Intratympanic steroid injections safe and effective for refractory Meniere's disease,finds study

Intratympanic steroid injections (ITSI) have become a promising treatment for refractory Meniere's disease due to less cochleovestibular damage. However, whether ITSI would be a good alternative to intratympanic gentamicin injections (ITGI) for refractory Meniere's disease still remains controversial. With this in mind, researchers intended to compare the therapeutic effect of ITSI and ITGI in patients with Meniere's disease refractory to conservative treatments, in terms of vertigo control and hearing outcomes, via a meta-analysis.

For the study ,using MEDLINE, PubMed, and EMBASE databases, the team calculated pooled odds ratio (OR) estimates of vertigo control rate (i.e., class A according to AAO-HNS guideline) and standardized mean differences (SMD) of spell count, pure tone audiometry (PTA) threshold and speech discrimination score (SDS) with a 95% confidence interval (CI). Furthermore, subgroup analyses were performed according to steroid type (methylprednisolone versus dexamethasone) and follow-up period (>1-year versus <1-year).

Results highlighted some key facts.

• Five studies involving 332 patients with refractory unilateral Meniere's disease were included. In the pooled analysis, those treated with ITGI showed higher ORs than those treated with ITSI in terms of vertigo control rate (OR: 2.39, 95% CI: 0.84–6.79, P = 0.102) and spell counts (SMD: 0.24, 95% CI: −0.12–0.59, P = 0.195), but it did not reach statistical significance.
• However, a substantial amount of heterogeneity (I2 = 71.0%, Q = 13.79, P = 0.008) and publication bias was found, suggesting a significant small-study effect. Additionally, ITSI elicited better hearing outcomes of the mean PTA threshold (SMD: 3.08, 95% CI: −1.18–7.35) and mean SDS (SMD: 11.15, 95% CI: −23.21–0.90) compared with ITGI, although no statistical significance. In subgroup analysis, the difference in vertigo control rate between ITGI and ITSI was not significant, regardless of the follow-up period and steroid type.
• Further, methylprednisolone appeared to be superior to dexamethasone for vertigo control.
• No significant complications from either treatment were reported in the literature.

"The results of this study further refine the recently proposed efficacy of ITSI for the treatment of refractory Meniere's disease,. Collectively, However, the current evidence on efficacy of ITSI for refractory Meniere's disease needs to be further clarified, given the substantial heterogeneity and potential biases."the team concluded.

For full article follow the link: https://doi.org/10.1016/j.amjoto.2021.103086

Source: American Journal of Otolaryngology