Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease.
OBJECTIVE
To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease.


METHODS
Retrospective study.


METHODS
Tertiary referral neurotology clinic.


METHODS
One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy.


METHODS
IT dexamethasone injections as needed to control vertigo attacks.


METHODS
A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment.


RESULTS
Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment.


CONCLUSIONS
IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.
Boleas-Aguirre
Maria Soledad
MS
Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.
Lin
Frank R
FR
Della Santina
Charles C
CC
Minor
Lloyd B
LB
Carey
John P
JP
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D001299:Audiometry; D003907:Dexamethasone / Q000008:administration & dosage* / Q000627:therapeutic use*; D004351:Drug Resistance; D005500:Follow-Up Studies; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D007267:Injections; D008137:Longitudinal Studies; D008575:Meniere Disease / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D014432:Tympanic Membrane
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D005839:Gentamicins; D003907:Dexamethasone