Intratympanic Steroids Alleviate Ménière's Disease

A new study suggests that injection of steroids into the ear is effective in the treatment of Meniere's disease, which causes debilitating dizzy spells.

Researchers at Imperial College London (ICL; United Kingdom) and Leicester University Hospitals (United Kingdom) conducted a double-blind comparative effectiveness trial to assess whether intratympanic administration of the corticosteroid methylprednisolone reduces vertigo, compared with the antibiotic gentamicin. In all, 256 patients with Ménière's disease were screened, 60 of who were enrolled and randomly assigned to gentamicin or methylprednisolone.

The primary outcome was vertigo frequency over the final six months of treatment, compared to the six months before the first injection. The results showed that the mean number of vertigo attacks decreased by 87% in the gentamicin group, and decreased by 90% in the methylprednisolone group. The most common adverse event was a minor ear infection; however, the patients who received the steroid injections had better speech discrimination than those who received gentamicin. The study was published on November 16, 2016, in The Lancet.

“Meniere's disease causes disabling attacks of dizziness that in some cases can leave people unable to work. However, at the moment the only treatment we have for severe cases is a so-called 'destructive treatment' that kill cells in the inner ear,” said lead Professor Adolfo Bronstein, MD, of the ICL department of medicine. “Doctors, including ourselves, always assumed steroid injections were less effective than the current treatment, but we were surprised to see they work just as well as gentamicin, but do much less harm.”

Ménière's disease, identified in the early 1800s, is a disorder of the inner ear characterized by episodes of vertigo, tinnitus, hearing loss, and fullness in the ear. Episodes generally last from 20 minutes to a few hours. Symptoms are believed to occur as the result of increased fluid buildup in the labyrinth of the inner ear. There is no cure, and measures to prevent attacks are overall poorly supported by the evidence. A low-salt diet, diuretics, and corticosteroids may be tried.

Related Links:
Imperial College London
Leicester University Hospitals