Intratympanic steroid injections for intractable Meniere's disease

Objective: To examine whether intratympanic injection of dexamethasone is e ffective in controlling vertigo in patients with Meniere's disease who have persistent vertigo despite standard medical treatment, including a low-sal t/no-caffeine diet and diuretics. Study Design: A prospective study. Method s: From August 1999 to November 2000, 21 patients with intractable Meniere' s disease underwent intratympanic injections of 4 mg/mL dexamethasone over a period of 4 weeks as an office procedure. American Academy of Otolaryngol ogy-Head and Neck Surgery guidelines for the definition and reporting of re sults in Meniere's disease were used.(1) Results: Complete relief of vertig o was maintained in 11 of the 21 patients (52%) at 3 months and in 9 of 21 patients (43%) at 6 months. Repeat injections in 5 patients who had initial control of vertigo, but later failed, yielded control in 3 (60%) patients. The complication rate was low: one patient had a 35-decibel pure tone aver age decrease in hearing during treatment and one patient had a persistent t ympanic membrane perforation. Conclusions. Intratympanic injections of dexa methasone are a reasonable initial surgical treatment for persistent vertig o in Meniere's disease. The principal benefits are avoidance of systemic ad ministration of steroids, lower cost than endolymphatic sac surgery, and ea se of administration as an office procedure. The disadvantages are the need for repeated office visits for injections and the decreasing effectiveness over time.