Intratympanic Dexamethasone in the Treatment of Meniere's Disease: A Comparison of Two Techniques.

Objective: To assess the efficacy and safety of two different intratympanic dexamethasone (IT Dex) injection protocols for intractable unilateral Meniere's disease. Study Design: Prospective case series. Setting: Tertiary neurotology clinic. Patients: One hundred six consecutive adult patients with definite unilateral Meniere's disease who had failed medical management were studied for an average of 1,061 days. None had previous oral steroid, IT steroid, or ablative treatment. Interventions: Two different IT Dex regimes, either a single injection or a series of four injections, that were subsequently repeated as indicated. Main Outcome Measure: Requirement for subsequent ablative therapy in the form of intratympanic gentamicin, vestibular nerve section, or labyrinthectomy. Hearing outcomes were measured using pure-tone average of 0.5, 1, 2, and 3 kHz on standard audiometry. Results: The number of intratympanic dexamethasone injections per patient ranged from 1 to 29 (median = 4). Using the Kaplan-Meier method, predicted survival (patients not requiring ablative therapy) at 2 and 4 years after initial treatment was 83.9 and 79.3%, respectively. The injection series protocol ultimately yielded 5% better survival than the single injection protocol, but this was not statistically significant. Injections did not protect against hearing loss, and the most recent pure-tone averages declined compared with pretreatment values by an average of 8.27 dB (p

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