Intratympanic steroid treatment for meniere's disease

Recently, doctors have started injecting steroids directly into the middle ear — a procedure called intratympanic treatment. This technique is thought to deliver more of the drug to the ear and to avoid some of the side effects that can come along with oral steroids. The side effects of oral therapy can be mild, like weight gain, mood changes and sleep disruption, or more serious, like high blood pressure and elevated blood sugar. Side effects of injected steroids are usually local, such as ear infection and vertigo. However, up until now, no study had compared the 2 treatments to see whether direct injection worked as well as oral steroids.

A single trial containing 22 patients, with a low risk of bias was included. This trial found that after 24 months, compared with placebo , the use of intratympanic dexamethasone demonstrated a statistically significant improvement in vertigo as defined by a respective improvement in functional level (90% versus 42%), class (82% versus 57%), change in Dizziness Handicap Inventory scores ( versus ) and mean vertigo subjective improvement (90% versus 57%). The treatment regime described by the authors involved daily injections of dexamethasone solution 4 mg/ml for five consecutive days. These results were clinically significant. No complications were reported.

The injections are performed with the patient lying down and using the office microscope. The ear is first cleaned of wax. A small area of the eardrum is numbed with a drop of medication. A small needle and syringe are then used and the needle is passed through the eardrum at the site that is numbed so that the tip is in the ear, near the round window. This is a membrane where drugs are absorbed in to the cochlea. The fluid is injected in to the middle ear and the patient stays lying down for 20-30 minutes during which he does not swallow or sniff. The drug sits against the round window and is absorbed in to the inner ear. The patient then sits up slowly and leaves the office. Patients should not drive for a few hours after this procedure. Water is kept out of the ear until it is confirmed that the tiny hole has healed.

Intratympanic steroid treatment for meniere's disease

intratympanic steroid treatment for meniere's disease

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