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Yin G, Zhicheng Li, Zhang S, Wang X, Yang J, Cai H, Zeng X. Analysis of the Efficacy and Safety of Intratymapanic Dexamethasone for Treating Meniere's Disease: A Randomized Controlled Trial. EAR, NOSE & THROAT JOURNAL 2022:1455613221120729. [PMID: 36154509 DOI: 10.1177/01455613221120729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVES Our objective was to study the efficacy and safety of intratymapanic dexamethasone (ITD) for treating in Méniere's disease in southern China. METHODS A total of 124 patients with Méniere's disease were randomly divided into 2 groups: ITD group (n = 62) and intratympanic lidocaine (ITL) group (n = 62). The ITD group was further randomly divided into 2 groups based on dexamethasone dosage: ITD1 (2 mg/ml) (n = 31) and ITD2 (5 mg/ml) group (n = 31). Symptom alleviation and complications were recorded after every treatment. RESULTS Vertigo was improved in 65% of patients who received ITD compared with 55% of patients who received ITL patients (P < .05). Three patients in the ITD2 group had from otomycosis, and 2 of these patients had a perforation; no tympanic membrane perforation was observed in the ITL and ITD1 group. CONCLUSIONS Compared with lidocaine, dexamethasone is more effective in alleviating vertigo, and a lower concentration of dexamethasone can reduce the occurrence of complications.
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Affiliation(s)
- Gendi Yin
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhicheng Li
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shuqi Zhang
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xinyi Wang
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiali Yang
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Hao Cai
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiangli Zeng
- The Department of Otolaryngology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Endoscopic Transcanal Labyrinthectomy for Intractable Meniere's Disease: An Alternative to Transmastoid Labyrinthectomy? Otol Neurotol 2022; 43:113-119. [PMID: 34889845 DOI: 10.1097/mao.0000000000003355] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe a novel approach for intractable Ménière's disease exclusively through a transcanal endoscopic ear surgery (TEES) approach. PATIENT A 56-year-old male with intractable Ménière's disease despite conservative treatment and chemical labyrinthectomy. INTERVENTIONS Transcanal endoscopic labyrinthectomy. MAIN OUTCOME MEASURE Subjective vertigo control, surgical morbidity. RESULTS The TEES approach provided a wide exposure of the oval window. This facilitated removal of stapes crura and footplate. After widening of the oval window, the perilymph was suctioned, and gentamicin was injected through the oval window. The oval window was obliterated using the perichondrium of the tragal cartilage and fibrin glue. After 2 years of follow-up, there was no recurrence of vertigo. CONCLUSIONS As a compelling alternative to the transmastoid approach, we propose endoscopic labyrinthectomy as an option for patients with intractable MD without functional hearing who have failed chemical labyrinthectomy. Additional studies are needed to determine the risk-benefit profile of this technique.
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Comparison of Hearing Preservation Outcomes Using Extended Versus Single-Dose Steroid Therapy in Cochlear Implantation. Otol Neurotol 2021; 41:e449-e457. [PMID: 32176129 DOI: 10.1097/mao.0000000000002570] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The purpose of this study was to compare the hearing preservation outcomes of patients who received extended versus single-dose steroid therapy in cochlear implant surgery. DESIGN Case-control. SETTING Tertiary referral centers in Taiwan from April 2017 to 2019. PARTICIPANTS A total of 70 patients aged 1 to 78 years old (mean = 18.04, standard deviation [SD] = 21.51) who received cochlear implantation via the round window approach were included in the study. Prospectively, 35 cases were enrolled for cochlear implantation with single-dose therapy. Thirty-five controls who underwent cochlear implantation with extended therapy were retrospectively enrolled after frequency matching. OUTCOME MEASURES The main outcome measure was the rate of hearing preservation. This was calculated based on the HEARRING Network formula and results were categorized as complete, partial, and minimal. Impedances served as secondary outcomes. RESULTS There was no significant difference in the complete hearing preservation rates between the extended and single-dose groups at 6 months postoperatively. Impedances were significantly lower in the extended group after 1 month and 6 months of follow up. When the complete and partial hearing preservation groups were compared, the size of round window opening and speed of insertion were found to be statistically significant. CONCLUSIONS Both extended and single-dose therapies result in good hearing preservation in patients who undergo cochlear implantation. However, better impedances can be expected from patients who received extended therapy. A slower speed of insertion and a widely opened round window play a role in hearing preservation.
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The Physiologic Role of Corticosteroids in Menière's Disease: An Update on Glucocorticoid-mediated Pathophysiology and Corticosteroid Inner Ear Distribution. Otol Neurotol 2021; 41:271-276. [PMID: 31821251 DOI: 10.1097/mao.0000000000002467] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
: There are multiple treatment options for Ménière's disease (MD), including dietary modifications, aminoglycoside therapy, and surgery. All have limitations, ranging from limited effectiveness to permanent hearing loss. Corticosteroids have long been used to manage MD due to their relative efficacy and tolerability, but the exact mechanism for disease alleviation is uncertain. Until recently, the precise distribution and role that glucocorticoid receptors play in inner ear diseases have remained largely uninvestigated. Several studies propose they influence mechanisms of fluid regulation through ion and water homeostasis. This review will provide an update on the basic science literature describing the activity of endogenous glucocorticoids and exogenous corticosteroids in the inner ear and the relevance to MD, as well as early clinical trial data pertaining to the application of novel technologies for more effective administration of corticosteroids for the treatment of MD.
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Evaluation of vestibular function following endolymphatic sac surgery. Eur Arch Otorhinolaryngol 2021; 279:1193-1201. [PMID: 33740085 DOI: 10.1007/s00405-021-06743-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/09/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate objective vestibular function after endolymphatic sac surgery (ELSS) for Menière's disease (MD), using comparative vestibular function tests: videonystagmography (VNG), vestibular evoked myogenic potentials (VEMP) and video head-impulse test (VHIT) METHODS: Patients with definite MD using the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) of 1995 criteria modified in 2015 and treated with ELSS (sac decompression or sac opening) were included. The primary outcome was the preservation of vestibular function, comparing pre- and postoperative vestibular function tests: VNG, VEMP, VHIT. Secondary outcomes were control of episodes of vertigo, hearing outcome using AAO-HNS criteria, and QoL using the Menière's disease outcome questionnaire. RESULTS 73 patients were included in the study. We found a significant preservation of vestibular function as measured by VNG and VHIT. There was no statistical difference in the presence or absence of cervical and ocular (P13/N23 and N1/P1) waves on VEMP pre- and postoperatively. 67% of patients had good control of episodes of vertigo post-operatively, with significantly better results in the sac opening group (75%). There was no significant change in hearing postoperatively, and QoL scores were significantly improved after surgery (p < 0.0001). CONCLUSION Endolymphatic sac surgery (ELSS) is a conservative surgical treatment, which does not negatively impact vestibular function. It was associated with improved control of episodes of vertigo, preservation of hearing, and a clear improvement in QoL scores. Despite its pathophysiology not being fully understood, it remains a first-line procedure preserving vestibular function, for MD refractory to medical management.
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Guigou C, Lalande A, Millot N, Belharet K, Bozorg Grayeli A. Use of Super Paramagnetic Iron Oxide Nanoparticles as Drug Carriers in Brain and Ear: State of the Art and Challenges. Brain Sci 2021; 11:358. [PMID: 33799690 PMCID: PMC7998448 DOI: 10.3390/brainsci11030358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 12/16/2022] Open
Abstract
Drug delivery and distribution in the central nervous system (CNS) and the inner ear represent a challenge for the medical and scientific world, especially because of the blood-brain and the blood-perilymph barriers. Solutions are being studied to circumvent or to facilitate drug diffusion across these structures. Using superparamagnetic iron oxide nanoparticles (SPIONs), which can be coated to change their properties and ensure biocompatibility, represents a promising tool as a drug carrier. They can act as nanocarriers and can be driven with precision by magnetic forces. The aim of this study was to systematically review the use of SPIONs in the CNS and the inner ear. A systematic PubMed search between 1999 and 2019 yielded 97 studies. In this review, we describe the applications of the SPIONS, their design, their administration, their pharmacokinetic, their toxicity and the methods used for targeted delivery of drugs into the ear and the CNS.
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Affiliation(s)
- Caroline Guigou
- Department of Otolaryngology-Head and Neck Surgery, Dijon University Hospital, 21000 Dijon, France;
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
| | - Alain Lalande
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
| | - Nadine Millot
- Laboratoire Interdisciplinaire Carnot de Bourgogne, UMR 6303, CNRS, Université Bourgogne Franche-Comté, BP 47870, 21078 Dijon, France;
| | - Karim Belharet
- Laboratoire PRISME, JUNIA Campus Centre, 36000 Châteauroux, France;
| | - Alexis Bozorg Grayeli
- Department of Otolaryngology-Head and Neck Surgery, Dijon University Hospital, 21000 Dijon, France;
- ImVia Laboratory, EA 7535, Université Bourgogne Franche-Comté, 21079 Dijon, France;
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Weckel A, Fraysse MJE, Marx M, Fraysse B, Gallois Y, Chabbert C. Vestibular disorders: clinician ENT perspective on the need for research and innovation. J Neurol 2020; 267:36-44. [PMID: 33048218 DOI: 10.1007/s00415-020-10242-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Vertigo and dizziness are a frequent reason for medical consultation. However, diagnostic and therapeutic management is sometimes limited, and clinicians are faced with many unmet needs. The purpose of this study was to identify and prioritize these needs. METHODS A questionnaire methodology was used to determine the need for innovation in vestibular disorder management. The questionnaire was sent to 19 teams in French-speaking ENT centers. We measured the concordance of the panel of experts on 56 questions related to the different vestibular pathologies encountered and the desired modalities of innovations. RESULTS Thirteen questions were identified as priorities. The needs expressed by the experts had better knowledge of the pathophysiological mechanisms of the main diseases encountered and the development of new treatment modalities. Particular attention was paid to inner ear imaging techniques and the development of specific electrophysiology techniques. DISCUSSION Some of the anticipated innovations are already under development, such as new inner ear fluid imaging techniques (hydrops visualization using MRI) or in situ treatments (transtympanic dexamethasone or gentamicin injections). Others, such as new electrophysiological techniques, are still not fully developed CONCLUSION: This study provides a snapshot of the needs of the medical profession in vestibular disorder management. It highlights a real concern of the attending personnel, as well as a critical need to optimize the means of diagnosing and treating patients with vestibular disorders.
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Affiliation(s)
- A Weckel
- ENT and Neurootology Department, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - M J Esteve Fraysse
- ENT and Neurootology Department, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - M Marx
- ENT and Neurootology Department, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - B Fraysse
- ENT and Neurootology Department, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - Y Gallois
- ENT and Neurootology Department, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - C Chabbert
- Pathophysiology and Therapy of Vestibular Disorders, UMR7260 Sensory and Cognitive Neuroscience, Marseille, France.
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Patel M. Intratympanic corticosteroids in Ménière's disease: A mini-review. J Otol 2017; 12:117-124. [PMID: 29937846 PMCID: PMC5963463 DOI: 10.1016/j.joto.2017.06.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 05/27/2017] [Accepted: 06/01/2017] [Indexed: 02/04/2023] Open
Abstract
This article reviews the effectiveness of intratympanic corticosteroids for vertigo control in Ménière's disease at 2-years follow-up according to the guidelines expressed by the American Academy of Otolaryngology-Head & Neck Surgery. Despite the increased use of intratympanic corticosteroids for vertigo control in Ménière's disease there is debate as to their effectiveness, particularly compared to gentamicin. Even so, after just a single course of injections, corticosteroids can reliably provide complete vertigo control (Class A) at 2-years in about 50% of cases as indicated in a recent double-blind randomized controlled clinical trial (Patel et al., 2016). But the effectiveness of intratympanic corticosteroids truly increases when treatment is provided 'as-needed', whereby complete vertigo control is established in up to 91% of cases. On the basis of available literature, there is good evidence to recommend the use of intratympanic steroid treatment for vertigo control in Ménière's disease, but patients must be monitored for non-response. The rationale for treating patients as-needed and the possible reasons for corticosteroid non-response are discussed.
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Control of vertigo in Ménière's disease by intratympanic dexamethasone. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 135:7-10. [PMID: 28760618 DOI: 10.1016/j.anorl.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The main objective was to assess the efficacy of intratympanic dexamethasone injection in controlling vertigo in unilateral Ménière's disease refractory to medical treatment. MATERIALS AND METHODS A retrospective study included 25 patients with disabling unilateral Ménière's disease, defined according to the American Academy of Otorhinolaryngology-Head and Neck Surgery (AAO-HNS) criteria. Patients received intratympanic dexamethasone during the monitoring period. Control of vertigo was classified according to AAO-HNS vertigo control index, at 6 months, 1 year, and 2 years after treatment initiation. Complications and progression of hearing were also assessed. RESULTS Satisfactory control (class A or B) was obtained in 92% of patients (n=23/25) at 6 months, 68% (n=17/25) at 1 year, and 70% (n=16/23) at 2 years. There was no worsening of hearing in those patients who were well-controlled by this therapeutic strategy. No local or systemic complications were observed during follow-up. CONCLUSION Dexamethasone is part of the management strategy for patients with Ménière's disease refractory to conventional treatment, implemented before destructive treatment. It achieves control of vertigo in 70% of patients at 2 years.
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Leng Y, Liu B, Zhou R, Liu J, Liu D, Zhang SL, Kong WJ. Repeated courses of intratympanic dexamethasone injection are effective for intractable Meniere's disease. Acta Otolaryngol 2017; 137:154-160. [PMID: 27650470 DOI: 10.1080/00016489.2016.1224920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION Intra-tympanic dexamethasone injection (ITD) could serve as a first-line intra-tympanic (IT) treatment for Meniere's disease (MD), regardless of hearing level. Even if the response to initial ITD course was unsatisfactory, a repeated course may be beneficial with some patients. OBJECTIVES This study examined the effect of repeated courses of ITD administered on demand and investigated the possibility of ITD as an initial IT treatment for medically intractable MD patients. METHOD Fifty-one patients who had been diagnosed with definite MD and given course(s) of ITD treatment were included. Vertigo control, pure tone average and functional disability scores were evaluated against the American Academy of Otolaryngology-Head and Neck Surgery guidelines for MD. RESULTS Vertigo disappeared or was substantially controlled in 58.8% and 23.5% of the patients, respectively, after the first ITD course. A repeated course further raised the complete vertigo control rate by 15.7% and intra-tympanic gentamycin injection could be postponed or avoided in 78.6% of the patients who required repeated IT treatment. Hearing was unchanged after the first course of ITD (p > .05). No significant differences were detected in the clinical profiles or laboratory findings between patients receiving single course of ITD and those on multiple courses (p > .05).
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Affiliation(s)
- Yangming Leng
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Bo Liu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Renhong Zhou
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Jingjing Liu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Dongdong Liu
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Su-Lin Zhang
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
| | - Wei-Jia Kong
- Department of Otolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, PR China
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Topf MC, Hsu DW, Adams DR, Zhan T, Pelosi S, Willcox TO, McGettigan B, Fisher KW. Rate of tympanic membrane perforation after intratympanic steroid injection. Am J Otolaryngol 2017; 38:21-25. [PMID: 27751619 DOI: 10.1016/j.amjoto.2016.09.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the rate of persistent tympanic membrane perforation after intratympanic steroid injection. To determine which comorbid conditions and risk factors are associated with prolonged time to perforation closure following intratympanic steroid injection. MATERIALS AND METHODS Clinical data were gathered for patients who had undergone intratympanic steroid injection to treat sudden sensorineural hearing loss or Ménière's disease. Primary outcomes analysis included rate of persistent tympanic membrane perforation, defined as perforation at least 90days following last injection, and time to perforation healing. Age, sex, number of injections, smoking status, diabetes mellitus, previous head and neck irradiation, and concurrent oral steroids, were analyzed as potential predictors of persistent perforation. RESULTS One hundred ninety two patients were included in this study. Three patients (1.6%) had persistent tympanic membrane perforations. All three patients received multiple injections. One patient underwent tympanoplasty for repair of persistent perforation. The median time to perforation healing was 18days. There was no statistically significant variable associated with time to perforation healing. However, patients with prior history of head and neck radiation averaged 36.5days for perforation healing compared to 17.5days with no prior history of radiation and this approached statistical significance (p=0.078). CONCLUSIONS The rate of persistent tympanic membrane perforation following intratympanic steroid injection is low. Patients with a history of radiation to the head and neck may be at increased risk for prolonged time for closure of perforation.
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Effects of two different local anaesthetic methods vs no anaesthesia on pain scores for intratympanic injections. The Journal of Laryngology & Otology 2016; 130:1153-1157. [PMID: 27821219 DOI: 10.1017/s0022215116009336] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study compared the pain associated with the intratympanic injection combined with various local anaesthetics vs without anaesthesia. METHODS The study included 40 patients (aged 18-78 years) who received intratympanic steroid injections for sudden idiopathic hearing loss or tinnitus. Each patient underwent all three injection methods at one-week intervals. Patients received one of two local anaesthetics (lidocaine injection or lidocaine spray) or no anaesthesia before intratympanic injection, and used a visual analogue scale to indicate the pain level after 5 and 45 minutes. RESULTS Five minutes after injection, patients who did not receive anaesthesia and those who received lidocaine spray reported lower pain scores than those who received a lidocaine injection (p < 0.05). There was no difference in pain scores for all three methods at 45 minutes after intratympanic injection. CONCLUSION Neither of the local anaesthetics was found to be superior to having no anaesthesia.
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Albu S, Nagy A, Doros C, Marceanu L, Cozma S, Musat G, Trabalzini F. Treatment of Meniere's disease with intratympanic dexamethazone plus high dosage of betahistine. Am J Otolaryngol 2016; 37:225-30. [PMID: 27178513 DOI: 10.1016/j.amjoto.2015.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 12/07/2015] [Accepted: 12/23/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of the present study was to assess if the combined therapy of intratympanic dexamethasone (ITD) and high dosage of betahistine (HDBH) is able to provide increased vertigo control compared to ITD alone in patients suffering from definite unilateral Meniere's disease (MD). MATERIALS AND METHODS Consecutive MD patients were enrolled and randomly divided in two groups, each comprising 33 cases. Group A received a combination of ITD and identical-appearing placebo pills while Group B received a combination of ITD and HDBH. ITD protocol consisted of three consecutive daily injections. HDBH comprised 144mg/day (48mg tid). The main outcome measures were: 1) vertigo class, pure tone average (PTA), speech discrimination score (SDS) and Functional Level Score (FLS) according to the American Academy of Otolaryngology-Head and Neck Surgery criteria; 2) complete and substantial vertigo control according to the Kaplan-Meier survival method. RESULTS Sixty two patients completed the 24-month follow-up. A complete vertigo control was achieved in 14 patients (44%) from Group A and in 22 patients (73.3%) from Group B, statistically significant (p=0.01). Complete vertigo relief is also significant according to the Kaplan-Meier method: p=0.027, log rank test. Substantial vertigo control was obtained in 21 patients (65.6%) in Group A and 27 patients (90%) in Group B. The difference is statistically significant, p=0.02. The difference is significant according to the Kaplan-Meier method: p=0.035, log rank test. No significant differences between hearing levels and tinnitus scores were demonstrated between the groups. CONCLUSIONS Our preliminary results demonstrate that complete and substantial vertigo control is significantly higher in patients treated with a combination of HDBH and ITD.
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Affiliation(s)
- Silviu Albu
- II-nd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca Cluj-Napoca, Romania; RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania.
| | - Alina Nagy
- RoNeuro Institute for Neurological Research and Diagnostic, Cluj-Napoca, Romania
| | - Caius Doros
- Department of Otolaryngology, Victor Babes University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | | | - Sebastian Cozma
- Department of Otolaryngology, Grigore T. Popa University of Medicine and Pharmacy Iasi, Iasi, Romania
| | - Gabriela Musat
- Department of Otolaryngology, Sf. Maria Hospital Bucuresti, Romania
| | - Franco Trabalzini
- Otology and Skull Base Surgery Unit, Siena University Hospital, Siena, Italy
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Kuthubutheen J, Smith L, Hwang E, Lin V. Preoperative steroids for hearing preservation cochlear implantation: A review. Cochlear Implants Int 2016; 17:63-74. [PMID: 26913646 DOI: 10.1080/14670100.2016.1148319] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.
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Affiliation(s)
- Jafri Kuthubutheen
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada.,b Department of Otolaryngology - Head and Neck Surgery , School of Surgery, University of Western Australia , Perth , Australia
| | - Leah Smith
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Euna Hwang
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
| | - Vincent Lin
- a Department of Otolaryngology - Head and Neck Surgery , University of Toronto, Sunnybrook Health Sciences Centre , Ontario , Canada
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Abstract
OBJECTIVE Determine whether intratympanic (IT) dexamethasone, when given on an as needed basis, can successfully control Ménière's disease (MD) symptoms in a large percentage of patients and allow them to avoid ablative therapies. STUDY DESIGN Retrospective chart review. SETTING Tertiary medical center. PATIENTS One hundred fifty-nine patients met the American Academy of Otolaryngology-Head and Neck Surgery criteria for unilateral definitive MD. All patients failed dietary and medical therapy and received at least one IT dexamethasone treatment by one of 4 otologists in an academic center. INTERVENTION(S) IT dexamethasone. MAIN OUTCOME MEASURE(S) Patients were determined to be treatment failures if they did not achieve satisfactory control of their symptoms with IT dexamethasone and chose another treatment modality. Treatment success was defined as IT dexamethasone providing control of MD symptoms to the degree that they did not require any other further treatment modalities. RESULTS Successful avoidance of ablative surgery was achieved in 81.1% of patients with greater than 24 months of follow-up. No statistically significant associations were found related to age, sex, laterality, or duration of symptoms. For each IT dexamethasone perfusion sequence, there was a 20.0% increase in likelihood of successful treatment (OR, 1.20; 95% CI, 1.01-1.40; p = 0.01). CONCLUSION IT dexamethasone is a successful adjuvant treatment for Ménière's disease in patients on medial therapy and dietary restrictions.
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Kuthubutheen J, Coates H, Rowsell C, Nedzelski J, Chen JM, Lin V. The role of extended preoperative steroids in hearing preservation cochlear implantation. Hear Res 2015; 327:257-64. [PMID: 26117408 DOI: 10.1016/j.heares.2015.06.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 05/03/2015] [Accepted: 06/12/2015] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Steroids have been shown to reduce the hearing threshold shifts associated with cochlear implantation. Previous studies have examined only the administration of steroids just prior to surgery. The aim of this study is to examine the role of extended preoperative systemic steroids in hearing preservation cochlear implantation. METHODS An animal model of cochlear implantation was used. 24 Hartley strain guinea pigs with a mean weight of 768 g and normal hearing were randomised into a control group, a second group receiving a single dose of systemic dexamethasone one day prior to surgery, and a third group receiving a daily dose of systemic dexamethasone for 5 days prior to surgery. A specially designed cochlear implant electrode by Med-EL (Innsbruck) was inserted through a dorsolateral approach to an insertion depth of 5 mm and left in-situ. Auditory brain stem responses at 8 kHz, 16 kHz and 32 kHz were measured preoperatively, and 1 week, 1 month and 2 months postoperatively. Cochlear histopathology was examined at the conclusion of the study. RESULTS At 1-week post operative, both groups receiving dexamethasone prior to implantation had smaller threshold shifts across all frequencies and which was significant at 32 kHz (p < 0.05). There were no differences among the three groups in the area of electrode related fibrosis. Spiral ganglion neuron (SGN) density was significantly higher in the group receiving steroids for 5 days, but only in the basal cochlear turn. DISCUSSION This is study demonstrates the benefits of extended preoperative systemic steroids on hearing outcomes and SGN density in an animal model of cochlear implantation surgery.
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Affiliation(s)
- Jafri Kuthubutheen
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada; School of Surgery, University of Western Australia, Perth, Western Australia, Australia.
| | - Harvey Coates
- School of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Corwyn Rowsell
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Julian Nedzelski
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Joseph M Chen
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
| | - Vincent Lin
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, Ontario, M4N 3M5, Canada
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Intratympanic dexamethasone versus high dosage of betahistine in the treatment of intractable unilateral Meniere disease. Am J Otolaryngol 2015; 36:205-9. [PMID: 25510210 DOI: 10.1016/j.amjoto.2014.10.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/21/2014] [Accepted: 10/25/2014] [Indexed: 11/23/2022]
Abstract
PURPOSE The objective of our randomized, double-blind study was to compare the effectiveness of intratympanic (IT) dexamethasone versus high-dosage of betahistine in the treatment of patients with intractable unilateral Meniere disease (MD). MATERIALS AND METHODS Sixty six patients with definite unilateral MD were randomly divided in two groups: Group A received a combination of IT dexamethasone (DX) and identical-appearing placebo pills while Group B received a combination of high-dosage betahistine and IT saline. Intratympanic injections were repeated for three times with an interlude of 3days. High-dosage of betahistine entailed 144mg/day. Mean outcome measures consisted of vertigo control, pure tone average (PTA), speech discrimination score, Functional Level Score, Dizziness Handicap Inventory and Tinnitus Handicap Inventory. RESULTS Fifty nine patients completed the study and were available at 12months for analysis. In Group A complete vertigo control (class A) was attained in 14 patients (46.6%) and substantial control (class B) in 7 patients (20%). In Group B, 12 patients (41%) achieved complete vertigo control (class A), 5 patients (17%) substantial control (class B). There is no statistical difference in vertigo control between the two treatment groups. In Group A hearing was unchanged in 14 patients and improved in 4 patients, while in Group B hearing was unchanged in 16 patients and improved in 2 patients. CONCLUSIONS Our preliminary results demonstrate that high-dosage of betahistine achieved similar outcomes as IT dexamethasone in the control of vertigo and hearing preservation.
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Martin-Sanz E, Esteban-Sanchez J, Rodrigañez-Riesco L, Sanz-Fernández R. Transitory effect on endolymphatic hydrops of the intratympanic steroids for Ménière's disease. Laryngoscope 2014; 125:1183-8. [PMID: 25429741 DOI: 10.1002/lary.25057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 10/29/2014] [Accepted: 11/03/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the changes in electrocochleography (EcohG) measurements after intratympanic (IT) dexamethasone therapy and to correlate them with the long-term effects on the control of vertigo. STUDY DESIGN Prospective outcomes research. METHODS This study included 62 patients with unilateral Ménière's Disease (MD) refractory to medical therapy for at least 1 year. Each patient was treated with a fixed protocol of three consecutive weekly injections of a commercial 4 mg/mL dexamethasone preparation. The 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria for reporting treatment outcomes for MD were used. Electrocochleography (EcohG) measurements were performed 1 month before and 1 and 12 months after IT steroid therapy. Caloric test and vestibular evoked myogenic potential (VEMPs) were performed before the IT treatment. The summating potential/action potential (SP/AP) ratio was measured before and after the IT treatment. A Kaplan-Meier analysis was used to evaluate the control of vertigo over a 2-year period. RESULTS Complete vertigo control (class A) was achieved in 26 patients (41.9%) at the 12-month follow-up and in 12 patients (19.3%) at the 24-month follow-up. A significant reduction (P < 0.01) in the SP/AP ratio after the IT steroid treatment was observed in the first-month determination, but no significant differences were found when the initial and 12-month determination were compared. CONCLUSIONS IT dexamethasone provides an alternative treatment for patients with Ménière's Disease. A transitory reduction of the endolymphatic hydrops is detected by the EcohG 1 month after treatment. The hydrops levels returned to their initial values in the 1-year EcohG follow-up. LEVEL OF EVIDENCE 2b.
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Control of Vertigo After Intratympanic Corticoid Therapy for Unilateral Ménière’s Disease. Otol Neurotol 2013; 34:1429-33. [DOI: 10.1097/mao.0b013e31828d655f] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabra N, Saliba I. The Effect of Intratympanic Methylprednisolone and Gentamicin Injection on Ménière’s Disease. Otolaryngol Head Neck Surg 2013; 148:642-7. [DOI: 10.1177/0194599812472882] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives To compare the efficacy of intratympanic injections of methylprednisolone (ITMP) and intratympanic injections of gentamicin (ITG) to control the symptoms of Ménière’s disease and to evaluate their effect on hearing level. Study Design A historical cohort study. Setting Tertiary referral center. Subjects and Methods Eighty-nine patients affected by Ménière’s disease were included in this study, of whom 47 were treated with ITG and 42 were treated with ITMP. Two periods of follow-up were considered: 0 to 6 months and 6 to 12 months after the intratympanic injections (ITI). Mean outcome measurements consisted of control of vertigo attacks, tinnitus, and aural fullness; pure-tone average (PTA); and speech discrimination score (SDS). Results The 2 groups had the same number of vertigo spells per month before ITI ( P = .883). Six to 12 months after ITI, 82.9% of the ITG group and 48.1% of the ITMP group achieved complete control of vertigo ( P = .004). There was better control of tinnitus and aural fullness with ITG than with ITMP ( P ≤ .002). The 2 groups had a statistically significant difference in hearing level before ITI ( P ≤ .001). This difference was no longer present 6 to 12 months after ITI ( P > .05). Conclusion Intratympanic injections of gentamicin are more efficient than ITMP in controlling the symptoms of Ménière’s disease. The 2 groups ended up without a difference in hearing level after ITI. According to these findings, administrating ITMP to control Ménière’s disease seems to be less beneficial than ITG.
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Affiliation(s)
- Nathalie Gabra
- Division of Otolaryngology–Head and Neck Surgery, Montreal University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Issam Saliba
- Division of Otolaryngology–Head and Neck Surgery, Montreal University Hospital Center, University of Montreal, Montreal, Quebec, Canada
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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. Otolaryngol Head Neck Surg 2011; 146:430-7. [PMID: 22101095 DOI: 10.1177/0194599811429432] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine the efficacy and safety of low-dose intratympanic gentamicin (ITG) compared with intratympanic dexamethasone (ITD) in patients with intractable unilateral Ménière disease (MD). STUDY DESIGN Open prospective randomized controlled study. SETTING Tertiary referral center. SUBJECTS AND METHODS Sixty patients affected by definite unilateral MD were enrolled between January 1, 2007, and June 30, 2008. Thirty-two patients were treated with a buffered gentamicin solution injected in the middle ear (maximum of 2 injections); 28 patients were treated with ITD (4 mg/mL, 3 injections at intervals of 1 every 3 days). Mean outcome measurements consisted of control of vertigo attacks, pure tone average (PTA), speech discrimination score, functional disability score, and statistical analysis using repeated measures analysis of variance. RESULTS In the ITG group at 2-year follow-up, complete control of vertigo (class A) was achieved in 26 patients (81%) and substantial control of vertigo (class B) in 4 patients (12.5%). In the ITD group, class A was achieved in 12 (43%), and class B in 5 (18%) patients. In the gentamicin group, 4 patients showed a reduction in PTA of ≥10 dB. In the ITD group, PTA was unchanged or slightly improved in 16 patients (belonging to class A-B) and worse in 12. CONCLUSIONS Low-dose ITG achieved better outcome than ITD in the control of vertigo attacks in patients suffering from unilateral MD, with a very low incidence of hearing deterioration. ITD offers poorer vertigo control rate, and hearing preservation is achieved only in cases with no vertigo recurrences.
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Affiliation(s)
- Augusto Pietro Casani
- Department of Neurosciences, Otorhinolaryngology Unit, Pisa University Hospital, Pisa, Italy.
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Strupp M, Brandt T. Current treatment of vestibular, ocular motor disorders and nystagmus. Ther Adv Neurol Disord 2011; 2:223-39. [PMID: 21179531 DOI: 10.1177/1756285609103120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Vertigo and dizziness are among the most common complaints with a lifetime prevalence of about 30%. The various forms of vestibular disorders can be treated with pharmacological therapy, physical therapy, psychotherapeutic measures or, rarely, surgery. In this review, the current pharmacological treatment options for peripheral and central vestibular, cerebellar and ocular motor disorders will be described. They are as follows for peripheral vestibular disorders. In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease a recent study showed long-term high-dose treatment with betahistine has a significant effect on the frequency of the attacks. The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA 2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. However, many other eye movement disorders such as ocular flutter opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA 2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Menière's disease, bilateral vestibular failure, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.
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Affiliation(s)
- Michael Strupp
- Professor of Neurology and Clinical Neurophysiology, University of Munich, Klinikum Grosshadern, Munich, Germany
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Strupp M, Thurtell MJ, Shaikh AG, Brandt T, Zee DS, Leigh RJ. Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus. J Neurol 2011; 258:1207-22. [PMID: 21461686 PMCID: PMC3132281 DOI: 10.1007/s00415-011-5999-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/01/2011] [Accepted: 03/04/2011] [Indexed: 01/28/2023]
Abstract
We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, University of Munich, Munich, Germany
| | - Matthew J. Thurtell
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, IA USA
| | - Aasef G. Shaikh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
| | - Thomas Brandt
- Department of Neurology, University of Munich, Munich, Germany
| | - David S. Zee
- Department of Neurology, John Hopkins Medical Center, Baltimore, MD USA
| | - R. John Leigh
- Neurology Service, Veterans Affairs Medical Center and Case Medical Center, Cleveland, OH USA
- Department of Neurology, University Hospitals, 11100 Euclid Avenue, Cleveland, OH 44106-5040 USA
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Abstract
Vertigo and dizziness are not independent disease entities, but instead symptoms of various diseases. Accordingly, a variety of treatment approaches are required. Here we review the most relevant drugs for managing dizziness, vertigo, and nystagmus syndromes. It is important to differentiate symptomatic treatment of nausea and vomiting with, for example, dimenhydrinate and benzodiazepines, and prophylactic treatment of motion sickness with scopolamine from a causal therapy of the underlying disorders. Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. The clinical entities are briefly described, the various medications are discussed in alphabetical order, and dosage, major side effects, contraindications, and alternative medications of each drug are displayed in boxes for easy reference.
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Affiliation(s)
- Doreen Huppert
- Institute of Clinical Neurosciences, University of Munich, Germany.
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Semaan MT, Megerian CA. Contemporary perspectives on the pathophysiology of Meniere's disease: implications for treatment. Curr Opin Otolaryngol Head Neck Surg 2011; 18:392-8. [PMID: 20639763 DOI: 10.1097/moo.0b013e32833d3164] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Meniere's disease is characterized by episodic vertigo, fluctuating hearing loss, aural fullness and tinnitus. Endolymphatic hydrops, found on post-mortem examination, is the histologic hallmark. Recent research suggests that endolymphatic hydrops results from cytochemical perturbations of unknown etiology that lead to disturbance of the normal endolymphatic fluid homeostasis. This consequent hydropic state or the associated cytochemical perturbations appears to create a neurotoxic environment that ultimately leads to spiral ganglion cell death likely via the apoptotic mechanism. This review highlights some of the recent advances in the understanding of the pathophysiology of endolymphatic hydrops and progressive cochleovestibular deterioration, with emphasis placed on its potential therapeutic implications. RECENT FINDINGS Recent evidence supports that endolymphatic hydrops is possibly an epiphenomenon, and is preceded by perturbation of the normal ionic transport regulatory mechanisms. Furthermore, chronic cochleovestibular deterioration appears to be the result of an excitotoxic response to chronic hydrops. A recently described animal model, the Phex mouse, carrying a mutation in the Phex Hyp-Duk gene, provides a novel insight to genetically regulated postnatal endolymphatic hydrops and a useful tool to expand our understanding. SUMMARY Despite encouraging recent advances, there are considerable challenges that remain in the development of targeted therapeutic interventions that may offer new avenues of neuroprotection in known cases of Meniere's disease. These advances will hopefully provide pharmacotherapeutic interventions aimed at preventing progressive cochleovestibular dysfunction.
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Affiliation(s)
- Maroun T Semaan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Abstract
BACKGROUND The lifelong prevalence of rotatory vertigo is 30%. Despite this high figure, patients with vertigo generally receive either inappropriate or inadequate treatment. However, the majority of vestibular disorders have a benign cause, take a favorable natural course, and respond positively to therapy. OBJECTIVE This review puts special emphasis on the medical rather than the physical, operative, or psychotherapeutic treatments available. METHODS A selected review of recent reports and studies on the medical treatment of peripheral and central vestibular disorders. RESULTS/CONCLUSIONS In vestibular neuritis, recovery of the peripheral vestibular function can be improved by oral corticosteroids; in Menière's disease, there is first evidence that high-dose, long-term administration of betahistine reduces attack frequency; carbamazepine or oxcarbamazepine is the treatment of first choice in vestibular paroxysmia, a disorder mainly caused by neurovascular cross-compression; the potassium channel blocker aminopyridine provides a new therapeutic principle for treatment of downbeat nystagmus, upbeat nystagmus, and episodic ataxia type 2.
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Affiliation(s)
- Thomas Brandt
- Ludwig-Maximilians-University, Institute of Clinical Neuroscience, Marchioninistr. 15, 81377 Munich, Germany.
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Crawley BK, Close A, Canto C, Harris JP. Susac's syndrome: Intratympanic therapy for hearing loss and a review of the literature. Laryngoscope 2009; 119:141-4. [DOI: 10.1002/lary.20040] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lee L, Pensak ML. Contemporary Role of Endolymphatic Mastoid Shunt Surgery in the Era of Transtympanic Perfusion Strategies. Ann Otol Rhinol Laryngol 2008; 117:871-5. [DOI: 10.1177/000348940811701201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Although there exist undisputed methods to permanently silence the aberrant end organ, controversy surrounds the durable efficacy of non-ablative interventions. This study provides a contemporary review of our institution's clinical experience in performing endolymphatic mastoid shunt surgery (EMSS) in patients with medically refractory endolymphatic hydrops, or Meniere's disease. Methods: Between 1984 and 2002, 1,612 patients were referred to our institution with a diagnosis of Meniere's disease. Of these referrals, 1,172 patients met the criteria for Meniere's disease. Although 553 patients responded to medical management, 486 patients underwent EMSS and 133 patients had refractory disease that required chemical or surgical obliterative interventions. The retrospective study utilizes data collected on 226 patients who were followed for a minimum of 5 years. Results: Overall, 78% patients responded favorably to EMSS, according to the functional level scale and class categories delineated by the American Academy of Otolaryngology-Head and Neck Surgery 1995 guidelines for control of vertigo. According to the Arenberg anatomic classification for endolymphatic sac location, EMSS achieved adequate control of vertigo in 86% of type I cases, 90% of type II cases, and 82% of type III cases. Conclusions: Endolymphatic mastoid shunt surgery is a relatively safe, effective procedure for the long-term control of vertigo in patients with medically refractory Meniere's disease.
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Ozer F, Unal OF, Atas A, Tekin O, Sungur A, Ayas K. Evaluation of the effect of dexamethasone in experimentally induced endolymphatic hydrops in guinea pigs. Am J Otolaryngol 2008; 29:88-93. [PMID: 18314018 DOI: 10.1016/j.amjoto.2007.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2006] [Revised: 02/05/2007] [Accepted: 02/21/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to investigate the audiological and histopathologic effects of dexamethasone in the treatment of experimentally induced endolymphatic hydrops. MATERIALS AND METHODS Thirty mature, male guinea pigs weighing 400 +/- 50 g were operated on to induce experimental endolymphatic hydrops in their right ear. Left ear served as control. Subjects were separated into control and dexamethasone groups, with the latter receiving dexamethasone 5 mg/(kg d) intraperitoneally for 10 days. Electrocochleography and auditory brainstem response were applied to all subjects at preoperation, on the second postoperative day and also on the 15th postoperative day in animals that lived for a long time. The histopathologic examination of the inner ear in all animals was done at the end of the study. RESULTS The summating potential and the ratio of the summating potential to the action potential measured on the second postoperative day were found to be increased in both groups, but more significantly in the control one. When the left and right ears were compared, significant difference was found in the control group; however, no significant difference was found between the ears in the dexamethasone group. Histopathologic examination revealed varying degrees of hydrops in the control group, but showed only normal findings or minor changes in the dexamethasone group. CONCLUSIONS Dexamethasone can prevent the audiological and histopathologic findings of experimentally induced endolymphatic hydrops. However, these results must be supported by clinical and experimental studies designed with a large number of subjects.
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Longitudinal results with intratympanic dexamethasone in the treatment of Ménière's disease. Otol Neurotol 2008; 29:33-8. [PMID: 18199956 DOI: 10.1097/mao.0b013e31815dbafc] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess patient satisfaction with vertigo control using intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral Ménière's disease. STUDY DESIGN Retrospective study. SETTING Tertiary referral neurotology clinic. PATIENTS One hundred twenty-nine subjects diagnosed with unilateral Ménière's disease still having vertigo despite medical therapy. INTERVENTION IT dexamethasone injections as needed to control vertigo attacks. MAIN OUTCOME MEASURE 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. RESULTS 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. CONCLUSION 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.
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Abstract
OBJECTIVES/HYPOTHESIS We examined whether sufficient water intake is effective in the long-term control of vertigo and hearing activity in patients with Meniere disease (MD) for whom conventional therapy has proven unsuccessful. STUDY DESIGN The authors conducted a time-series study with historical control. METHODS Eighteen patients with MD in group 1 drank 35 mL/kg per day of water for 2 years. Twenty-nine patients with MD treated with the conventional dietary and diuretic therapy for more than 2 years during 1992 to 1999 at the same hospital were enrolled in a historical control of group 2. RESULTS Patients in group 1 dramatically relieved vertigo and significantly improved in the hearing of the worst pure-tone average of three frequencies (0.125, 0.25, and 0.5 kHz) (low PTA) during the last 6 months of the study period. In contrast, patients in group 2 became worse in both the four- (0.5, 1, 2, and 4 kHz) frequency PTA and the low PTA, although their vertigo did improve. The number of patients whose hearing were improved, unchanged, and worse were 4, 12, and 2 in group 1 and 2, 11, and 16 in group 2, respectively. CONCLUSION Deliberate modulation of the intake of water may be the simplest and most cost-effective medical treatment for patients with MD. Larger studies will be needed to confirm these results in a larger patient cohort.
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Affiliation(s)
- Hideaki Naganuma
- Department of Otorhinolaryngology, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa 228-8555, Japan.
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Strupp M, Brandt T. Pharmacological advances in the treatment of neuro-otological and eye movement disorders. Curr Opin Neurol 2006; 19:33-40. [PMID: 16415675 DOI: 10.1097/01.wco.0000196156.00481.e1] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW First, to describe the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and ocular motor disorders. Second, to identify vestibular and ocular motor disorders in which treatment trials are warranted. RECENT FINDINGS Peripheral vestibular disorders: In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Ménière's disease treatment strategies range from low-salt diet, diuretics, and betahistine, to intratympanic injection of corticosteroids or gentamicin. Unfortunately most of the trials on Ménière's disease do not have an up-to-date design. In bilateral vestibulopathy steroids do not seem to improve vestibular function.Central vestibular, cerebellar, and ocular motor disorders: The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. Many other eye movement disorders, however, such as ocular flutter, opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. SUMMARY Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Ménière's disease, bilateral vestibulopathy, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.
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Abstract
Hearing loss can be caused by acoustic trauma, aging, ototoxic medications, and various other causes. At the cellular level hearing loss seems to be mediated by reactive oxygen species and ultimately through the activation of apoptotic mechanisms. This article explains the cellular and molecular mechanisms of hearing loss and presents medications that could be used in the intratympanic treatment of hearing loss.
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Affiliation(s)
- David M Barrs
- Department of Otolaryngology Head and Neck Surgery/Audiology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
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