abstract
Background: Numerous treatments strategies were used for Meniere disease (MD). In this study, we aimed to compare the efficacy of intratympanic dexamethasone versus intratympanic placebo in intractable MD.
Methods: This was a single-blinded randomized clinical trial. All patients with Intractable MD underwent ventilation tube insertion into tympanic membrane and were randomly allocated to two groups of 18-patients. The patients of the first group used dexamethasone base drop (placebo) every other day, the second group used dexamethasone drop for 3 months, and all patients were followed for 12 months.
Results: Control of vertigo and tinnitus with dexamethasone was more than the placebo, but there was no statistically significance difference between two groups (P > 0.05). Hearing function improvement and aural fullness resolution were higher in the placebo group, but there was no statistically significance difference, too (P > 0.05). Vertigo control in dexamethasone group in our study ranged from 72.2% to 83.3% of patients at different intervals. These figures ranged from 66.6% to 83.3% in placebo group. The highest rate of hearing function improvement in our study was 27.7% in placebo group. Tinnitus also followed the same pattern as hearing function.
Conclusions: Intratympanic dexamethasone for MD is very satisfactory if medical treatment fails with good vertigo control and no risk to hearing.
2. Kimura RS. Experimental blockage of the endolymphatic duct and sac and its effect on the inner ear of the guinea pig. A study on endolymphatic hydrops. Ann Otol Rhinol Laryngol 1967; 76(3): 664-87.
3. Yamamoto E, Mizukami C. Development of the vestibular aqueduct in Meniere's disease. Acta Otolaryngol Suppl 1993; 504: 46-50.
4. Alleman AM, Dornhoffer JL, Arenberg IK, Walker PD. Demonstration of autoantibodies to the endolymphatic sac in Meniere's disease. Laryngoscope 1997; 107(2): 211-5.
5. Evans KL, Baldwin DL, Bainbridge D, Morrison AW. Immune status in patients with Meniere's disease. Arch Otorhinolaryngol 1988; 245(5): 287-92.
6. Brookes GB. Circulating immune complexes in Meniere's disease. Arch Otolaryngol Head Neck Surg 1986; 112(5): 536-40.
7. Morrison AW. Anticipation in Meniere's disease. J Laryngol Otol 1995; 109(6): 499-502.
8. Klockars T, Kentala E. Inheritance of Meniere's disease in the Finnish population. Arch Otolaryngol Head Neck Surg 2007; 133(1): 73-7.
9. Calenoff E, Zhao JC, Derlacki EL, Harrison WH, Selmeczi K, Dutra JC, et al. Patients with Meniere's disease possess IgE reacting with herpes family viruses. Arch Otolaryngol Head Neck Surg 1995; 121(8): 861-4.
10. Welling DB, Daniels RL, Brainard J, Western LM, Prior TW. Detection of viral DNA in endolymphatic sac tissue from Meniere's disease patients. Am J Otol 1994; 15(5): 639-43.
11. Parker W. Meniere's disease etiologic considerations. Arch Otolaryngol Head Neck Surg 1995; 121(4): 377-82.
12. Radtke A, Lempert T, Gresty MA, Brookes GB, Bronstein AM, Neuhauser H. Migraine and Meniere's disease: is there a link? Neurology 2002; 59(11): 1700-4.
13. Mizukoshi K, Ino H, Ishikawa K, Watanabe Y, Yamazaki H, Kato I, et al. Epidemiological survey of definite cases of Meniere's disease collected by the seventeen members of the Meniere's Disease Research Committee of Japan in 1975-1976. Adv Otorhinolaryngol 1979; 25: 106-11.
14. Barrs DM, Keyser JS, Stallworth C, McElveen JT Jr. Intratympanic steroid injections for intractable Meniere's disease. Laryngoscope 2001; 111(12): 2100-4.
15. Phillips JS, Westerberg B. Intratympanic steroids for Meniere's disease or syndrome. Cochrane Database Syst Rev 2011; (7): CD008514.
16. Harris JP, Ryan AF. Fundamental immune mechanisms of the brain and inner ear. Otolaryngol Head Neck Surg 1995; 112(6): 639-53.
17. Riente L, Bongiorni F, Nacci A, Migliorini P, Segnini G, Delle SA, et al. Antibodies to inner ear antigens in Meniere's disease. Clin Exp Immunol 2004; 135(1): 159-63.
18. Ruckenstein MJ, Prasthoffer A, Bigelow DC, Von Feldt JM, Kolasinski SL. Immunologic and serologic testing in patients with Meniere's disease. Otol Neurotol 2002; 23(4): 517-20.
19. Rauch SD, San Martin JE, Moscicki RA, Bloch KJ. Serum antibodies against heat shock protein 70 in Meniere's disease. Am J Otol 1995; 16(5): 648-52.
20. Suslu N, Yilmaz T, Gursel B. Utility of immunologic parameters in the evaluation of Meniere's disease. Acta Otolaryngol 2009; 129(11): 1160-5.
21. Derebery MJ, Rao VS, Siglock TJ, Linthicum FH, Nelson RA. Meniere's disease: An immune complex-mediated illness? Laryngoscope 1991; 101(3): 225-9.
22. Gazquez I, Soto-Varela A, Aran I, Santos S, Batuecas A, Trinidad G, et al. High prevalence of systemic autoimmune diseases in patients with Meniere's disease. PLoS One 2011; 6(10): e26759.
23. Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009; 11(3): 229.
24. Alarcon-Segovia D, Alarcon-Riquelme ME, Cardiel MH, Caeiro F, Massardo L, Villa AR, et al. Familial aggregation of systemic lupus erythematosus, rheumatoid arthritis, and other autoimmune diseases in 1,177 lupus patients from the GLADEL cohort. Arthritis Rheum 2005; 52(4): 1138-47.
25. McCall AA, Swan EE, Borenstein JT, Sewell WF, Kujawa SG, McKenna MJ. Drug delivery for treatment of inner ear disease: current state of knowledge. Ear Hear 2010; 31(2): 156-65.
26. Itoh A, Sakata E. Treatment of vestibular disorders. Acta Otolaryngol Suppl 1991; 481: 617-23.
27. Montandon P, Guillemin P, Hausler R. Prevention of vertigo in Meniere's syndrome by means of transtympanic ventilation tubes. ORL J Otorhinolaryngol Relat Spec 1988; 50(6): 377-81.
28. Shea JJ Jr, Ge X. Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Meniere's disease. Otolaryngol Clin North Am 1996; 29(2): 353-8.
29. Silverstein H, Isaacson JE, Olds MJ, Rowan PT, Rosenberg S. Dexamethasone inner ear perfusion for the
treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial. Am J Otol 1998; 19(2): 196-201.
30. Garduno-Anaya MA, Couthino De Toledo H, Hinojosa-Gonzalez R, Pane-Pianese C, Rios-Castaneda LC. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Meniere's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngol Head Neck Surg 2005; 133(2): 285-94.
| Files | ||
| Issue | Vol 3 No 3-4 (2016) | |
| Section | Original Article(s) | |
| Keywords | ||
| Meniere disease Intratympanic injection Dexamethasone Placebos | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
