Schoo Desi P, Tan Grace X, Ehrenburg Matthew R, Pross Seth E, Ward Bryan K, Carey John P
Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, MD 21218 USA.
Curr Otorhinolaryngol Rep. 2017 Jun;5(2):132-141. doi: 10.1007/s40136-017-0153-5. Epub 2017 May 3.
Aminoglycosides and corticosteroids are commonly used to treat Menière's disease. Intratympanic (IT) administration of these medications allows high inner ear concentrations without significant adverse systemic effects. As a direct result, IT therapy has grown in popularity. Recent studies have compared patient outcomes between IT aminoglycosides and corticosteroids. This review summarizes these findings.
Trials comparing IT corticosteroids to IT placebo or oral therapy have had conflicting results. Most recently, Lambert et al. investigated the effect of IT dexamethasone in a sustained-release formulation compared to placebo. Their findings demonstrated improvement in some secondary measures of vertigo with the sustained-release formulation.IT gentamicin is known to be effective in controlling vertigo in Menière's disease. In a recent study from 2016, Patel et al compared IT gentamicin and IT methylprednisolone in a double-blind, randomized controlled trial and identified no significant differences between the two in vertigo control.
IT injections of aminoglycosides and corticosteroids can improve vertigo control. Hearing and vestibular loss however may result with IT aminoglycosides. Corticosteroids demonstrate limited hearing loss but may not have the same efficacy in controlling vertigo. Further investigation in the etiology of Menière's disease is needed to tailor the proposed treatment to suit the disease mechanism.
氨基糖苷类药物和皮质类固醇常用于治疗梅尼埃病。鼓膜内（IT）给药这些药物可使内耳达到高浓度，且无明显的全身性不良反应。因此，IT疗法越来越受欢迎。最近的研究比较了IT氨基糖苷类药物和皮质类固醇的患者治疗效果。本综述总结了这些研究结果。
将IT皮质类固醇与IT安慰剂或口服疗法进行比较的试验结果相互矛盾。最近，兰伯特等人研究了与安慰剂相比，缓释剂型的IT地塞米松的效果。他们的研究结果表明，缓释剂型在眩晕的一些次要指标上有所改善。已知IT庆大霉素对控制梅尼埃病的眩晕有效。在2016年的一项最新研究中，帕特尔等人在一项双盲随机对照试验中比较了IT庆大霉素和IT甲泼尼龙，发现两者在眩晕控制方面无显著差异。
IT注射氨基糖苷类药物和皮质类固醇可改善眩晕控制。然而，IT氨基糖苷类药物可能导致听力和前庭功能丧失。皮质类固醇导致的听力损失有限，但在控制眩晕方面可能没有相同的疗效。需要对梅尼埃病的病因进行进一步研究，以便调整建议的治疗方法以适应疾病机制。
