Intratympanic injections of a steroid are an effective treatment for Ménière’s disease, according to the results of a study recent published in The Lancet.
Researchers from Imperial College London in the United Kingdom compared current treatments for Ménière’s disease. They found that intratympanic administration of the corticosteroid methylprednisolone is as effective as the current “gold standard” treatment of intratympanic gentamicin, but without the side effects associated with the latter. While gentamicin reduces vertigo, it can damage vestibular function and worsen hearing.
In the study, 256 patients with Ménière’s disease were screened between June 2009 and April 2013, 60 of whom were enrolled and randomly assigned: 30 to gentamicin and 30 to methylprednisolone. In all 60 participants, the mean number of vertigo attacks in the final 6 months of the study period when compared with the 6 months before the first injection (primary outcome) decreased by 87% in the gentamicin group and by 90% in the methylprednisolone group.
Additionally, the patients who received the steroid injections had better speech discrimination than those who received gentamicin.
In an accompanying editorial, Steven D. Rauch, MD, with the department of otolaryngology at Massachusetts Eye and Ear Infirmary, Harvard Medical School in Boston, said, “The study offers robust evidence that both of these treatments have substantial efficacy, with each achieving about 90% reduction of vertigo attacks. … The data showed a dramatic drop in vertigo frequency soon after treatment and no reactivation over 24 months of follow-up, which is persuasive evidence of a true treatment effect.”
He added that “The equivalence of outcome of these two treatments has shed no new light on the underlying mechanisms of Ménière’s disease, but will still have important clinical impact. Since we now know that either intratympanic corticosteroid or intratympanic gentamicin can be used to achieve vertigo control, the actual decision of which to use will be based on doctor and patient consideration of auditory and vestibular side-effects, status of the contralateral ear, general health factors, and patient preference.”