Intratympanic Therapies for Menière’s Disease

Schuknecht H. Meniere’s disease: a correlation of symptomatology and pathology. Laryngoscope. 1963;73:651–65.

• Casani AP, Cerchiai N, Navari E, Dallan I, Piaggi P, Sellari-Franceschini S. Intratympanic gentamicin for meniere’s disease: short- and long-term follow-up of two regimens of treatment. Otolaryngol Head Neck Surg. 2014;150(5):847–52. This retrospective study compares the previous higher-dose intratympanic gentamicin regimen with a more recently used lower‐dose treatment. High control rates were achieved.

• Quaglieri S, Gatti O, Rebecchi E, Manfrin M, Tinelli C, Mira E, et al. Intratympanic gentamicin treatment “as needed” for meniere’s disease. Long-term analysis using the Kaplan–Meier method. Eur Arch Otorhinolaryngol. 2013;271(6):1443–9. This retrospective study reinforces the notion that patients can be treated with lower doses of intratympanic gentamicin, with repeat doses "as needed" should symptoms persist.

• Wasson J, Upile N, Pfleiderer A. Intratympanic gentamicin treatment for unilateral Ménière’s disease: long-term follow up of a proven regime. J Laryngol Otol. 2013;127(1):20–4. This retrospective review is a follow-up of previously published results. Patients were contacted via telephone to survey ongoing symptom control following a high‐dose intratympanic gentamicin protocol.

• Walther LE, Huelse R, Blättner K, Bloching MB, Blödow A. Dynamic change of VOR and otolith function in intratympanic gentamicin treatment for Ménière’s disease: case report and review of the literature. Case Rep Otolaryngol. 2013;2013:1–5. This case report describes the timecourse of the objective changes (video head impulse test, oVEMP, cVEMP, and bithermal calorics) in the weeks following a single dose of intratympanic getamicin.

• Martin Sanz E, Zschaeck C, Christiane ZL, Gonzalez M, Manuel GJ, Mato T, et al. Control of vertigo after intratympanic corticoid therapy for unilateral Ménière’s disease: a comparison of weekly versus daily fixed protocols. Otol Neurotol. 2013;34(8):1429–33. This retrospective study reports no significant difference in vertigo control following a weekly intratympanic dexamethasone protocol compared to a daily protocol.

• Martin-Sanz E, Luzardo CZ, Riesco LR, Patino TM, Sanz R. The use of electrocochleography to monitor the response of Ménière’s disease patients to intratympanic steroids. Acta Otolaryngol. 2013;133(11):1158–64. This is the first prospective study evaluating the effects of intratympanic steroids (dexamethasone) with electrocochleography. The group also reports vertigo control rates using a weekly dosing regimen.

• 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. This retrospective study compares vertigo control rates in patients receiving either intratympanic gentamicin or methylprednisolone. Significantly better vertigo control is achieved in the gentamicin group.

• Paradis J, Hu A, Parnes LS. Endolymphatic sac surgery versus intratympanic gentamicin for the treatment of intractable Ménière’s disease: a retrospective review with survey. Otol Neurotol. 2013;34(8):1434–7. This retrospective study is the only recent report comparing results of surgical intervention with intratympanic gentamicin for control of vertigo.

• Lambert PR, Nguyen S, Maxwell KS, Tucci DL, Lustig LR, Fletcher M, et al. A randomized, double-blind, placebo-controlled clinical study to assess safety and clinical activity of OTO-104 given as a single intratympanic injection in patients with unilateral Ménière’s disease. Otol Neurotol. 2012;33(7):1257–65. This is the only randomized, double‐blind, placebo‐controlled clinical study reviewed. In addition, the study introduces the use of a novel, longer‐acting steroid preparation.

Monsell E, Balkany T, Gates G. Committee on hearing and equilibrium guidelines for the diagnosis and evaluation of therapy in Menière’s disease. Otolaryngol Head Neck Surg. 1995;113(3):181–5.

Itoh A, Sakata E. Treatment of vestibular disorders. Acta Otolaryngol Suppl. 1991;481:617–23.

Hamid M, Trune D. Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg. 2008;16(5):434–40.

Parnes LS, Sun AH, Freeman DJ. Corticosteroid pharmacokinetics in the inner ear fluids: an animal study followed by clinical application. Laryngoscope. 1999;109(7 Pt 2):1–17.

Trune DR, Kempton JB, Harrison AR, Wobig JL. Glucocorticoid impact on cochlear function and systemic side effects in autoimmune C3.MRL-Faslpr and normal C3H/HeJ mice. Hear Res. 2007;226(1–2):209–17.

Hu A, Parnes LS. Intratympanic steroids for inner ear disorders: a review. Audiol Neurootol. 2009;14(6):373–82.

Garduño-Anaya MA, Couthino De Toledo H, Hinojosa-González R, Pane-Pianese C, Ríos-Castañeda LC. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière’s disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngol Head Neck Surg. 2005;133(2):285–94.

Sennaroglu L, Sennaroglu G, Gursel B, Dini FM. Intratympanic dexamethasone, intratympanic gentamicin, and endolymphatic sac surgery for intractable vertigo in Meniere’s disease. Otolaryngol Head Neck Surg. 2001;125(5):537–43.

Phillips J, Westerberg B. Intratympanic steroids for Ménière’s disease or syndrome. Cochrane Database Syst Rev. 2011;7:CD008514.

Schuknecht H. Ablation therapy in the management of Ménière’s disease. Acta Otolaryngol Suppl. 1957;47(s132):1–42.

Lange G. Gentamicin and other ototoxic antibiotics for the transtympanic treatment of Meniere’s disease. Arch Otorhinolaryngol. 1989;246(5):269–70.

Lyford-Pike S, Vogelheim C, Chu E, Della Santina CC, Carey JP. Gentamicin is primarily localized in vestibular type I hair cells after intratympanic administration. J Assoc Res Otolaryngol. 2007;8(4):497–508.

• Huon L, Fang T, Wang P. Outcomes of intratympanic gentamicin injection to treat Meniere’s disease. Otol Neurotol. 2012;33(5):706–14. This meta‐analysis reviews vertigo control, tinnitus, aural fullness and hearing outcomes following intratympanic gentamicin therapy, with multiple dosing strategies included in the pooled data.

Derebery MJ, Fisher LM, Berliner K, Chung J, Green K. Outcomes of endolymphatic shunt surgery for Ménière’s disease: comparison with intratympanic gentamicin on vertigo control and hearing loss. Otol Neurotol. 2010;31(4):649–55.

• Casani AP, Piaggi P, Cerchiai N, Seccia V, Franceschini SS, Dallan I. Intratympanic treatment of intracts unilateral Meniere disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngol Head Neck Surg. 2012;146(3):430–7. This randomized controlled trial compares results of intratympanic gentamicin with dexamethasone. Significantly higher vertigo control rates were obtained in the gentamicin group.

Chia SH, Gamst AC, Anderson JP, Harris JP. Intratympanic gentamicin therapy for Ménière’s disease: a meta-analysis. Otol Neurotol. 2004;25(4):544–52.

Radtke A, Lempert T, Gresty MA, Brookes GB, Bronstein AM, Neuhauser H. Migraine and Meniere’s disease: is there a link? Neurology. 2002;59(11):1700–4.

Silverstein H, Smouha E, Jones R. Natural history vs. surgery for Meniere's disease. Otolaryngol Head Neck Surg. 1989;100:6–16.

Nguyen KD, Minor LB, Della Santina CC, Carey JP. Time course of repeated intratympanic gentamicin for Ménière’s disease. Laryngoscope. 2009;119(4):792–8.