Therapeutic Effect of Intratympanic Injection of Dexamethasone plus Hyaluronic Acid on Patients with Meniere's disease

Document Type : Original

Authors

1 Department of Otorhinolaryngology, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

2 Department of Ophthalmology, Isfahan Eye Research Center, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

3 School of Medicine, Isfahan University of Medical Science, Isfahan, Iran.

Abstract

Introduction:
 Intratympanic therapy, as a widely used treatment for inner ear diseases, is regarded as a therapeutic method in controlling the vertigo of the patients with Meniere’s disease. This study was designed to evaluate the effect of the Intratympanic dexamethasone-hyaluronic acid combination on patients suffering from Meniere’s disease.
 
Materials and Methods:
This study was a clinical trial on patients with Meniere’s disease during 2016-2017. Patients received two Intratympanic injections of dexamethasone plus hyaluronic acid as a mixture within a month. Before and 2 weeks after the intervention, pure tone average (PTA) at 0.5, 1, 2, and 4 KHz frequencies, speech discrimination score (SDS), dizziness handicap inventory (DHI), and tinnitus handicap inventory (THI) scores were evaluated for each patient. The obtained scores were statistically analyzed.
 
Results:
This study was conducted on a total number of 25 patients with Meniere's disease. The mean age of participants in this study was 44.71±4.92 years. Gender distribution among participants revealed that 36% of patients were male. The mean values of PTA, SDS, and THI were not significantly different before and after the intervention. However, the mean score of DHI decreased significantly after the intervention (P<0.001).
 
Conclusion:
Intratympanic dexamethasone/hyaluronic acid had a positive effect on the vertigo of the investigated patients without any significant improvement in hearing impairment and tinnitus in the short term.

Keywords

Main Subjects

References

1. Nin F, Hibino H, Doi K, Suzuki T, Hisa Y, Kurachi Y. The endocochlear potential depends on two K+ diffusion potentials and an electrical barrier in the stria vascularis of the inner ear. Proceedings of the National Academy of Sciences. 2008; 105(5):1751-6.
2. Selivanova OA, Gouveris H, Victor A, Amedee RG, Mann W. Intratympanic dexamethasone and hyaluronic acid in patients with low-frequency and Meniere's-associated sudden sensorineural hearing loss. Otology & Neurotology. 2005;26(5):890-5.
3. Sajjadi H, Paparella MM. Meniere's disease. The Lancet. 2008;372(9636):406-14.
4. Alexander TH, Harris JP. Current epidemiology of Meniere's syndrome. Otolaryngologic Clinics of North America. 2010;43(5):965-70.
5. Sharon JD, Trevino C, Schubert MC, Carey JP. Treatment of Meniere’s disease. Current treatment options in neurology. 2015;17(4):14.
6. Nakashima T, Pyykkö I, Arroll MA, Casselbrant ML, Foster CA, Manzoor NF, et al. Meniere's disease. Nature reviews Disease primers. 2016;2: 16028.
7. Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP. Longitudinal results with intratympanic dexamethasone in the treatment of Meniere’s disease. Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology. 2008; 29(1):33.
8. Hu A, Parnes LS. Intratympanic steroids for inner ear disorders: a review. Audiology and Neurotology. 2009;14(6):373-82.
9. Garduño-Anaya MA, De Toledo HC, Hinojosa-González R, Pane-Pianese C, Ríos-Castañeda LC. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Meniere’s disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngology-Head and Neck Surgery. 2005;133 (2):285-94.
10. Bjurström S, Slepecky N, Angelborg C. A histopathological study of the inner ear after the administration of hyaluronan into the middle ear of the guinea pig. Acta Oto-Laryngologica. 1987; 104 (sup442):62-5.
11. Gouveris H, Selivanova O, Mann W. Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of intravenous steroid and vasoactive therapy. European Archives of Oto-Rhino-Laryngology and Head & Neck. 2005; 262(2):131-4.
12. Gouveris H, Schuler-Schmidt W, Mewes T, Mann W. Intratympanic dexamethasone/hyaluronic acid mix as an adjunct to intravenous steroid and vasoactive treatment in patients with severe idiopathic sudden sensorineural hearing loss. Otology & Neurotology. 2011;32(5):756-60.
13. Lopez-Escamez JA, Carey J, Chung W-H, Goebel JA, Magnusson M, Mandala M, et al. Criterios diagnósticos de enfermedad de Menière. Documento de consenso de la Bárány Society, la Japan Society for Equilibrium Research, la European Academy of Otology and Neurotology (EAONO), la American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) y la Korean Balance Society. Acta otorrinolaringologica espanola. 2016;67(1):1-7.
14. Nola G, Mostardini C, Salvi C, Ercolani A, Ralli G. Validity of Italian adaptation of the Dizziness Handicap Inventory (DHI) and evaluation of the quality of life in patients with acute dizziness. Acta Otorhinolaryngologica Italica.  2010;30(4).
15. Bencsik B, Tamás L, Trimmel K, Stauder A. Hungarian adaptation of the Tinnitus Handicap Inventory: reliability and validity. European Archives of Oto-Rhino-Laryngology. 2015; 272(9): 2243-8.
16. Kangasniemi E, Hietikko E. The theory of autoimmunity in Meniere’s disease is lacking evidence. Auris Nasus Larynx. 2018;45(3):399-406.
17. Greco A, Gallo A, Fusconi M, Marinelli C, Macri G, De Vincentiis M. Meniere's disease might be an autoimmune condition? Autoimmunity reviews. 2012;11(10):731-8.
18. Itoh A, Sakata E. Treatment of vestibular disorders. Acta Oto-Laryngologica. 1991; 111 (sup481): 617-23.
19. Shea JJ, Ge X. Dexamethasone perfusion of the labyrinth plus intravenous dexamethasone for Ménière's disease. Otolaryngologic clinics of North America. 1996;29(2):353-8.
20. Silverstein H, Isaacson JE, Olds MJ, Rowan PT, Rosenberg S. Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial. The American journal of otology. 1998; 19(2):196-201.
21. Trune DR, Beth Kempton J, Kessi M. Aldosterone (Mineralocorticoid) Equivalent to Prednisolone (Glucocorticoid) in Reversing Hearing Loss in MRL/MpJ‐Faslpr Autoimmune Mice. The Laryngoscope. 2000;110(11):1902-6.
22. Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. The Laryngoscope. 1999;109(S91): 1-17.
23. Silverstein H, Choo D, Rosenberg S, Kuhn J, Seidman M, Stein I. Intratympanic steroid treatment of inner ear disease and tinnitus (preliminary report). Ear, nose, & throat journal. 1996;75(8):468-71.
24. Arriaga MA, Goldman S. Hearing results of intratympanic steroid treatment of endolymphatic hydrops. The Laryngoscope. 1998;108(11):1682-5.
25. Memari F, Hassannia F. Effect of Intratympanic Dexamethasone on Controlling Tinnitus and Hearing loss in Meniere's Disease [corrected]. Iranian journal of otorhinolaryngology. 2014;26(76):129-33.
26. Masoumi E, Dabiri S, Ashtiani MTK, Erfanian R, Sohrabpour S, Yazdani N, et al. Methylprednisolone versus Dexamethasone for Control of Vertigo in Patients with Definite Meniere's disease. Iranian journal of otorhinolaryngology. 2017;29(95):341.
27. Dabiri SS, Gharibi R, Nejadian F, Yazdani N, Hoseinabadi R, Rezazadeh N, et al. Intratympanic Injection of Dexamethasone and Electrocochleographic Data in Cases of Definite One Sided Refractory Meniere's Disease. Iranian journal of otorhinolaryngology. 2017;29(92):121-5.
Iranian Journal of Otorhinolaryngology
Volume 31, Issue 4 - Serial Number 105
July and August 2019
Pages 217-223

Files

Share

How to cite

Statistics