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Published on: February 27, 2018
Intratympanic gentamicin compared with placebo for Ménière's disease
Fernanda de Amesti1, Maria Jesus Santander2, Matias Winter2
1Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Proyecto Epistemonikos, Santiago, Chile.
Introduction:
Ménière's disease is a multifactorial disorder affecting the inner ear, characterized by episodes of spontaneous and recurrent vertigo, fluctuating hearing loss and tinnitus. Intratympanic gentamicin therapy has been used to reduce the intensity and frequency of attacks in intractable Ménière's disease, but it is associated with hearing loss. There is controversy regarding its efficacy and safety.
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 13 systematic reviews that included 80 primary studies overall, of which three correspond to randomized trials. We concluded that intratympanic gentamicin may improve the control of vertigo, and result in little or no difference to tinnitus, but the certainty of the evidence is low. Furthermore, we are uncertain whether intratympanic gentamicin reduces hearing or the frequency of vertigo attacks as the certainty of the evidence has been assessed as very low.
Insights
Intratympanic gentamicin may help control vertigo in Ménière
Area of Science:
- Otolaryngology
- Neurology
- Inner Ear Disorders
Background:
- Ménière's disease involves recurrent vertigo, hearing loss, and tinnitus.
- Intratympanic gentamicin is a treatment for severe Ménière's disease.
- Gentamicin therapy's effectiveness and safety are debated, with potential hearing loss risks.
Purpose of the Study:
- To evaluate the efficacy and safety of intratympanic gentamicin for Ménière's disease.
- To synthesize evidence from systematic reviews and primary studies.
- To assess the certainty of evidence regarding treatment outcomes.
Main Methods:
- Systematic search of the Epistemonikos database, including MEDLINE, EMBASE, and Cochrane.
- Data extraction from systematic reviews and reanalysis of primary studies.
- Meta-analysis and GRADE approach for summarizing findings.
Main Results:
- Included 13 systematic reviews and 80 primary studies.
- Intratympanic gentamicin may improve vertigo control.
- Evidence for effects on tinnitus, hearing loss, and vertigo attack frequency is of low to very low certainty.
Conclusions:
- Intratympanic gentamicin shows potential for vertigo management in Ménière's disease.
- The evidence regarding tinnitus, hearing preservation, and attack frequency reduction is uncertain.
- Further high-quality research is needed to clarify treatment benefits and risks.
