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Long-Term Follow-Up of Intratympanic Methylprednisolone Versus Gentamicin in Patients With Unilateral Menière's Disease

Harcourt, Jonny Philip*; Lambert, Aileen*; Wong, Phui Yee*; Patel, Mitesh; Agarwal, Kiran; Golding, John Foster†,‡; Bronstein, Adolfo Miguel

doi: 10.1097/MAO.0000000000002108
VESTIBULAR DISORDERS
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Objectives: To determine whether long term (>48 months) symptomatic vertigo control is sustained in patients with Menière's disease from a previous comparative trial of intratympanic methylprednisolone versus gentamicin, and if the two treatments remain nonsignificantly different at long-term follow-up.

Study Design: Mail survey recording vertigo frequency in the previous one and six months, further intratympanic treatment received, and validated symptom questionnaires.

Setting: Outpatient hospital clinic setting.

Patients: Adult patients with definite unilateral refractory Menière's disease, who previously received intratympanic treatment in a comparative trial.

Intervention: A survey of trial participants who received intratympanic gentamicin (40 mg/mL) or methylprednisolone (62.5 mg/mL).

Outcome measures: Primary: number of vertigo attacks in the 6 months prior to receiving this survey compared with the 6 months before the first trial injection. Secondary number of vertigo attacks over the previous 1 month; validated symptom questionnaire scores of tinnitus, dizziness, vertigo, aural fullness, and functional disability.

Results: Forty six of the 60 original trial patients (77%) completed the survey, 24 from the gentamicin and 22 from the methylprednisolone group. Average follow-up was 70.8 months (standard deviation 17.0) from the first treatment injection. Vertigo attacks in the 6 months prior to receiving the current survey reduced by 95% compared to baseline in both drug groups (intention-to-treat analysis, both p < 0.001). No significant difference between drugs was found for the primary and secondary outcomes. Eight participants (methylprednisolone = 5 and gentamicin = 3) required further injections for relapse after completing the original trial.

Conclusion: Intratympanic methylprednisolone treatment provides effective long-lasting relief of vertigo, without the known inner-ear toxicity associated with gentamicin. There are no significant differences between the two treatments at long term follow-up.

*Ear, Nose and Throat Department

Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital

Department of Psychology, University of Westminster, London, UK

Address correspondence and reprint requests to Adolfo Miguel Bronstein, F.R.C.P., Neuro-otology Unit, Division of Brain Sciences, Imperial College London, Charing Cross Hospital, London W6 8RF, UK; E-mail: a.bronstein@imperial.ac.uk

The original trial was funded by the Ménière Society (UK), and supported by the Biomedical Research Centre at Imperial College London and Imperial NHS.

This follow-up study was supported by the Biomedical Research Centre at Imperial College and Imperial NHS.

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company