Steroid injections through the eardrum reduce dizziness in Meniere’s disease, study findsBMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6185 (Published 18 November 2016) Cite this as: BMJ 2016;355:i6185
Injections of the steroid methylprednisolone through the eardrum are as effective as the current standard treatment of gentamicin in reducing dizziness in patients with Meniere’s disease but without the associated risk of hearing loss, a randomised trial has shown.1
Meniere’s disease causes severe attacks of vertigo. It affects around 30 000 people in the UK and usually occurs in people over 40, although the cause is unknown. The current standard treatment is intratympanic injections of gentamicin but this relies on the ototoxic effects of the antibiotic and around 20% of patients are left with permanent hearing loss.
Corticosteroids have been used to treat Meniere’s disease but there have been no trials comparing their efficacy with gentamicin. Researchers carried out a double blind trial, randomly assigning 60 patients with unilateral Meniere’s disease to two intratympanic injections of methylprednisolone or gentamicin, given two weeks apart.
The results, published in the Lancet, showed that patients given methylprednisolone had a similar reduction in vertigo attacks as those given gentamicin.
Patients treated with methylprednisolone showed a 90% reduction in the mean number of attacks they experienced, from 16.4 (standard deviation 12.5) in the six months before treatment to 1.6 (3.4) at 18-24 months after treatment. This compared with an 87% reduction in attacks with gentamicin, from a mean of 19.9 (SD 16.7) to 2.5 (5.8) (mean difference between treatments −0.9, 95% confidence interval −3.4 to 1.6).
Both drugs were well tolerated with no safety concerns.
“Meniere’s disease causes disabling attacks of dizziness that in some cases can leave people unable to work. However, at the moment the only treatment we have for severe cases is a ‘destructive treatment’ that kills cells in the inner ear,” lead author Adolfo Bronstein, from Imperial College, London, said.
“Doctors, including ourselves, have always assumed that steroid injections were less effective than the current treatment, but we were surprised to see that they work just as well but do much less harm,” he said.
The researchers said that patients with refractory unilateral Meniere’s disease now had a choice of two effective treatments. They noted, “Gentamicin is a vestibulotoxic treatment and the loss of vestibular function after injection is expected. If we add to this the small but not negligible risk to hearing posed by gentamicin injections, patients and doctors should weigh carefully individual circumstances and preferences when choosing a drug.”
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