メニエール病のステロイド療法と補助・代替薬 ＰｒｅｄｎｉｓｏｌｏｎｅとＡｚｅｌａｓｔｉｎｅ

Abstract

The first report concerning the effectiveness of a steroid in the treatment of Meniere's disease was written by Hauser in 1959. However, steroid therapy itself has been relegated to the treatment of “food allergy”, or atopic allergy or Type I reactions. On the other hand, since McCabe's report of “autoimmune sensorineural hearing loss”, several researchers have emphasized autoimmunity in the genesis of Meniere's disease and the effectiveness of steroids in its treatment.Half of the active members of the Japan Society of Equilibrium Research actually use steroids in the treatment of Meniere's disease (Yazawa). Nevertheless, there are only a few reports describing steroid therapy of Meniere's disease. The first aim of this study is the demonstration of the effectiveness of a steroid, prednisolone, in the treatment of Meniere's disease.In 16 patients (14- with Meniere's disease, two with delayed endolymphatic hydrops), the oral administration of prednisolone (average 15mg/day) caused significant (p <0.05) reduction of low-tone hearing loss, nystagmus, vertigo, dizziness and tinnitus.The second aim of this study is seeking out and confirming an effective alternative to steroids to avoid side effects and dependency. A new anti-allergic agent, azelastine, which predominantly depresses the release of inflamatory chemical transmitters such as leukotriene C3, D4 and prostaglandin E2, was given in a dose of 2-3 mg/day immediately after steroid therapy to the same patients and resulted in significant (p <0.01) improvement of hearing with reduction of nystagmus, vertigo, dizziness and tinnitus. In a single dose given to 9 patients it caused significant (p <0.05) improvement in the same symptoms.The importance of an alternative to steroids in the treatment of Meniere's disease is emphasized, and the contribution of autoimmunity in the etiology of Meniere's disease is discussed.