1 research outputs found
Longitudinal Results With Intratympanic Dexamethasone in the Treatment of Ménière’s Disease
To assess patient satisfaction with vertigo control using
intratympanic (IT) dexamethasone (12 mg/mL) for medically refractory unilateral
Meniere's disease. STUDY DESIGN: Retrospective study. SETTING: Tertiary referral
neurotology clinic. PATIENTS: One hundred twenty-nine subjects diagnosed with
unilateral Meniere'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 Meniere'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