Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice.
BACKGROUND
Meniere's syndrome or disease (MS/D) is typically characterised by episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss. There are multiple options available for treatment with variation in consensus on the best intervention.


OBJECTIVE
To evaluate the evidence on the efficacy of intratympanic therapies [steroids, gentamicin, antivirals and other therapies] on the frequency and severity of vertigo and other symptoms of MS/D.


METHODS
A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders group trials register using various MeSH. The search was restricted to English and human subjects, and the last date of search was December 2014.


METHODS
Randomised controlled trials of intratympanic therapies [steroids, gentamicin antivirals and latanoprost] versus a placebo or another treatment.


RESULTS
We analysed 8 RCT's comparing intratympanic steroids, gentamicin, ganciclovir (antiviral) and latanoprost versus another form of intratympanic treatment or placebo.


CONCLUSIONS
On the basis of 6 RCT's (n = 242), there is evidence to support the effectiveness of intratympanic steroids and gentamicin to control symptoms of vertigo in MS/D albeit with a risk of hearing loss with gentamicin. However, there was no consensus found on doses or treatment protocols. There was no evidence to support the use of other forms of intratympanic therapy (antivirals and latanoprost) in MS/D.
Otology & Skull base surgery, The Royal Infirmary of Edinburgh, Scotland, UK.
M I
MI
Syed
Otology/Neurotology, University Health Network, Toronto, ON, Canada, M5G 2C4.
O
O
Ilan
Otology/Neurotology, University Health Network, Toronto, ON, Canada, M5G 2C4.
J
J
Nassar
Otology/Neurotology, University Health Network, Toronto, ON, Canada, M5G 2C4.
J A
JA
Rutka
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D019317:Evidence-Based Medicine / Q000379:methods*; D005938:Glucocorticoids / Q000008:administration & dosage*; D006309:Hearing / Q000502:physiology*; D006801:Humans; D000069555:Injection, Intratympanic; D008575:Meniere Disease / Q000188:drug therapy* / Q000503:physiopathology; D011187:Posture / Q000502:physiology*; D016032:Randomized Controlled Trials as Topic
D000900:Anti-Bacterial Agents; D005938:Glucocorticoids