Systematic Review of Intratympanic Injection of Gentamicin versus Steroids in the treatment of Intractable Meniere’s Disease

Abstract

Ménière’s disease is an incapacitating disease in which recurrent attacks of vertigo are accompanied by hearing loss, tinnitus and / or aural fullness. The attacks of vertigo may follow each other with intervals of days, weeks or even months. While the attacks are discontinuous, these symptoms are synchronous. Usually, the attacks become less severe and disappear after two to eight years in 60% to 80% of sufferers (Silverstein et al., 1989), with profound lasting hearing loss and tinnitus, although there is great variability in the presentation and natural course of the disease. The disorder is not always easy to diagnose and there is no ’gold standard’ diagnostic test. It is almost certainly over-diagnosed by non-specialists. The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) has produced diagnostic guidelines which have been revised twice (Monsell et al., 1995), but these are not universally accepted. Nevertheless, they provide a standard which can be applied easily to make the diagnosis in normal clinical practice. In brief, these guidelines now stipulate that a definite diagnosis can only be made on the basis of : 1. At least two spontaneous episodes of rotational vertigo lasting at least 20 minutes. 2. Audiometric confirmation of a sensorineural hearing loss. 3. Tinnitus and/or a perception of aural fullness. These criteria exclude most other vestibular conditions, but further investigation is also necessary to exclude other disease processes, such as an acoustic neuroma (Phillips and Westerberg, 2011). The difficulty in the treatment of the patients with disabling Meniere’s disease led many researchers to find alternative therapeutic strategies to the traditional medical or surgical therapy.The most popular of these are intratympanic steroids and intratympanic gentamicin.Oral and intravenous treatment of steroids, although very easy to use, has well-known long-term side effects. Therefore, they must be used with caution and only when there is absolute necessity.This shows the importance of local steroid administration (Sennaroglu et al., 2001).