Abstract
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 methods
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CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials.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.
Plain language summary
Intratympanic steroids for Ménière’s disease or syndrome
Ménière’s disease is a disorder of the inner ear which results in a spinning form of dizziness (vertigo), hearing loss and ringing in the ear (tinnitus); this can be very disabling. The cause of Ménière’s disease is unknown. There has been some support in the medical literature for a course of treatment that involves the injection of steroids through the eardrum and into the middle ear to reduce the frequency and severity of these symptoms.
We looked for studies which compared steroid injections in the ear with placebo in patients with Ménière’s disease or syndrome. Only one study satisfied the prespecified inclusion criteria for this review. This study demonstrated a benefit of this treatment for patients with Ménière’s disease; at 24 months the patients in the treatment group had far fewer episodes of vertigo. The results of this review are encouraging, however as it is based solely on the results of a single study, further research is required.
