Servicio de Otorrinolaringología, Hospital Universitario Fundación Alcorcón, Madrid, Spain.
Otol Neurotol. 2010 Jan;31(1):162-7. doi: 10.1097/MAO.0b013e3181c34e53.
To describe the long-term efficacy of transtympanic steroids (TTS) using methyl-prednisolone in the treatment of Ménière's disease (MD).
Descriptive prospective study.
Pure-tone average (PTA) corresponding to the conversational frequencies on the audiogram (0.5, 1, 2, and 3 kHz), visual analog scale on tinnitus annoyance, and number of vertigo spells 24 months after treatment.
Thirty-four MD patients referred to a tertiary center were treated with TTS. All patients were diagnosed as probable or definitive MD (following American Academy of Otolaryngology-Head and Neck Surgery 1995 criteria) and treated by TTS (3 consecutive doses). Data from 32 patients were achieved after 12 months. Forty-eight percent of the patients reduced the PTA in 10 or more decibels, average improvement was 8.6 dB compared with initial PTA (p = 0.004). Tinnitus relief was achieved by 81.5% of the patients. Number of vertigo spells was reduced from 4.3 to 0.3 after 12 months (p = 0.002); 81% of the patients were free of vertigo spells, and 92.6% had 1 or less spells of vertigo. Data from 29 patients were achieved after 24 months. A reduction of PTA in 10 or more decibels was shown by the 33.3% of the sample, and PTA improved in 3.3 dB compared with initial PTA (nonsignificant). Tinnitus relief was achieved in 78% of the patients. Number of vertigo spells was reduced from 4.3 to 0.5 (p = 0.033). Seventy-eight percent of the cases were free of vertigo, and 96% had none or 1 spell. Because of an increase in any of the symptoms, 12 patients (35.2%) required retreatment with 1 or 2 series of TTS (1-3 doses) along the 2-year period. Two patients of the sample (6.25%) required transtympanic gentamicin for vertigo control due to lack of benefit with TTS (14 and 18 mo since TTS).
Transtympanic steroids in this cohort were associated with good preservation of hearing. Tinnitus control is achieved in more than 70% of the patients, and number of vertigo spells can be dramatically reduced in more than 90% of the patients after a 24-month follow-up.
描述鼓室内注射甲泼尼龙治疗梅尼埃病（MD）的长期疗效。
描述性前瞻性研究。
听力图上会话频率（0.5、1、2 和 3 kHz）对应的纯音平均（PTA）、耳鸣烦恼的视觉模拟量表以及治疗后 24 个月眩晕发作次数。
34 例 MD 患者被转诊至三级中心接受 TTS 治疗。所有患者均被诊断为可能或明确的 MD（根据美国耳鼻喉头颈外科学会 1995 年的标准），并接受了 TTS（3 个连续剂量）治疗。32 例患者在 12 个月后获得了数据。48%的患者 PTA 降低了 10 分贝或更多，与初始 PTA 相比，平均改善了 8.6 分贝（p=0.004）。81.5%的患者耳鸣得到缓解。治疗后 12 个月，眩晕发作次数从 4.3 次减少至 0.3 次（p=0.002）；81%的患者无眩晕发作，92.6%的患者眩晕发作次数为 1 次或更少。29 例患者在 24 个月后获得了数据。样本中 33.3%的患者 PTA 降低了 10 分贝或更多，与初始 PTA 相比，PTA 改善了 3.3 分贝（无统计学意义）。78%的患者耳鸣得到缓解。眩晕发作次数从 4.3 次减少至 0.5 次（p=0.033）。78%的病例无眩晕，96%的病例无眩晕或仅 1 次眩晕。由于任何症状的加重，12 例（35.2%）患者在 2 年期间需要接受 1 或 2 个系列的 TTS（1-3 个剂量）治疗。由于 TTS 治疗无效，2 例患者（6.25%）需要鼓室内庆大霉素治疗以控制眩晕（自 TTS 治疗后 14 个月和 18 个月）。
在本队列中，鼓室内注射类固醇与听力良好保存相关。超过 70%的患者耳鸣得到控制，超过 90%的患者眩晕发作次数在 24 个月随访后显著减少。
