Intratympanic steroids for Ménière's disease or syndrome

John S Phillips, Brian Westerberg
Cochrane Database of Systematic Reviews 2011 July 6, (7): CD008514

BACKGROUND: Ménière's disease is a disorder characterised by hearing loss, tinnitus and disabling vertigo. The use of intratympanic steroids to reduce the severity of these symptoms has been gaining popularity.

OBJECTIVES: To assess the effectiveness of intratympanic steroids on the frequency and severity of attacks of vertigo, on chronic symptoms such as tinnitus, imbalance and hearing loss, and on the progression of these symptoms in patients with definite Ménière's disease or syndrome, as defined by the AAO-HNS Committee.

SEARCH STRATEGY: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 13 January 2011.

SELECTION CRITERIA: Randomised controlled trials of intratympanic dexamethasone versus placebo in patients with Ménière's disease.

DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial risk of bias and extracted data. We contacted study authors for further information where possible.

MAIN RESULTS: A single trial containing 22 patients, with a low risk of bias was included. This trial found that after 24 months, compared with placebo, the use of intratympanic dexamethasone demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in functional level (90% versus 42%), class (82% versus 57%), change in Dizziness Handicap Inventory scores (60.4 versus 41.3) and mean vertigo subjective improvement (90% versus 57%). The treatment regime described by the authors involved daily injections of dexamethasone solution 4 mg/ml for five consecutive days. These results were clinically significant. No complications were reported.

AUTHORS' CONCLUSIONS: The results of a single trial provide limited evidence to support the effectiveness of intratympanic steroids in patients with Ménière's disease. This trial demonstrated a statistically and clinically significant improvement of the frequency and severity of vertigo measured 24 months after the treatment was administered. It is important to note that there were a few aspects of the study which we were unable to clarify with the study authors.

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