難治性メニエール病症例に対するステロイド鼓室内投与の治療効果についての検討

Abstract

Meniere's disease (MD) is a clinically defined disorder, characterized by recurrent episodic vertigo with aural fullness, tinnitus, and sensorineural hearing loss. Most patients with MD maintain their normal daily activities by conservative approaches including a low salt diet and diuretics, but one third of them fail to control the vertigo attacks and progressive hearing loss occurs. The current study aimed to examine whether intratympanic injection of steroids was effective in the long term control of vertigo for patients with intractable MD. We conducted a retrospective outcome review of 21 patients with MD who were treated with an intratympanic injection of dexamethasone. Outcomes were determined by subjective assessment of vertigo control and by objective changes in the audiometric pure-tone average (PTA). We adopted the AAO-HNS guidelines that use a number of scales to define the frequency of vertiginous episodes at post injection and long term outcomes of treatment at 18 to 24 months after the last dexamethasone injection. At the 2-year follow up, complete control of vertigo (class A) was achieved in 8 patients (38%) and substantial control of vertigo (class B) in 6 (29%). The remaining 7 patients (33%) were classified as a failure (class D or E). The level of hearing was unchanged in 19 (90%), and increased or decreased in one patient each. These findings suggest that when the vertiginous symptoms still persist after 6 months of medical treatment, intratympanic steroid injections can be started, with the high probability of long term alleviation of vertigo attacks without causing hearing loss.