Intratympanic Steroid Therapy for Advanced Ménière’s Disease: Are There Effects on the Vestibular System?

Abstract

Introduction: Ménière’s Disease (MD) is associated with rotatory vertigo, unstable levels of hearing, tinnitus, along with vegetative symptoms and postural instability. Progressive hearing loss can be treated in part successfully with Intratympanic Steroid (ITS) (dexamethasone) injection. Aim: To investigate the effects of ITS treatment on vestibular system in MD. Materials and Methods: This retrospective case-control study, was conducted at Semmelweis University, Department of Otolaryngology and Head and Neck Surgery during the period of January 2018 to March 2020. Study involved 120 patients data suffering from advanced MD. Thirty-eight patients suffering from advanced stage of MD received ITS treatment along with 82 patients with advanced MD that were treated with conservative treatment based on international guidelines. The results of vestibular function tests using ultrasound-computercraniocorpography (US-COMP-CCG) before and after administration of ITS injection were compared, using MannWhitney U test and Logistic Regression. To analyse the baseline characteristic of the control and treated groups, Mann-Whitney U test and Chi-square test were applied. Results: Based on the comparison between the baseline characteristic of the control and ITS groups, there was no significant difference detected in case of the US-COMP-CCG parameters, nor was it when the distribution of age groups and gender were contrasted. When the distribution of US-COMPCCG parameters before and after the steroid treatment were contrasted using boxplots, there was no obvious difference between the parameters, which was also strengthened by the non-significant statistical difference. In case of the parameters of stepping test the same outcome was detected. Comparing the boxplots of the parameters of both tests after the treatment and of the control group, no significant difference was detected. Long-term follow-up data analysis was carried out using Kaplan-Meier curve and Logistic Regression, and there was no statistically significant difference between the treated and nontreated groups {p=0.445; Odds ratio: 1.654 (95% CI: 0.166- 0.197)}. Conclusion: Based on US-COMP-CCG, the ITS injection seems to have no impact on the vestibular system, although seems to be efficient in the management of some cases of MD.

Keywords

• intratympanic steroid injection
• postural balance
• vestibular function tests
• vertigo