Intratympanic Steroid Therapy for Advanced Ménière’s Disease: Are There Effects on the Vestibular System?

Introduction: Ménière’s Disease (MD) is associated with rotatory vertigo, unstable levels of hearing, tinnitus, along with vegetative symptoms and postural instability. Progressive hearing loss can be treated in part successfully with Intratympanic Steroid (ITS) (dexamethasone) injection. Aim: To investigate the effects of ITS treatment on vestibular system in MD. Materials and Methods: This retrospective case-control study, was conducted at Semmelweis University, Department of Otolaryngology and Head and Neck Surgery during the period of January 2018 to March 2020.Study involved 120 patients data suffering from advanced MD. Thirty-eight patients suffering from advanced stage of MD received ITS treatment along with 82 patients with advanced MD that were treated with conservative treatment based on international guidelines. The results of vestibular function tests using ultrasound-computer-craniocorpography (US-COMP-CCG) before and after administration of ITS injection were compared, using Mann-Whitney U test and Logistic Regression. To analyse the baseline characteristic of the control and treated groups, Mann-Whitney U test and Chi-square test were applied. Results: Based on the comparison between the baseline characteristic of the control and ITS groups, there was no significant difference detected in case of the US-COMP-CCG parameters, nor was it when the distribution of age groups and gender were contrasted. When the distribution of US-COMP-CCG parameters before and after the steroid treatment were contrasted using boxplots, there was no obvious difference between the parameters, which was also strengthened by the non-significant statistical difference. In case of the parameters of stepping test the same outcome was detected. Comparing the boxplots of the parameters of both tests after the treatment and of the control group, no significant difference was detected. Long-term follow-up data analysis was carried out using Kaplan-Meier curve and Logistic Regression, and there was no statistically significant difference between the treated and nontreated groups {p=0.445; Odds ratio: 1.654 (95% CI: 0.166-0.197)}. Conclusion: Based on US-COMP-CCG, the ITS injection seems to have no impact on the vestibular system, although seems to be efficient in the management of some cases of MD.

Download Full-text

Ménière’s Disease; Pathology of the Vestibular System; Presbyacusis

Ear, Nose and Throat Histopathology ◽

10.1007/978-1-4471-3332-2_9 ◽

1987 ◽

pp. 103-112

Author(s):

L. Michaels

Keyword(s):

Vestibular System ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Ménière's Disease

Download Full-text

Outcomes of Endolymphatic Sac Surgery for Meniere’s Disease with and without Comorbid Migraine

International Journal of Otolaryngology ◽

10.1155/2021/7987851 ◽

2021 ◽

Vol 2021 ◽

pp. 1-7

Author(s):

Norman A. Orabi ◽

Brian M. Kellermeyer ◽

Christopher A. Roberts ◽

Stephen J. Wetmore ◽

Adam M. Cassis

Keyword(s):

Meniere’S Disease ◽

Adult Patients ◽

Menière’S Disease ◽

Endolymphatic Sac ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Psychiatric Comorbidities ◽

Significant Difference ◽

Ménière's Disease

Purpose. To explore outcomes of endolymphatic sac surgery for patients with Meniere’s disease with and without the comorbid condition of migraine. Materials and Methods. A retrospective chart review of adult patients undergoing endolymphatic sac surgery at a single tertiary care center from 1987 to 2019 was performed. All adult patients who failed medical therapy and underwent primary endolymphatic sac surgery were included. The main outcome measures were vertigo control and functional level scale (FLS) score. Patient characteristics, comorbidities, and audiometric outcomes were tracked as well. Results. Patients with Meniere’s disease and migraine had a stronger association with psychiatric comorbidities (64.29% vs. 25.80%, p = 0.01 ), shorter duration of vertigo episodes (143 vs. 393 min, p = 0.02 ), and younger age (36.6 vs. 50.8 yr, p = 0.005 ) at the time of endolymphatic sac surgery. Postoperative pure tone averages and word recognition scores were nearly identical to preoperative baselines. Class A vertigo control (47.92%) was most common, followed by class B vertigo control (31.25%). The FLS score improved from 4.2 to 2.8 ( p < 0.001 ). Both patients with and without migraine had classes A-B vertigo control (66.67% vs. 80.95%) without any statistically significant difference ( p = 0.59 ). Of the patients who required secondary treatment (10.42%), none had migraine. Conclusions. Endolymphatic sac surgery is an effective surgical intervention for Meniere’s disease with and without migraine. Patients with comorbid migraine tend to be younger and present with psychiatric comorbidities.

Download Full-text

Vibration-induced nystagmus in patients with chronic unilateral Meniere's disease

Auditory and Vestibular Research ◽

10.18502/avr.v30i4.7448 ◽

2021 ◽

Author(s):

Elaheh Mosharaf Dehkordi ◽

Moslem Shaabani ◽

Ali Kouhi ◽

Mohsen Vahedi

Keyword(s):

Vestibular Stimulation ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Spontaneous Nystagmus ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Vibratory Stimulation ◽

Menière's Disease ◽

Significant Difference ◽

Ménière's Disease

Background and Aim: Meniere's disease (MD) is one of the inner ear disorders associated with fluctuating hearing loss, vertigo, ear fullness, and tinnitus. Vestibular stimulation delas with the integrity of the peripheral vestibular system and may cause nystagmus due to the functional asymmetry between right and lef peripheral vestibular system. This study aimed to assess the vibration-induced nystagmus (VIN) in patients with chronic unilateral MD and investigate the effectiveness of this test in detecting the affected ear in these patients. Methods: This study was conducted on 29 patients with chronic unilateral MD. For this purpose, spontaneous nystagmus (SN) and VIN at frequencies of 30 Hz and 100 Hz were recorded by videonystagmography test under five recording conditions. The vibratory stimulation was presented to both healthy and affected ears. Collected were analyzed in SPSS v.22 software. Results: Vibratory stimulation compared to the unstimulated condition, revealed a significant difference in eye movements for both healthy and affected ears. Moreover, the difference between VIN and SN in the affected ear was much greater than in the healthy ear. Conclusion: In patients with chronic unilateral MD, 100 Hz vibratory stimulation of the affected ear induces more reliable nystagmus than 30 Hz stimulation and unstimulated condition. The VIN test can be used for the evaluation of the vestibular system function and is a promising technique to detect the MD ear. Keywords: Meniere's disease; spontaneous nystagmus; vibration-induced nystagmus; chronic; definite; vestibular vibrator

Download Full-text

Copulometry Before and After Treatment of Ménière’s Disease with Ganglion Stellatum Blockade

ORL ◽

10.1159/000274057 ◽

1957 ◽

Vol 19 (5) ◽

pp. 343-357

Author(s):

K. van der Vis

Keyword(s):

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Ganglion Stellatum ◽

Before And After ◽

Ménière's Disease

Download Full-text

Effectiveness of intratympanic dexamethasone for the treatment of vertigo attacks in patients with Ménière’s disease compared with betahistine pharmacotherapy

Journal of International Medical Research ◽

10.1177/0300060520985647 ◽

2021 ◽

Vol 49 (4) ◽

pp. 030006052098564

Author(s):

András Molnár ◽

Stefani Maihoub ◽

László Tamás ◽

Ágnes Szirmai

Keyword(s):

Symptomatic Treatment ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Significant Difference ◽

Group A ◽

Ménière's Disease ◽

Group B

Objective This study analyzed the possible effects of intratympanic steroid (ITS) therapy in the symptomatic treatment of vertigo attacks in patients with Ménière’s disease. Methods Thirty-five patients treated with ITS (dexamethasone) plus betahistine (Group A) and 35 patients treated with betahistine alone (Group B) were enrolled in this investigation. Complaints were analyzed using medical records and vertigo diaries. Statistical analysis was conducted using IBM SPSS V24 software. Results Based on the analysis, there were no significant differences in baseline features between the two groups. When the occurrence of vertigo attacks was compared using the Kaplan–Meier method, no significant difference was detected between Groups A and B (odds ratio [OR] = 1.051, 95% confidence interval [CI] = 0.965–1.067; p = 0.972). In addition, no difference in the incidence of vertigo attacks was noted in group A between the periods of treatment with betahistine alone and betahistine plus ITS when the groups were analyzed via logistic regression (OR = 1.07, 95% CI = 0.065–1.467; p = 0.614). Conclusion It can be concluded that the addition of ITS therapy to betahistine did not improve outcomes in patients with Ménière’s disease. Further prospective studies should be conducted to analyze the results in a more detailed manner.

Download Full-text

Streptomycin Treatment for Meniere's Disease

Annals of Otology Rhinology & Laryngology ◽

10.1177/00034894840930s408 ◽

1984 ◽

Vol 93 (4_suppl) ◽

pp. 44-48 ◽

Cited By ~ 25

Author(s):

Herbert Silverstein

Keyword(s):

Vestibular System ◽

Low Dose ◽

Meniere’S Disease ◽

Menière’S Disease ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Outpatient Basis ◽

Menière's Disease ◽

Intratympanic Injection ◽

Ménière's Disease

This paper describes the author's 10-year experience using streptomycin sulfate in the treatment of Meniere's disease in the following: the classical Schuknecht ablation of the vestibular system in bilateral Meniere's disease (eight patients); the classical Schuknecht ablation of the vestibular system in unilateral Meniere's disease in the only hearing ear (five patients); the intratympanic treatment of unilateral Meniere's disease (four patients); and low dose intramuscular outpatient treatment in unilateral Meniere's disease (five patients). The results of bilateral vestibular ablation were similar to those obtained previously by Schuknecht and others: patients developed profound ataxia with a wide-based gait and oscillopsia, which improved rapidly over a period of months; approximately 30% of patients experienced significant improvement in hearing, which usually deteriorated again after several months; and all patients were relieved of vertigo. Patients with unilateral Meniere's disease in the only hearing ear responded similarly, and hearing was preserved in all cases. Intramuscular streptomycin ablation of the vestibular system is strongly recommended in place of surgery in the only hearing ear in Meniere's disease. Controlled intratympanic injection of streptomycin is not successful as yet because of difficulty in controlling the dose. Low dose subototoxic streptomycin treatment on an outpatient basis offers promise for relief of Meniere's attacks, and may improve hearing in some cases without producing the temporary disabling effects of ataxia and oscillopsia. Streptomycin and similar drugs which may reduce endolymph production may eventually be the treatment of choice for Meniere's disease.

Download Full-text

The effect of surgical removal of the extraosseous portion of the endolymphatic sac in patients suffering from Menière's disease

The Journal of Laryngology & Otology ◽

10.1017/s0022215100135637 ◽

1996 ◽

Vol 110 (11) ◽

pp. 1008-1011 ◽

Cited By ~ 16

Author(s):

William P. R. Gibson

Keyword(s):

Meniere’S Disease ◽

Menière’S Disease ◽

Endolymphatic Sac ◽

Meniere's Disease ◽

Ménière’S Disease ◽

Menière's Disease ◽

Drainage Procedure ◽

Significant Difference ◽

Ménière's Disease ◽

Attacks Of Vertigo

AbstractBetween April 1990 and June 1996, the extraosseous portion of endolymphatic sac has been removed from the affected ear in 77 patients suffering from Menière's disease. Removal of the extraosseous part of the endolymphatic sac without any drainage procedure did not increase the frequency or severity of the attacks of vertigo in any patient. The results of 43 patients with unilateral disease who had a follow-up period of two years are presented. Only eight of the patients had more than two recurrent attacks of vertigo lasting over two minutes within the two years after the surgery, and in three of these patients the severity of the attacks was greatly reduced. In 56 per cent of the operated ears, the hearing deteriorated at least 10 dBHL across five audiometric frequencies (250 Hz, 500 Hz. 1 kHz. 2 kHz and 3 kHz). To the author, endolymphatic sac removal appeared to provide better relief from vertigo than a simple drainage procedure with less tendency for recurrence several months or years after the initial surgery. At present, the statistical analysis of the results shows no significant difference between removal of the extraosseous portion of the endolymphatic sac and the ‘so called’ endolymphatic sac drainage procedures.

Download Full-text