Intratympanic injections of dexamethasone for long-term control of vertigo

To examine whether intratympanic injection of dexamethasone is effective in long-term control of vertigo for patients with Ménière disease whose dietary and diuretic therapy has proved unsuccessful.

Retrospective chart review performed at Carolina Ear and Hearing Clinic, Raleigh, North Carolina.

Thirty-four patients with intractable Meniere disease were given intratympanic injections of corticosteroids using dexamethasone 10 mg/mL for 4 weeks. The control of vertigo was documented in the 2-year period after completion of the course of injections. All patients were continued on a diet and a diuretic during the study period.

Only 24% (8 of 34) of patients had control of vertigo with a single course of injections. Three patients had control of vertigo for 12 months and responded to a repeat series of injections with good control. Five patients who had recurrent vertigo at 6 months or earlier responded to repeat injections, for a total of 16 patients (47%) whose vertigo was controlled with a single course or multiple courses of intratympanic injections of corticosteroids.

Approximately one-half of patients (47%) with intractable Ménière disease achieved control of vertigo with one or more courses of intratympanic injections of corticosteroids. A single course of treatment alone can be expected to produce long-term control of vertigo in only one-fourth (24%) of patients. This study indicates that intratympanic injections of corticosteroids should not be expected to give long-term control of vertigo in patients with Ménière disease. Multiple courses of intratympanic injections of corticosteroids, in conjunction with other treatments, are necessary in most patients with Ménière disease who have intractable vertigo.