Intratympanic steroid injections for intractable Ménière's disease.
OBJECTIVE
To examine whether intratympanic injection of dexamethasone is effective in controlling vertigo in patients with Ménière's disease who have persistent vertigo despite standard medical treatment, including a low-salt/no-caffeine diet and diuretics.


METHODS
A prospective study.


METHODS
From August 1999 to November 2000, 21 patients with intractable Ménière's disease underwent intratympanic injections of 4 mg/mL dexamethasone over a period of 4 weeks as an office procedure. American Academy of Otolaryngology-Head and Neck Surgery guidelines for the definition and reporting of results in Ménière's disease were used.


RESULTS
Complete relief of vertigo was maintained in 11 of the 21 patients (52%) at 3 months and in 9 of 21 patients (43%) at 6 months. Repeat injections in 5 patients who had initial control of vertigo, but later failed, yielded control in 3 (60%) patients. The complication rate was low: one patient had a 35-decibel pure tone average decrease in hearing during treatment and one patient had a persistent tympanic membrane perforation.


CONCLUSIONS
Intratympanic injections of dexamethasone are a reasonable initial surgical treatment for persistent vertigo in Ménière's disease. The principal benefits are avoidance of systemic administration of steroids, lower cost than endolymphatic sac surgery, and ease of administration as an office procedure. The disadvantages are the need for repeated office visits for injections and the decreasing effectiveness over time.
Barrs
D M
DM
Carolina Ear and Hearing Clinic, Raleigh, North Carolina 27609, USA. barrs@carolinaear.com
Keyser
J S
JS
Stallworth
C
C
McElveen
J T
JT
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001301:Audiometry, Pure-Tone; D001309:Auditory Threshold / Q000187:drug effects; D003907:Dexamethasone / Q000008:administration & dosage*; D004432:Ear, Middle / Q000187:drug effects*; D005260:Female; D006801:Humans; D007267:Injections; D008297:Male; D008575:Meniere Disease / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
D003907:Dexamethasone