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Interventions for Menière's disease: an umbrella systematic review
Babette Fiebke van Esch1,2, Hester van der Zaag-Loonen3, Tjasse Bruintjes3
1Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands B.F.van_Esch@lumc.nl.
Objectives:
To systematically review the efficacy of interventions for Menière's disease (MD) to report clinical implications of the results and to identify areas for future valuable research.
Methods:
In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Abstracts (PRISMA-A) guideline, a systematic online database search was conducted in which MEDLINE (PubMed), Embase (Ovid) and CENTRAL (Cochrane Library) were searched until May 2021 in order to search for the efficacy of treatment was analysed in a systematic review. Systematic reviews (SRs) on treatments for MD were screened for eligible interventions. From these SRs, we included placebo randomised controlled trials (RCTs). A separate search was conducted to identify RCTs on treatment modalities that were systematically reviewed yet published after the conduction of these SRs. The primary outcome was control of vertigo as defined by the American guideline as published in 1995. The PRISMA-A and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise and evaluate the certainty of evidence.
Results:
We found five SRs from which 19 RCTs were extracted. Five RCTs were added by the separate search resulting in a total of 25 RCTs (n=1248) which evaluated the efficacy of betahistine dihydrochloride, intratympanic injections with gentamicin or steroids, endolymphatic sac surgery and pressure pulse therapy. Evidence on the efficacy of interventions for patients with MD is generally of low certainty. Betahistine (48 mg per day and 144 mg per day) and positive pressure therapy probably do not reduce MD symptoms when compared with placebo. Intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in MD when compared with placebo.
Conclusions:
A definite effective and well-tolerated therapy for MD has yet to be discovered and information on the natural course of disease is one of the biggest flaws in current research.
Prospero Registration Number:
CRD4201502424.
Insights
Current Meniere's disease treatments like betahistine and pressure therapy show limited efficacy. While some injections and surgery may help, definitive effective therapies for Meniere's disease are still needed.
Area of Science:
- Otolaryngology
- Neurology
- Clinical Trials
Background:
- Meniere's disease (MD) is a chronic inner ear disorder characterized by vertigo, tinnitus, and hearing loss.
- Effective and well-tolerated treatments for MD remain a significant clinical challenge.
Purpose of the Study:
- To systematically review the efficacy of various interventions for Meniere's disease.
- To provide clinical implications and identify research gaps for MD treatments.
Main Methods:
- A systematic review of randomized controlled trials (RCTs) was conducted using PRISMA-A guidelines.
- Searches included MEDLINE, Embase, and CENTRAL databases up to May 2021, supplemented by a separate RCT search.
- The primary outcome was vertigo control; evidence certainty was assessed using the GRADE approach.
Main Results:
- Twenty-five RCTs (n=1248) evaluated betahistine, intratympanic gentamicin/steroids, endolymphatic sac surgery, and pressure pulse therapy.
- Evidence for most MD interventions is of low certainty.
- Betahistine and pressure pulse therapy likely show no significant benefit over placebo; intratympanic injections and surgery may offer symptom reduction.
Conclusions:
- No definitive, well-tolerated therapy for Meniere's disease has been established.
- A lack of data on the natural disease course is a major limitation in current MD research.
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