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Comparing Intratympanic to Surgical Management in Refractory Meniere Disease: A Systematic Review Plus Network

Alireza Sharifi1, Hamed Sajjadi2, Kristen K Steenerson2

  • 1Department of Otolaryngology - Head and Neck Surgery, Otorhinolaryngology Research Center, Amir A'lam Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Otology & Neurotology : Official Publication of the American Otological Society, American Neurotology Society [And] European Academy of Otology and Neurotology
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PubMed
Summary

Vestibular nerve section (VNS) offers superior hearing preservation and vertigo control for Meniere disease (MD) compared to intratympanic gentamicin (ITGI). Intratympanic gentamicin showed better vertigo control than other methods but carries ototoxic risks.

Keywords:
CorticosteroidsGentamicinIntratympanicMeniere diseaseNetwork meta-analysisSurgery

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Area of Science:

  • Otolaryngology
  • Neurosurgery
  • Evidence-Based Medicine

Background:

  • Meniere disease (MD) is a chronic inner ear disorder characterized by vertigo, tinnitus, hearing loss, and aural fullness.
  • Refractory MD cases often require interventions beyond medical management, necessitating a comparison of available surgical and intratympanic treatments.

Purpose of the Study:

  • To compare the efficacy of intratympanic gentamicin (ITGI), intratympanic corticosteroids (ITSI), vestibular nerve section (VNS), and endolymphatic sac surgery (ELSS) for managing refractory Meniere disease.
  • To evaluate hearing preservation and vertigo control rates across these interventions.

Main Methods:

  • A systematic review and meta-analysis were conducted following PRISMA guidelines.
  • Included studies compared ITGI, ITSI, VNS, and ELSS using AAO-HNS (1995) criteria for vertigo control and PTA/SDS for hearing outcomes.
  • Searched Embase, PubMed, Web of Science, Medline, Scopus, Google Scholar, and Cochrane Central Register of Control Trials up to April 2025.

Main Results:

  • Vestibular nerve section (VNS) demonstrated significantly better pure-tone average (PTA) and speech discrimination score (SDS) outcomes compared to intratympanic gentamicin (ITGI).
  • Intratympanic gentamicin showed a higher vertigo control rate than endolymphatic sac surgery (ELSS) and intratympanic corticosteroids (ITSI), with the difference against ITSI being statistically significant.
  • No significant differences in hearing or vertigo control were found between ELSS or ITSI and ITGI, nor was VNS statistically superior to ITGI in vertigo control.

Conclusions:

  • Vestibular nerve section (VNS) is the most effective treatment option for refractory Meniere disease, particularly after failure of other therapies.
  • Intratympanic gentamicin (ITGI) is more effective for vertigo control than ELSS and ITSI but requires careful dosing due to potential ototoxicity.