Long-term follow-up of intratympanic methylprednisolone versus gentamicin in patients with unilateral Menière's disease
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
OBJECTIVES: To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and if the two treatments remain nonsignificantly different at long-term follow-up. STUDY DESIGN: Mail survey recording vertigo frequency in the previous one and six months, further intratympanic treatment received, and validated symptom questionnaires. SETTING: Outpatient hospital clinic setting. PATIENTS: Adult patients with definite unilateral refractory Menière's disease, who previously received intratympanic treatment in a comparative trial. INTERVENTION: A survey of trial participants who received intratympanic gentamicin (40 mg/mL) or methylprednisolone (62.5 mg/mL). OUTCOME MEASURES: Primary: number of vertigo attacks in the 6 months prior to receiving this survey compared with the 6 months before the first trial injection. Secondary number of vertigo attacks over the previous 1 month; validated symptom questionnaire scores of tinnitus, dizziness, vertigo, aural fullness, and functional disability. RESULTS: Forty six of the 60 original trial patients (77%) completed the survey, 24 from the gentamicin and 22 from the methylprednisolone group. Average follow-up was 70.8 months (standard deviation 17.0) from the first treatment injection. Vertigo attacks in the 6 months prior to receiving the current survey reduced by 95% compared to baseline in both drug groups (intention-to-treat analysis, both p < 0.001). No significant difference between drugs was found for the primary and secondary outcomes. Eight participants (methylprednisolone = 5 and gentamicin = 3) required further injections for relapse after completing the original trial. CONCLUSION: Intratympanic methylprednisolone treatment provides effective long-lasting relief of vertigo, without the known inner-ear toxicity associated with gentamicin. There are no significant differences between the two treatments at long term follow-up.
Date Issued
2019-04
Date Acceptance
2019-04-01
Citation
Otology and Neurotology, 2019, 40 (4), pp.491-496
ISSN
1531-7129
Publisher
Lippincott, Williams & Wilkins
Start Page
491
End Page
496
Journal / Book Title
Otology and Neurotology
Volume
40
Issue
4
Copyright Statement
© 2019 Lippincott Williams & Wilkins, Inc. This is a non-final version of an article published in final form in Otology & Neurotology: April 2019 - Volume 40 - Issue 4 - p 491–496 https://dx.doi.org/10.1097/MAO.0000000000002108
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/30870364
PII: 00129492-201904000-00018
Subjects
0608 Zoology
1103 Clinical Sciences
Otorhinolaryngology
Publication Status
Published
Coverage Spatial
United States
Date Publish Online
2019-04-01