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Intratympanic Steroid for Menière's Disease

A Systematic Review

Devantier, Louise*,†; Djurhuus, Bjarki Ditlev; Hougaard, Dan Dupont§; Händel, Mina Nicole||,¶; Guldfred, Frank Liviu-Adelin#; Schmidt, Jesper Hvass**,††; Edemann-Callesen, Henriette||

doi: 10.1097/MAO.0000000000002255
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Objectives: To investigate the beneficial effects and safety of intratympanic steroid installation compared with placebo in patients with Menière's disease.

Methods: We performed a systematic literature search in MEDLINE and EMBASE for existing systematic reviews and individual randomized controlled trials (RCTs). Studies were included if they investigated the usage intratympanic steroids in patients aged 18 and above, with definite or probable Menière's disease. The quality of the identified existing reviews was assessed using the AMSTAR tool. The risk of bias in RCTs was assessed using the Cochrane Risk of Bias Tool and overall quality of the individual outcomes was evaluated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method.

Results: The literature search provided four systematic reviews, from which one yielded a sufficient AMSTAR evaluation and subsequently provided three RCTs relevant for inclusion. Due to the lack of sufficient reporting of the data, quantitative synthesis was not applicable. In the qualitative synthesis for the primary outcome, the results from the RCTs showed that there was a slight indication of steroid treatment reducing the frequency of vertiginous attacks. No serious adverse events were reported. Based on the GRADE approach the quality for both findings is very low. No studies reported on the secondary outcomes.

Conclusion: The effect of intratympanic steroid treatment in Menière's disease is questionable. There is a great need for further research to sufficiently assess whether steroid treatment may be considered as a safe and effective treatment for patients with Menière's disease.

*Department of Clinical Medicine, Aarhus C

Department of Oto-Rhino-Laryngology, Regional Hospital West Jutland

Department of Ear, Nose, Throat and Maxillofacial Surgery, Zealand University Hospital, Koege

§Department of Otolaryngology, Head & Neck Surgery and Audiology, Aalborg University Hospital, Aalborg

||The Danish Health Authority, Copenhagen

The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark

#Ear, Nose and Throat Clinic, Faxe

**Department of ORL, Head and Neck Surgery and Audiology, Odense University Hospital

††Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark

Address correspondence and reprint requests to Louise Devantier, M.D., Department of Clinical Medicine, Aarhus University, Noerrebrogade 44, Building 10G, 2nd floor 8000 Aarhus C, Denmark; E-mail: louisedevantier@clin.au.dk

The study was initiated and financed by the Danish Health Authority.

The authors disclose no conflicts of interest.

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