Kilpatrick J K, Sismanis A, Spencer R F, Wise C M
Department of Otolaryngology-Head and Neck Surgrey, Medical College of Virginia of Virginia of Commononwealth University, Richmond, USA.
Ear Nose Throat J. 2000 Feb;79(2):82-3, 86-8, 91-2.
In this retrospective clinical trial, we evaluated the effectiveness of low-dose oral methotrexate in the management of bilateral Ménière's disease of immune-mediated origin. At our tertiary-care referral center, we evaluated ten men and eight women who had longstanding bilateral Ménière's disease that had been unresponsive to traditional conservative medical management. Sixteen of these patients had steroid-responsive bilateral Ménière's disease. Two patients had contraindications to steroids, but their clinical and laboratory evaluations were consistent with an immune-mediated process. Patients were treated with 7.5 to 20 mg/week of oral methotrexate. The mean duration of treatment was 16.7 months (range: 8 to 35), with a mean followup of 2 years (range: 9 mo to 5 yr). Changes in clinical symptoms (vertigo, hearing loss, tinnitus, and aural fullness), audiometric changes, and side effects of therapy were evaluated. Vertigo resolved in 14 patients (78%), was substantially alleviated in three patients (17%), and remained unchanged in one patient (6%). Hearing improved in five patients (28%) and stabilized in seven patients (39%). Tinnitus and aural fullness resolved or was relieved in 11 of 17 (65%) and 13 of 14 (93%) patients, respectively. Side effects were minimal and reversible. We conclude that low-dose oral methotrexate is effective and safe for treating bilateral Ménière's disease of immune-mediated origin. In this study, methotrexate alleviated vertiginous symptoms and improved or stabilized hearing in most patients. Low-dose methotrexate can be considered for patients with immune-mediated bilateral Ménière's disease when long-term treatment is required or when a steroid or cyclophosphamide is contraindicated.
在这项回顾性临床试验中，我们评估了低剂量口服甲氨蝶呤治疗免疫介导性双侧梅尼埃病的有效性。在我们的三级医疗转诊中心，我们评估了10名男性和8名女性，他们患有长期双侧梅尼埃病，对传统保守药物治疗无反应。其中16例患者的双侧梅尼埃病对类固醇治疗有反应。2例患者有类固醇治疗的禁忌证，但他们的临床和实验室评估结果与免疫介导过程一致。患者接受每周7.5至20毫克的口服甲氨蝶呤治疗。平均治疗持续时间为16.7个月（范围：8至35个月），平均随访时间为2年（范围：9个月至5年）。评估了临床症状（眩晕、听力损失、耳鸣和耳胀满感）的变化、听力测定变化以及治疗的副作用。14例患者（78%）眩晕症状消失，3例患者（17%）明显缓解，1例患者（6%）无变化。5例患者（28%）听力改善，7例患者（39%）听力稳定。17例患者中有11例（65%）耳鸣症状消失或缓解，14例患者中有13例（93%）耳胀满感症状消失或缓解。副作用轻微且可逆。我们得出结论，低剂量口服甲氨蝶呤治疗免疫介导性双侧梅尼埃病有效且安全。在本研究中，甲氨蝶呤缓解了大多数患者的眩晕症状，改善或稳定了听力。对于需要长期治疗或有类固醇或环磷酰胺禁忌证的免疫介导性双侧梅尼埃病患者，可考虑使用低剂量甲氨蝶呤。
