Ménière’s disease

Ménière’s disease causes patients to suffer vertigo attacks and hearing loss. Current treatments in aggressive cases consist of antibiotic injection, but because of its negative side effects, a new study has shown the efficacy of another treatment.

 

Ménière’s disease is a condition of the inner ear which causes episodes of vertigo and hearing loss. Its cause is not known, but is likely a combination of genetic predisposition, abnormal immune response, improper fluid drainage and/or head trauma. The most concerning parts of the disease are the unexpected bouts of vertigo and hearing loss, which can be disorienting and interrupt an individual’s life, leading to fatigue, stress and anxiety.




In severe cases with frequent vertigo attacks, inner ear injections can be helpful. This involves injecting gentamicin, an ototoxic (toxic to the ear) antibiotic, into the eardrum. This reduces the balancing function of said ear, allowing the other, healthy ear, to handle balancing functions. The treatment effectively reduces vertigo attacks, but the ototoxic nature of the treatment risks permanent hearing loss.

In a new study, Patel et al. investigated the efficacy of using methylprednisolone, a corticosteroid, as an alternative to gentamicin to reduce vertigo. Using a corticosteroid as opposed to an antibiotic is not ototoxic, reducing the likelihood of hearing loss. A double blind study was conducted, recruiting patients aged 18-70 years old with Ménière’s disease, with 2 injections conducted 2 weeks apart. The patients were then followed for 2 years, with assessments at baseline, 1, 2, 6, 12 and 24 months following injection. Patients were assessed via self-reported surveys on vertigo, dizziness and functionality, and audiometry tests. The drugs were measured on their effectiveness in reducing vertigo and maintaining hearing ability.

This study showed similar effects in vertigo reduction between the methylprednisolone and gentamicin. Both showed similar significant reductions in vertigo attacks compared to non-intervening remission rates and audiometry tests did not differentiate between the two treatments, though fewer patients experienced clinically meaningful reductions in hearing ability when treated with the methylprednisolone. Vestibular function was also tested, as though it does not predict clinically relevant symptoms, it is an objective measure of vestibular damage. As expected, the corticosteroid preserved vestibular function while the ototoxic antibiotic damaged the inner ear.

A main strength of the study is the length of assessment, which shows the duration of treatment effectiveness and likelihood of needing repeated injections. A limitation of the study was the lack of a placebo group, but researchers deemed leaving a group untreated for 2 years to be unethical. Nonetheless, the results of the study suggest methylprednisolone injections to be a safe and effective treatment for Ménière’s disease as an alternative to gentamicin. Both treatments are available to clinicians and patients and should be assigned on a case by case basis. For example, gentamicin may require less repeat treatments, though it comes with increased risk of hearing loss, so someone unconcerned with hearing loss living in a remote location may prefer gentamicin injections.

 

Written By: Wesley Tin, BMSc




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