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Positive pressure therapy for Ménières disease
Jorge Holmberg1, Martín de Amesti1, Andrés Rosenbaum2
1Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile.
Introduction:
Ménière's disease is a disorder of the inner ear characterized by episodes of spontaneous vertigo, fluctuating hearing loss and tinnitus. Positive pressure therapy has been used to reduce the intensity and frequency of episodes, but it is not clear whether it is actually effective.
Methods:
We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach.
Results And Conclusions:
We identified five systematic reviews including 22 studies overall, of which five were randomized trials. We concluded positive pressure therapy probably leads to slightly worse hearing and makes little or no difference in the intensity of vertigo. In addition, we are uncertain whether positive pressure therapy improves functionality or decreases vertigo attacks as the certainty of the evidence has been assessed as very low.
Insights
Positive pressure therapy for Ménière's disease may slightly worsen hearing and offers no significant benefit for vertigo intensity. Its effectiveness for functionality and reducing vertigo attacks remains uncertain due to very low-certainty evidence.
Area of Science:
- Otolaryngology
- Neurology
- Internal Medicine
Background:
- Ménière's disease involves inner ear issues causing vertigo, hearing loss, and tinnitus.
- Positive pressure therapy is a treatment option, but its efficacy is debated.
Purpose of the Study:
- To evaluate the effectiveness of positive pressure therapy for Ménière's disease.
Main Methods:
- A comprehensive search was conducted in the Epistemonikos database, encompassing multiple health information sources.
- Data from five systematic reviews, including five randomized trials, were analyzed.
- A meta-analysis was performed, and findings were summarized using the GRADE approach.
Main Results:
- Positive pressure therapy appears to slightly impair hearing.
- The therapy showed minimal to no effect on vertigo intensity.
- Evidence regarding improvements in functionality or reduction in vertigo attacks was of very low certainty.
Conclusions:
- Positive pressure therapy is unlikely to be beneficial for Ménière's disease symptoms.
- Further high-quality research is needed to clarify the role of positive pressure therapy.
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