Transitory effect on endolymphatic hydrops of the intratympanic steroids for Ménière's disease.

Abstract

OBJECTIVES/HYPOTHESIS:

This study aimed to evaluate the changes in electrocochleography (EcohG) measurements after intratympanic (IT) dexamethasone therapy and to correlate them with the long-term effects on the control of vertigo.

STUDY DESIGN:

Prospective outcomes research.

METHODS:

This study included 62 patients with unilateral Ménière's Disease (MD) refractory to medical therapy for at least 1 year. Each patient was treated with a fixed protocol of three consecutive weekly injections of a commercial 4 mg/mL dexamethasone preparation. The 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria for reporting treatment outcomes for MD were used. Electrocochleography (EcohG) measurements were performed 1 month before and 1 and 12 months after IT steroid therapy. Caloric test and vestibular evoked myogenic potential (VEMPs) were performed before the IT treatment. The summating potential/action potential (SP/AP) ratio was measured before and after the IT treatment. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period.

RESULTS:

Complete vertigo control (class A) was achieved in 26 patients (41.9%) at the 12-month follow-up and in 12 patients (19.3%) at the 24-month follow-up. A significant reduction (P < 0.01) in the SP/AP ratio after the IT steroid treatment was observed in the first-month determination, but no significant differences were found when the initial and 12-month determination were compared.

CONCLUSIONS:

IT dexamethasone provides an alternative treatment for patients with Ménière's Disease. A transitory reduction of the endolymphatic hydrops is detected by the EcohG 1 month after treatment. The hydrops levels returned to their initial values in the 1-year EcohG follow-up.

LEVEL OF EVIDENCE:

2b.

• Authors: Eduardo Martin-Sanz, Jonathan Esteban-Sanchez, Laura Rodrigañez-Riesco, Ricardo Sanz-Fernández
• Journal: The Laryngoscope (Laryngoscope) Vol. 125 Issue 5 Pg. 1183-8 (May 2015) ISSN: 1531-4995 [Electronic] United States
• PMID: 25429741 (Publication Type: Journal Article)
• Copyright: © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Chemical References

• Glucocorticoids
• Dexamethasone

Topics

• Audiometry, Evoked Response
• Dexamethasone (administration & dosage)
• Ear, Middle
• Endolymphatic Hydrops (drug therapy)
• Female
• Follow-Up Studies
• Glucocorticoids (administration & dosage)
• Humans
• Male
• Meniere Disease (drug therapy)
• Middle Aged
• Prospective Studies
• Time Factors
• Treatment Outcome