Medical management of Meniere's disease

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

Objective

To explore the long-term efficacy and safety of dexamethasone treatment via tympanic antrum catheterization (TAC) in intractable Meniere's disease (MD).

Methods

In this retrospective analysis, 60 unilateral intractable MD patients treated with TAC in our hospital from January 2020 to August 2020 were followed for 2 years. Fifty patients who underwent endolymphatic sac decompression (ESD) and 50 patients who accepted intratympanic steroids (ITS) were established as the control groups. Vertigo control, hearing level, tinnitus, aural fullness and functional level were assessed during the study.

Results

The effective vertigo control rate of intractable MD patients with TAC treatment was 76.7% (46/60) after 2 years follow-up, with a complete control rate of 58.3% (35/60) and a substantial control rate of 18.3% (11/60). The vertigo control rate of TAC was comparable to that of ESD (χ2 = 0.313, p > 0.05), and significantly higher than that of ITS (χ2 = 4.380, p < 0.05). The hearing loss rate of these patients was 10.8% (4/37), which was not significantly different from the control groups (χ2 = 2.452, p > 0.05). The tinnitus improvement rate of patients with TAC was 56.7% (34/60), which was significantly higher than that of patients with ESD (χ2 =11.962, p < 0.001) and ITS (χ2 =15.278, p < 0.001). The aural fullness improvement rate in the TAC group was 56.7% (34/60), which was significantly higher than that in the ESD (χ2 = 11.962, p < 0.001) and ITS groups (χ2 = 5.635, p < 0.05). The functional level improvement rate in the TAC group was 71.7% (43/60), which was much higher than that in the ITS group (χ2 = 17.256, p < 0.001), but there was no significant difference between TAC and ESD (χ2 = 0.410, p > 0.05). No patients had complications or adverse reactions following TAC treatment.

Conclusion

Dexamethasone treatment via TAC can effectively control vertigo attacks and improve related symptoms of intractable MD patients, providing valuable new insights into the treatment of MD.

Trends in the diagnosis and the management of Meniere's disease: Results of a survey

OBJECTIVE: To determine the practices of the American Neurotology Society (ANS) membership in the evaluation and treatment of the Meniere's patient.

STUDY DESIGN: Prospective.

INTERVENTION: Questionnaire.

MAIN OUTCOME MEASURE: Respondents’ response to questions pertaining to the diagnostic and therapeutic practices in the management of Meniere's disease.

RESULTS: Three hundred members of ANS were mailed a 15-item questionnaire. Two hundred three responded, for a 67.7% response rate. For the diagnosis of Meniere's disease, 1 in 3 practitioners relied solely on history, physical exam, and audiometry, whereas 2 in 3 relied in part on adjunctive tests, such as electrocochleography (ECOG) and electronystagmography (ENG). Two in 3 practitioners pursued retrocochlear studies on initial evaluation, with the overwhelming majority using MRI. In treating Meniere's disease, conservative medical management was preferred. For medically recalcitrant Meniere's disease, endolymphatic sac surgery (ESS) was the most commonly employed initial intervention (50%), followed by transtympanic gentamicin (38%). Currently, <10% routinely recommend the Meniett device. Eighty-three percent include ESS as a therapeutic option for medically recalcitrant Meniere's disease. The vast majority continue to perform surgical labyrinthectomies and vestibular nerve sections for Meniere's disease.

CONCLUSIONS: Meniere's disease continues to pose a difficult diagnostic and therapeutic problem, resulting in heterogeneous approaches to both evaluation and treatment. Despite the 1995 American Academy of Otolaryngology guidelines in the diagnosis of Meniere's disease, most clinicians rely in part on ENG or ECOG in diagnosing Meniere's disease. Furthermore, despite the passing of 20 years since the publications claiming a purely placebo effect, ESS is the most commonly employed initial surgical treatment for Meniere's disease. (Otolaryngol Head Neck Surg 2005;132: 722-6.)

Long-term effects of intratympanic methylprednisolone perfusion treatment on intractable Ménière's disease

Objective:

This study aimed to investigate the long-term efficacy of intratympanic methylprednisolone perfusion treatment for intractable Ménière's disease.

Methods:

A retrospective analysis of 17 intractable Ménière's disease patients treated with intratympanic methylprednisolone perfusion was performed. Treatment efficacy was evaluated according to the American Academy of Otolaryngology–Head and Neck Surgery criteria. Short and long-term control or improvement rates were calculated after 6 and 24 months, respectively.

Results:

Sixteen patients were followed for more than two years. Short- and long-term vertigo control rates were 94 per cent and 81 per cent, respectively; short- and long-term functional activity improvements were 94 per cent and 88 per cent, respectively. The pure tone average was 53 ± 14 dB before treatment, and 50 ± 16 dB at 6 months and 52 ± 20 dB at 24 months after intratympanic methylprednisolone perfusion. Tinnitus was controlled or improved in five patients over the two-year follow-up period.

Conclusion:

Intratympanic methylprednisolone perfusion can effectively control vertigo and improve functional activity in intractable Ménière's disease patients with good hearing preservation. It may therefore be a viable alternative treatment for intractable Ménière's disease.

Meniere's disease

Meniere's disease is a chronic illness that affects a substantial number of patients every year worldwide. The disease is characterised by intermittent episodes of vertigo lasting from minutes to hours, with fluctuating sensorineural hearing loss, tinnitus, and aural pressure. Although there is currently no cure, more than 85% of patients with Meniere's disease are helped by either changes in lifestyle and medical treatment, or minimally invasive surgical procedures such as intratympanic steroid therapy, intratympanic gentamicin therapy, and endolymphatic sac surgery. Vestibular neurectomy has a very high rate of vertigo control and is available for patients with good hearing who have failed all other treatments. Labyrinthectomy is undertaken as a last resort and is best reserved for patients with unilateral disease and deafness.

Terapia de reentrenamiento (TRT) en el acúfeno de la enfermedad de Ménière

OBJECTIVE

To evaluate the response of tinnitus in Meniere's disease patients (MD) using the Tinnitus Retraining Therapy (TRT). This management includes a wide cognitive medical counselling and natural or prosthetic sound therapies (hearing aid or noise generator).

DESIGN

Descriptive prospective study (EBM level 3).

PATIENTS

Twenty-five patients diagnosed as definitive MD (AAO-HNS 95 criteria) were enrolled in our tinnitus protocol.

MAIN OUTCOME MEASURES

Tinnitus changes were reported according to patient's self-evaluation, a visual analogue scale on tinnitus intensity (EVA) and the Tinnitus Handicap Inventory (THI).

RESULTS

Seventy-three percent of the patients improved their tinnitus after 6 months of treatment (p < 0.05). THI scores were reduced from the initial 47% to 24% (p < 0.05) and EVA from 6.6 to 5.2 (p < 0.05). After 12 months, the response was slightly worse: 68% improved according to their self-evaluation (p < 0.05), THI score reached 20% (p < 0.05) but EVA did not improve significantly (6.4). Patients that refused prosthesis adaptation (hearing aid or noise generator) did not improved and the THI score (48%) and EVA score (6.6) did not change.

CONCLUSIONS

TRT has proved to be an effective method for tinnitus treatment in MD that improves patient's self-evaluation, tinnitus loudness and handicap scores. Individualized medical counselling and an exhaustive prosthesis adaptation are crucial to guarantee satisfactory results.

Oral Administration of Prednisone to Control Refractory Vertigo in Ménière's Disease: A Pilot Study

OBJECTIVE

To establish whether the oral administration of moderate doses of prednisone reduces refractory vertigo in Ménière's disease.

STUDY DESIGN

Blinded, randomized, controlled trial.

SETTING

Tertiary referral center.

PATIENTS

Patients with Ménière's disease with limited vertigo control (Class C) and severe disability (Scale 3).

INTERVENTIONS

Two groups (n = 8 per group) were treated orally with either diphenidol (25 mg/d) plus acetazolamide (250 mg/48 h) (control group), or the same treatment plus prednisone (0.35 mg/kg) daily for 18 weeks (prednisone group).

MAIN OUTCOME MEASURES

The variables evaluated were the frequency and duration of vertigo, tinnitus, aural fullness, and audiographic parameters. The clinical surveillance was performed for 12 months after prednisone withdrawal.

RESULTS

The frequency and duration of vertigo episodes were reduced by 50% and 30%, respectively, by prednisone treatment. Prednisone-treated patients manifested a significant reduction in tinnitus. No changes were observed in aural fullness or hearing. No metabolic or infectious disorders were observed.

CONCLUSION

Oral prednisone helps to control refractory vertigo in Ménière's disease. These preliminary data suggest that prednisone can be a good noninvasive antivertigo management regimen for these patients.