Intratympanic Dexamethasone in the Treatment of Ménière's Disease

Abstract

Objectives: Describe vertigo control outcomes when intratympanic steroid injections are used for medically refractory Ménière’s disease. Methods: A retrospective chart review was performed of patients diagnosed with unilateral Ménière’s disease at a tertiary academic center. Patients were included who underwent intratympanic (IT) dexamethasone therapy after failing initial medical treatment between July of 2007 and July of 2013. Vertigo control was defined as when patients were satisfied and did not progress to further nonablative or ablative treatment. Results: Forty-one patients with Ménière’s disease underwent IT dexamethasone injections after failing medical therapy. Twenty-six patients (63%) underwent more than 1 injection, with a median of 2 injections in the study population. Fifteen patients (37%) had vertigo control, at a mean follow-up time of 9 months after the last injection. Vertigo control required 1 injection in 6 patients (40%), 2 in 2 patients (13%), 3 in 5 patients (33%), 4 in 1 patient (7%), and 5 in 1 patient (7%). Nineteen patients (46%) underwent further treatment that included endolymphatic sac surgery (9), IT gentamicin (5), betahistine therapy (4), and labyrinthectomy (1). No complications of infection or tympanic membrane perforation from the injections were observed. Conclusions: IT dexamethasone injection therapy can control vertigo symptoms in patients with Ménière’s disease. However, this retrospective study reports a lower control rate than that reported in previous studies. Further studies are necessary to clarify specific patient factors that would predispose towards vertigo control with IT dexamethasone.