[Intratympanic corticosteroid perfusion in the therapy of Meniere's disease].
2014
Introduction. Over the last two decades the intratympanic perfusion of
corticosteroids has been used as a minimally invasive surgical therapy of
Meniere’s disease. According to experimental studies the antiinflammatory,
immunoprotective, antioxidant and neuroprotective role of the locally
perfused corticosteroids was noticed in the inner ear structures. The
recovery of action potentials in the cells of the Corti organ was confirmed
as well as a decreased expression of aquaporine-1, a glycoprotein responsible
for labyrinth hydrops and N and K ions derangement. Objective. The study
showed results of intratympanic perfusion therapy with dexamethasone in
patients with retractable Meniere’s disease who are resistant to conservative
treatment. Methods. Single doses of 4 mg/ml dexamethasone were given
intratympanically in 19 patients with retractable Meniere’s disease. Six
single successive doses of dexamethasone were administered in the
posteroinferior quadrant of the tympanic membrane. Follow-up of the patients
was conducted by using a clinical questionnaire a month after completed
perfusion series as well as on every third month up to one year. Results. One
month after completed first course of perfusions, in 78% of patients, vertigo
problems completely ceased or were markedly reduced. The recovery of hearing
function was recorded in 68% and marked tinnitus reduction in 84% of
patients. After a year of follow-up, in 63% of patients the reduction of
vertigo persisted, while hearing function was satisfactory in 52%. Tinitus
reduction was present in 73% of patients. Conclusion. Intratympanic perfusion
of dexamethasone in patients with Meniere’s disease is a minimally invasive
therapeutic method that contributes to the reduction of the intensity of
vertigo recurrent attacks, decrease of the intensity of tinnitus and
improvement of the average hearing threshold. Patients with chronic diseases
and Meniere’s disease who are contraindicted for systemic administration of
cortocosteroids (hypertension, diabetes, glaucoma, peptic ulcer, etc.) have
an additional therapeutic option by dexamethasone intratympanic perfusion.
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