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Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease.

TitleLongitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease.
Publication TypeJournal Article
Year of Publication2008
AuthorsBoleas-Aguirre MSoledad, Lin FR, Santina CCDella, Minor LB, Carey JP
JournalOtol Neurotol
Volume29
Issue1
Pagination33-8
Date Published2008 Jan
ISSN1531-7129
KeywordsAnti-Bacterial Agents, Anti-Inflammatory Agents, Audiometry, Dexamethasone, Drug Resistance, Follow-Up Studies, Gentamicins, Humans, Injections, Longitudinal Studies, Meniere Disease, Retrospective Studies, Survival Analysis, Treatment Failure, Treatment Outcome, Tympanic Membrane
Abstract

<p><b>OBJECTIVE: </b>To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease.</p><p><b>STUDY DESIGN: </b>Retrospective study.</p><p><b>SETTING: </b>Tertiary referral neurotology clinic.</p><p><b>PATIENTS: </b>One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy.</p><p><b>INTERVENTION: </b>IT dexamethasone injections as needed to control vertigo attacks.</p><p><b>MAIN OUTCOME MEASURE: </b>A Kaplan-Meier time-to-event method was used to determine the rate of "survival," meaning sufficient satisfaction with vertigo control that the subject did not wish to have subsequent ablative treatment. "Failure" was defined as poor control and the choice to proceed to ablative treatment.</p><p><b>RESULTS: </b>Acceptable vertigo control ("survival") was achieved in 117 (91%) of 129 subjects. Vertigo control required only one dexamethasone injection in 48 (37%), 2 injections in 26 (20%), 3 injections in 18 (14%), and 4 injections in 10 (8%). More than 4 injections were needed in 15 subjects (21%). Of 12 failures (9%), 9 occurred within 6 months of the first IT dexamethasone injection. Follow-up data for 2 years were available for 96 subjects. Of these, 87 (91%) had vertigo control with IT dexamethasone, of whom 61 (70)% required no further injections after 2 years, 23 (26%) continued to receive IT dexamethasone injections, and 3 (3%) chose IT gentamicin treatment.</p><p><b>CONCLUSION: </b>IT dexamethasone injection therapy on an as-needed outpatient basis can provide vertigo control that is satisfactory in patients with Ménière's disease. The Kaplan-Meier method addresses the need for an outcome measure suited to repeated treatments and variable lengths of follow-up. However, due to the retrospective nature of this study, the presence of bias caused by loss of subjects from follow-up cannot be ruled out.</p>

DOI10.1097/mao.0b013e31815dbafc
Alternate JournalOtol. Neurotol.
Citation KeyCK37
PubMed ID18199956
PubMed Central IDPMC2937266
Grant ListR01 DC005040-05 / DC / NIDCD NIH HHS / United States
DC005040-05 / DC / NIDCD NIH HHS / United States
R01 DC005040-04 / DC / NIDCD NIH HHS / United States
DC005040-04 / DC / NIDCD NIH HHS / United States
DC005040-06 / DC / NIDCD NIH HHS / United States
R01 DC005040-06 / DC / NIDCD NIH HHS / United States