Abstract
Abstract The aim of the study was to investigate the role of intratympanic (IT) dexamethasone in the treatment of medically refractory Meniere’s disease (MD) using two different concentrations. Twenty-four adults with unilateral MD received a single IT injection of dexamethasone at 4 or 10 mg/ml concentration. Partial or no improvement over the next 1 month following injection necessitated a second injection. Before and after injection, all patients underwent detailed history taking, were evaluated with the Dizziness Handicap Inventory scale, and underwent basic audiological evaluation and assessment of cervical-vestibular evoked myogenic potential. The presence or absence of spontaneous, post-head-shaking, and positional nystagmus was assessed using a video-nystagmography system. Twelve patients served as the control group and were followed up subjectively for 1 month. Both 4 and 10 mg/ml IT dexamethasone improved all subjective symptoms and pure-tone audiometry thresholds. The cervical-vestibular evoked myogenic potential asymmetry ratio dropped after injection. However, the 10 mg/ml concentration was superior to the 5 mg/ml concentration in improving the signs of disease activity, Dizziness Handicap Inventory scores, and the duration of vertigo attacks. No change was reported by the controls. IT dexamethasone injection might be helpful in controlling MD in some patients. The 10 mg/ml dexamethasone concentration controls vertigo at both the subjective and objective level. Especially if used early in the course of the disease
Highlights
Meniere’s disease (MD) is a chronic disorder affecting the inner ear, characterized by recurrent episodes of spontaneous vertigo, fluctuating sensorineural hearing loss, and tinnitus, often with a feeling of fullness in the ear
MD according to the classification of Committee of Hearing and Equilibrium [10]
The mean age was 46.83 ± 11.95 years in subgroup A and 43.08 ± 13.45 years in subgroup B, whereas the control group had a mean age of 45 ± 13 years
Summary
Meniere’s disease (MD) is a chronic disorder affecting the inner ear, characterized by recurrent episodes of spontaneous vertigo, fluctuating sensorineural hearing loss, and tinnitus, often with a feeling of fullness in the ear. Treatment options include lifestyle modifications, medications such as diuretics [3], vestibular suppressants (Claes and Van de Heyning, 1997) [4], oral steroids [5], and intratympanic (IT) injection of dexamethasone and/or gentamicin [6,7]. When less invasive medical therapies fail to provide symptomatic relief after 6 months, the patient is said to have ‘intractable’MD. A more invasive treatment option, such as IT injection of steroid, should be considered [8]. IT steroid is a convenient and easy office-based treatment with minimal side effects, mainly limited to pain, inflammatory middle-ear changes, short-lasting vertigo, and tympanic membrane perforation [9]. The steroid most often used for IT therapy is dexamethasone. Dexamethasone seems to be the best tolerated with the longest half-life of up to 36–54 h [7]
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