Symptom‐Based Intratympanic Dexamethasone for MénièreDisease

Abstract

Objective: Understand the effectiveness of intratympanic (IT) dexamethasone for Ménière disease when given on an as-needed basis for worsening symptoms. Method: Retrospective cohort of 115 patients with AAO-HNS criteria for definite Ménière disease who had failed lifestyle modifications and medical therapy. All patients received initial IT dexamethasone treatment. If unsuccessful in controlling symptoms, patients then chose further IT dexamethasone injections or ablative therapy (IT gentamicin or endolymphatic sac surgery). Results: Of the 115 patients in this study, 92 (80.0%) reported satisfactory control of their Ménière disease symptoms with IT dexamethasone while 18 (20.0%) chose to receive ablative therapy. In those patients controlled with IT dexamethasone 58 (63.0%) were controlled with 3 or less injections, 28 (30.4%) were controlled with 4 to 10 injections, and 6 (6.5%) were controlled with more than 10 injections. Of those patients who chose ablative therapy, 8 (34.8%) chose IT gentamicin and 15 (65.2%) chose endolymphatic sac surgery. Age, sex, and duration of symptoms were not statistically associated with failed IT dexamethasone therapy (all P > .05). Conclusion: While multiple injections may be required, IT dexamethasone appears to be an effective alternative to ablative therapy in controlling symptoms in the majority of patients and can be used on an as-needed basis when a patient’s symptoms significantly worsen.