Duration of symptom control following intratympanic dexamethasone injections in Meniere's disease

Eur Arch Otorhinolaryngol. 2022 Nov;279(11):5191-5198. doi: 10.1007/s00405-022-07368-w. Epub 2022 Apr 10.

Abstract

Purpose: Intratympanic (IT) injections of corticosteroids have emerged as a non-ablative alternative to gentamicin in the management of refractory Meniere's disease. However, currently, the duration of the symptom control achieved via intratympanic corticosteroids is under reported.

Methods: We retrospectively reviewed the notes of all patients who underwent IT injections of dexamethasone for the treatment of definite Meniere's disease at a single tertiary referral university centre over a 6-year period. We included demographic information, the number of procedures patients required, duration of symptom-control achieved (time interval between repeat IT injections), and the presence of co-morbidities, with a focus on the presence of autoimmune disease.

Results: We identified 27 patients who underwent a total of 42 procedures; 23/27 (85.2%) patients demonstrated clinical response with a median period of symptom control of 14.5 months (range 1-64, IQR 10.25). The median longest asymptomatic period per patient was 19 months (range 11-64, IQR: 18). Interestingly, all patients with autoimmune disease (7/27) demonstrated a clinical response; autoimmune disease was found to be a statistically significant predictor of response to treatment (p = 0.002). In patients who received repeated treatment following disease relapse, there was no difference in duration of symptom-control achieved.

Conclusions: IT steroids can provide an effective alternative to gentamicin ablation. Symptom control is achieved for a median of 14.5 months, and treatment can be repeated with no loss of efficacy. Those patients who have an underlying autoimmune co-morbidity are more likely to demonstrate a clinical response to therapy, which may provide insight into the underlying pathophysiology of Meniere's disease.

Keywords: Corticosteroids; Dizziness; Injection; Meniere’s disease.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Autoimmune Diseases* / drug therapy
  • Dexamethasone
  • Gentamicins
  • Humans
  • Meniere Disease* / complications
  • Meniere Disease* / drug therapy
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Anti-Bacterial Agents
  • Gentamicins
  • Dexamethasone