Methylprednisolone Versus Dexamethasone for Control of Vertigo in Patients with Definite Meniere's Disease: A Randomized Clinical Trial

Document Type: Original

Authors

1 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran

2 Otorhinolaryngology Research Center, Tehran University of Medical Sciences, Tehran, Iran.

3 Otorhinolaryngology Research Center, Tehran University of Medical Siences, Tehran, Iran

4 otorhinolaryngology research center, Tehran University of Medical Sciences, Tehran , Iran

Abstract

Introduction:
Definite Meniere's diseaseis associated with two or more definitive periods of vertigo along with hearing loss, plus tinnitus or aural fullness or both. This study aimed to compare the effect of intratympanic dexamethasone and methylprednisolone on the functional-level scale of pure-tone audiometry (PTA), and class outcome measures of vertigo.
 Materials and Methods:
In this clinical study, 69 patients with definite Meniere's disease, referred to the tertiary otolaryngology center, were randomly assigned to two groups: 36 patients were treated with intratympanic dexamethasone (4mg/dl) and 33 patients were treated with intratympanic methylprednisolone (40mg/dl). Each group received three weekly injections. After a follow-up of 1 and 6 months, PTA changes and vertigo control were evaluated.
 Results:
There was no statistically significant difference between the two groups with regard to control of vertigo (P=0.866, P=0.879 for 1 and 6 months post injection, respectively). PTA improvement was statistically significantly higher in the methylprednisolone group (P=0.006).
 Conclusion:
In summary, intratympanic corticosteroid is an effective treatment for Meniere's disease and can prevent other invasive treatments. Intratympanic methylprednisolone can improve hearing level to a greater extent than intratympanic dexamethasone, but the two groups were similarly beneficial in controlling vertigo. However, there was a trend toward a more sustained benefit with methylprednisolone.

Keywords

Main Subjects


1. Crane BT, Minor LB. Peripheral vestibular disorders. In: Flint PW, Haughey BH, Robbins KT, Thomas JR, Niparko JK, Lund VJ, et al. Cummings Otolaryngology- Head and Neck Surgery. 6th edition. Philadelphia, Elsevier Health Sciences; 2015:2553.

2. Casani AP, Piaggi P, Cerchiai N, Seccia V, Franceschini SS, Dallan I. Intratympanic treatment of intractable unilateral Meniere disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngology Head Neck Surg. 2012; 146(3):
430-7.

3. Vlastarakos PV, Iacovou E, Nikolopoulos TP. Is gentamycin delivery via sustained-release vehicles a safe and effective treatment for refractory Meniere's disease? A critical analysis of published interventional studies. Eur Arch Otorhinolaryngol. 2017;  274(3): 1309–15.

4. McRackan TR, Best J, Pearce EC, Bennett ML, Dietrich M, Wanna GB, et al. Intratympanic dexamethasone as a symptomatic treatment for Meniere’s disease. Otolog Neurotol. 2014; 35(9): 1638–40.

5. Lavigne P, Lavigne F, Saliba I. Intratympanic corticosteroids injections: a systematic review of literature. Eur Arch Oto-Rhino-Laryngol. 2016; 273(9): 2271–8.

6. Miller MW, Agrawal Y. Intratympanic therapies for Meniere’s disease. Curr Otorhinolaryngol Rep. 2014; 2(3): 137–43.

7. Albu S, Chirtes F, Trombitas V, Nagy A, Marceanu L, Babighian G, et al. Intratympanic dexamethasone versus high dosage of betahistine in the treatment of intractable unilateral Meniere disease. Am J Otolaryngol. 2015; 36(2): 205–9.

8. Ren H, Yin T, Lu Y, Kong W, Ren J. Intratympanic dexamethasone injections for refractory Meniere' s disease. Int J Clin Exp Med. 2015; 8(4): 6016–23.

9. Atrache Al Attrache N, Krstulovic C, Perez Guillen V, Morera Perez C, Perez Garrigues H. Response Over Time of Vertigo Spells to Intratympanic Dexamethasone Treatment in Meniere's Disease Patients. J Int Adv Otol. 2016; 12(1): 92–7.

10. Weckel A, Marx M, Esteve-Fraysse MJ. Control of vertigo in Meniere's disease by intratympanic dexamethasone. Eur Ann Otorhinolaryngol Head Neck Dis. 2017; S1879-7296(17): 30112-6.

11. Liu B, Leng Y, Zhou R, Liu J, Liu D, Zhang SL, et al. Intratympanic steroids injection is effective for the treatment of drop attacks with Meniere's disease and delayed endolymphatic hydrops: A retrospective study. Medicine (Baltimore).  2016; 95(52): e5767.

12.  Leng Y, Liu B, Zhou R, Liu J, Liu D, Zhang SL, et al. Repeated courses of intratympanic dexamethasone injection are effective for intractable Meniere's disease. Acta Otolaryngol.2017; 137(2): 154–60.

13. Martin-Sanz E, Esteban-Sanchez J, Rodriganez-Riesco L, Sanz-Fernandez R. Transitory effect on endolymphatic hydrops of the intratympanic steroids for Meniere's disease. Laryngoscope. 2015; 125(5): 1183–8.

14. Dabiri Satri S, Gharibi R, Nejadian F, Yazdani N, Hoseinabadi R, Rezazadeh N, et al. Intratympanic Injection of Dexamethasone and Electrocochleo- graphic Data in Cases of Definite One Sided Refractory Meniere's Disease. Iran J Otorhino- laryngol. 2017; 29(92): 121–5.

15. Patel M, Agarwal K, Arshad Q, Hariri M, Rea P, Seemungal BM, et al. Intratympanic methyl- prednisolone versus gentamicin in patients with unilateral Ménière's disease: a randomised, double-blind, comparative effectiveness trial. Lancet.  2016; 388(10061): 2753–62.

16. She W, Lv L, Du X, Li H, Dai Y, Lu L, et al. Long-term effects of intratympanic methylpre- dnisolone perfusion treatment on intractable Ménière's disease. J Laryngol Otol. 2015; 129(03): 232–7.

17. Phillips JS, Westerberg B. Intratympanic steroids for Meniere's disease or syndrome. Cochrane Database Syst Rev. 2011(7): CD008514.

18. Lavigne P, Lavigne F, Saliba I. Intratympanic corticosteroids injections: a systematic review of literature. Eur Arch Otorhinolaryngol. 2016; 273(9): 2271–8.

19. Syed MI, Ilan O, Nassar J, Rutka JA. Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice. Clin Otolaryngol. 2015; 40(6): 682–90.

20. Gabra N, Saliba I. The effect of intratympanic methylprednisolone and gentamicin injection on Ménière’s disease. Otolaryngol Head Neck Surg. 2013:148(4): 642-7.

21. Pullens B, van Benthem PP. Intratympanic gentamicin for Meniere's disease or syndrome. Cochrane Database Syst Rev. 2011(3): CD008234.