Transtympanic steroids for Ménière's disease

To describe the long-term efficacy of transtympanic steroids (TTS) using methyl-prednisolone in the treatment of Ménière's disease (MD).

Descriptive prospective study.

Pure-tone average (PTA) corresponding to the conversational frequencies on the audiogram (0.5, 1, 2, and 3 kHz), visual analog scale on tinnitus annoyance, and number of vertigo spells 24 months after treatment.

Thirty-four MD patients referred to a tertiary center were treated with TTS. All patients were diagnosed as probable or definitive MD (following American Academy of Otolaryngology-Head and Neck Surgery 1995 criteria) and treated by TTS (3 consecutive doses). Data from 32 patients were achieved after 12 months. Forty-eight percent of the patients reduced the PTA in 10 or more decibels, average improvement was 8.6 dB compared with initial PTA (p = 0.004). Tinnitus relief was achieved by 81.5% of the patients. Number of vertigo spells was reduced from 4.3 to 0.3 after 12 months (p = 0.002); 81% of the patients were free of vertigo spells, and 92.6% had 1 or less spells of vertigo. Data from 29 patients were achieved after 24 months. A reduction of PTA in 10 or more decibels was shown by the 33.3% of the sample, and PTA improved in 3.3 dB compared with initial PTA (nonsignificant). Tinnitus relief was achieved in 78% of the patients. Number of vertigo spells was reduced from 4.3 to 0.5 (p = 0.033). Seventy-eight percent of the cases were free of vertigo, and 96% had none or 1 spell. Because of an increase in any of the symptoms, 12 patients (35.2%) required retreatment with 1 or 2 series of TTS (1-3 doses) along the 2-year period. Two patients of the sample (6.25%) required transtympanic gentamicin for vertigo control due to lack of benefit with TTS (14 and 18 mo since TTS).

Transtympanic steroids in this cohort were associated with good preservation of hearing. Tinnitus control is achieved in more than 70% of the patients, and number of vertigo spells can be dramatically reduced in more than 90% of the patients after a 24-month follow-up.