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Effects of endolymphatic sac drainage with steroids for intractable Meniere's disease: a long-term follow-up and
Tadashi Kitahara1, Takeshi Kubo, Shin-ichi Okumura
1Department of Otolaryngology, Osaka University, School of Medicine, Osaka, Japan. tkitahara@ent.med.osaka-u.ac.jp
Objective:
Meniere's disease is a common inner ear disease with an incidence of 15 to 50 per 100,000 population. Since Meniere's disease is thought to be triggered by an immune insult to the inner ear, we examined intraendolymphatic sac application of steroids as a new therapeutic strategy for intractable Meniere's disease.
Study Design:
Prospective randomized controlled study.
Methods:
Between 1996 and 2005, we enrolled and assigned 197 intractable Meniere's patients to three groups in a randomized controlled trial: Group I (G-I)- patients who underwent endolymphatic sac drainage and steroid-instillation; Group II (G-II)-those who underwent endolymphatic sac drainage without steroid-instillation; and Group III (G-III)-those who declined endolymphatic sac drainage. Definitive spells and hearing in all three groups were determined for 2 to 7 years after treatment.
Results:
According to the 1995 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) criteria, 2-year results demonstrated that vertigo was completely controlled in 88.0% of patients in G-I (n = 100), 85.1% of patients in G-II (n = 47), and 8.0% in G-III (n = 50). Statistically, G-I = G-II>G-III. Hearing was improved in 49.0% of patients in G-I, 31.9% in G-II, and 6.0% in G-III (G-I>G-II>G-III). Results after 7 years showed that vertigo was completely controlled in 78.8% of patients in G-I, 79.2% in G-II, and 25.0% in G-III (G-I = G-II>G-III). Hearing improved in 36.5% of patients in G-I, 8.3% in G-II, and 0.0% in G-III (G-I>G-II = G-III).
Conclusions:
From non-surgical observation in G-III for at least 7 years after treatment, steroids instilled into endolymphatic sac in G-I patients significantly improved hearing in intractable Meniere's patients, more so than endolymphatic sac drainage without steroids in G-II patients.
Insights
Steroid application into the endolymphatic sac offers significant hearing improvement for Meniere's disease patients. This treatment, combined with drainage, effectively controlled vertigo, demonstrating a promising therapeutic strategy for intractable cases.
Area of Science:
- Otolaryngology
- Neurology
- Immunology
Background:
- Meniere's disease is a common inner ear disorder affecting 15-50 per 100,000 people.
- The condition is thought to stem from immune system involvement in the inner ear.
Purpose of the Study:
- To investigate intraendolymphatic sac steroid application as a novel treatment for intractable Meniere's disease.
- To evaluate the efficacy of steroids in managing vertigo and hearing loss associated with Meniere's disease.
Main Methods:
- A prospective randomized controlled trial involving 197 patients with intractable Meniere's disease.
- Patients were divided into three groups: endolymphatic sac drainage with steroid instillation (G-I), endolymphatic sac drainage without steroids (G-II), and no drainage (G-III).
- Outcomes, including vertigo spells and hearing, were assessed for 2 to 7 years post-treatment.
Main Results:
- After 2 years, vertigo was controlled in 88.0% (G-I), 85.1% (G-II), and 8.0% (G-III).
- Hearing improved in 49.0% (G-I), 31.9% (G-II), and 6.0% (G-III).
- Long-term (7-year) results showed sustained vertigo control in 78.8% (G-I) and 79.2% (G-II), with significant hearing improvement in G-I (36.5%) compared to G-II (8.3%).
Conclusions:
- Intraendolymphatic sac steroid instillation significantly enhances hearing in patients with intractable Meniere's disease.
- Steroid application combined with endolymphatic sac drainage provides superior hearing benefits compared to drainage alone.
- The study supports steroids as a valuable therapeutic option for Meniere's disease, particularly for hearing preservation.
