Center for Rehabilitative Auditory Research, Guizhou Provincial People's Hospital, Guiyang, China.
Centre for Speech and Language Therapy and Hearing Sciences, Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cardiff, UK.
Clin Otolaryngol. 2019 Jul;44(4):619-627. doi: 10.1111/coa.13350. Epub 2019 May 23.
It is generally accepted that intratympanic injection provides an effective approach to manage severe vertigo in Ménière's disease. Although there are several medications available, that which is the most effective is still subject to debate.
To assess the effectiveness and safety of the different medications used in the treatment of Ménière's disease by intratympanic injection using a network meta-analysis.
PubMed, EMBASE, CINAHL and CENTRAL were searched. Only randomised controlled trials that compared the effectiveness of medications used for intratympanic injection to treat Ménière's disease with each other or a placebo were included. The primary outcome assessed was the effectiveness of medication in the management of vertigo symptoms. The effectiveness was expressed in terms of risk ratio (RR) with a 95% credible interval (CrI) for individual studies analysed. Network meta-analyses were performed by Stata version 15.0 using the network package.
Nine studies involving 314 patients treated with five different medications were included in the present analysis. A number of injections given varied from 1 to 10 and the follow-up time from 3 to 28 months. When compared to each other or to a placebo, Gentamicin was found to be the most efficacious medication, followed by Methylprednisolone, Latanoprost, Dexamethasone and Ganciclovir in order of effectiveness. However, no significant difference in efficacy was found between Gentamicin and Methylprednisolone when outcomes from studies with a follow-up time equal to or more than 24 months were analysed. It was not possible to conduct subgroup and sensitivity analysis because of the limited number of studies that were included.
All medications are more effective than a placebo in the treatment of Ménière's disease by intratympanic injection. According to the SUCRA, Gentamicin ranked the most effective, with Gentamicin and Methylprednisolone equally effective in the long-term effect. When the potential risk of hearing loss induced by Gentamicin is taken into consideration, Methylprednisolone may be the best choice for the treatment of Ménière's disease by intratympanic injection.
鼓室内注射被普遍认为是治疗梅尼埃病重度眩晕的有效方法。虽然有多种药物可供选择，但哪种药物最有效仍存在争议。
通过网络荟萃分析评估鼓室内注射治疗梅尼埃病时不同药物的疗效和安全性。
检索 PubMed、EMBASE、CINAHL 和 CENTRAL。仅纳入比较鼓室内注射治疗梅尼埃病时不同药物相互之间或与安慰剂疗效的随机对照试验。主要结局评估药物治疗眩晕症状的效果。个体研究分析采用风险比（RR）及其 95%可信区间（CrI）表示。网络荟萃分析采用 Stata 15.0 软件的网络包进行。
本分析纳入了 9 项研究，共 314 例患者，分别接受 5 种不同药物治疗。注射次数从 1 到 10 次不等，随访时间从 3 到 28 个月不等。与其他药物或安慰剂相比，庆大霉素是最有效的药物，其次是甲泼尼龙、拉坦前列素、地塞米松和更昔洛韦。然而，当分析随访时间等于或超过 24 个月的研究结果时，发现庆大霉素和甲泼尼龙的疗效无显著差异。由于纳入的研究数量有限，无法进行亚组和敏感性分析。
与安慰剂相比，所有药物在鼓室内注射治疗梅尼埃病时均更有效。根据 SUCRA 值，庆大霉素的疗效最佳，而在长期疗效方面，庆大霉素和甲泼尼龙的疗效相当。当考虑到庆大霉素引起听力损失的潜在风险时，甲泼尼龙可能是鼓室内注射治疗梅尼埃病的最佳选择。
