Differences in responsiveness of intratympanic steroid injection for intractable vertigo in Meniere's disease.

Abstract

OBJECTIVES:

The efficacy of intratympanic steroid (ITS) injection for intractable Meniere's disease has been reported; however, its differences in responsiveness are not fully understood. This study investigated the clinical characteristics of patients who responded to ITS injection treatment.

METHODS:

This retrospective study included 32 patients with Meniere's disease who were unable to control frequent vertigo attacks despite conservative treatment for at least 3 months. They received an intratympanic injection of dexamethasone (3.3 mg/mL) in the affected side at least three times. We measured hearing threshold, subjective symptom scores, cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP), and performed glycerol and bithermal caloric tests.

RESULTS:

Satisfactory control of vertigo for 1 year after the first round of injection was found in 18 patients (56.3%; the response group). However, the injections failed to control vertigo in the other 14 patients (43.8%; the non-response group), and they were then treated with middle ear micropressure therapy. The response group showed improvement in low-frequency hearing, whereas hearing acuity did not change in the non-response group. Significantly reduced amplitude of cVEMP on the affected side was found in 62.5% of patients in the response group; however, no patients in the non-response group showed reduced amplitude of cVEMP.

CONCLUSIONS:

ITS injection significantly improved the subjective symptoms for intractable Meniere's disease; however, the long-term effects were heterogeneous. Our results suggest that reduced amplitude in cVEMP is associated with the effectiveness of ITS injection treatment.

• Authors: Hiroshi Okuda, Mitsuhiro Aoki, Bakushi Ogawa, Hirofumi Shibata, Natsuko Ueda, Toshimitsu Ohashi, Hisamitsu Hayashi, Takezumi Nishihori, Bunya Kuze, Takenori Ogawa
• Journal: American journal of otolaryngology (Am J Otolaryngol) 2021 Nov-Dec Vol. 42 Issue 6 Pg. 103141 ISSN: 1532-818X [Electronic] United States
• PMID: 34171697 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Elsevier Inc. All rights reserved.

Chemical References

• Dexamethasone

Topics

• Adult
• Aged
• Aged, 80 and over
• Caloric Tests (methods)
• Dexamethasone (administration & dosage)
• Female
• Humans
• Injection, Intratympanic
• Male
• Meniere Disease (complications, diagnosis, physiopathology)
• Middle Aged
• Treatment Outcome
• Vertigo (diagnosis, drug therapy, etiology, physiopathology)
• Vestibular Evoked Myogenic Potentials