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.
Mail survey recording vertigo
frequency in the previous one and six months, further intratympanic treatment received, and validated symptom questionnaires.
Outpatient hospital clinic setting.
Adult patients with definite unilateral refractory Menière's disease
, who previously received intratympanic treatment in a comparative trial.
A survey of trial participants who received intratympanic gentamicin
(40 mg/mL) or methylprednisolone (62.5 mg/mL).
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
, aural fullness, and functional disability.
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.