steroids

https://link.springer.com/article/10.1007%2Fs00415-020-10011-5

https://www.ncbi.nlm.nih.gov/pubmed/32588183?dopt=Abstract

What is the efficacy of gentamicin on the incidence of vertigo attacks and hearing in patients with Meniere’s disease compared with steroids? A meta-analysis.

J Neurol. 2020 Jun 25;:

Authors: Jiang M, Zhang Z, Zhao C

Abstract

OBJECTIVE: To compare the efficacy of gentamicin and steroids in patients with Meniere’s disease (MD).

METHODS: The study protocol was structured in accordance with the Population, Intervention, Comparison and Outcome (PICO) framework. We used “Endnote” (Thomson ResearchSoft; Stanford, Connecticut, the United States) to retrieve database documents. A systematic literature search of Web of Science and PubMed Database through May 2020 was conducted using specific search terms. Inclusion criteria, exclusion criteria, vertigo improvement, and exact hearing changes were defined. Review Manager 5.3 (Cochrane) was used for data analysis.

RESULTS: A total of 80 articles were searched from Web of Science and 23 articles were searched from PubMed database. After further reviewing the specific points of the inclusion criteria and exclusion criteria, 9 papers were finally selected. Intratympanic gentamicin (ITG) was superior to intratympanic steroid (ITS) in reducing the number of vertigo attacks (odds ratio (OR) 3.08, 95% confidence intervals (CI) [2.05-3.65]), probability (P) < 0.01). As for hearing improvement, we did the analysis twice. With all the studies included, the odds of hearing improvement (by "x") was 0.31 among patients receiving gentamicin compared to those treated by steroids (OR 0.31, 95% CI [0.16-0.61]). But after removing one study with outlying results from the analysis, this effect disappeared. Hearing loss of ITG and ITS was not statistically significant (P = 0.29). CONCLUSIONS: ITG is superior to ITS in reducing the number of vertigo attacks in the treatment of MD (P < 0.01); the impact on hearing is more heterogeneous in the studies. Overall, there was no clear difference between ITG and ITS on hearing improvement and on hearing loss. PMID: 32588183 [PubMed - as supplied by publisher] PubMed:32588183

https://www.sciencedirect.com/science/article/pii/S1672293018300916

https://www.ncbi.nlm.nih.gov/pubmed/31223300?dopt=Abstract

Autoinflammatory characteristics and short-term effects of delivering high-dose steroids to the surface of the intact endolymphatic sac and incus in refractory Ménière’s disease.

J Otol. 2019 Jun;14(2):40-50

Authors: Zou J

Abstract

Objective: To investigate immune-related genetic background in intractable Meniere’s disease (MD) and the immediate results of a novel therapy by delivering steroids to the surface of the intact endolymphatic sac (ES) and incus in a sustainable manner.

Case report and methods: Candidate genes involved in immune regulation were sequenced using a next-generation sequencing method in a patient with intractable MD. Mutations were confirmed using the Sanger sequencing method. The ES was exposed, and gelatin sponge particles were immersed in high-dose methylprednisolone solution and placed onto the surface of ES. “L”-shaped gelatin sponge strips were immersed in dexamethasone solution and served as a guiding device for the steroids by touching the incus and gelatin sponge particles on the surface of the ES. Gelatin sponge particles immersed in dexamethasone solution were placed around the gelatin sponge strips and sealed using fibrin glue.

Results: Autoinflammation in the refractory MD case was indicated by genotype, including novel heterozygous mutations of PRF1, UNC13D, SLC29A3, ITCH, and JAK3, as well as phenotype. The vertigo was fully relieved immediately after operation. Tinnitus and aural fullness were resolved 3 weeks after operation, whereas hearing improved in 2 mon postoperation. No recurrence was noted during the 5-monfollow-up, and the final MRI supported the novel therapeutic hypothesis.

Conclusion: Autoinflammation was involved in a refractory MD. This novel therapy, which involves the delivery of steroids to the surface of the intact ES and incus, is effective in relieving vertigo and tinnitus and improves hearing function of refractory MD.

PMID: 31223300 [PubMed]

PubMed:31223300

Intratympanic gentamicin is superior to intratympanic steroids in reducing the number of vertigo attacks in the treatment of Meniere’s disease

Novel therapy which uses gelatin sponge particles to help deliver high-dose steroids to the inner ear, relieves vertigo, tinnitus, and hearing loss in refractory Ménière’s disease