Li Shuna, Ilmari Pyykkő, Zhang Qing, Yang Jun, Duan Maoli
Department of Otorhinolaryngology-Head & Neck Surgery，Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine，Shanghai，200092，China.
Institute of Otology，School of Medicine，Shanghai Jiaotong University.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2022 Jul;36(7):487-491. doi: 10.13201/j.issn.2096-7993.2022.07.001.
Intratympanic（IT） drug delivery receives attention due to its effectivity in treatment for Menière's disease（MD）. Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable. The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus（ICON） on treatment of Menière's disease（2018）, Clinical Practice Guideline（2020） and European Position statement on Diagnosis and Treatment of Menière's disease（2018） are taken into account for reference, and follow advice from experts from Europe, USA and China. Experts agree on the following: ①The effectiveness of IT methylprednisolone（ITM） on vertigo control seems to be somewhat better than that of IT dexamethasone（ITD）, and ITM can restore hearing in some cases. ②Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin（ITG） in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. ③Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear. More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.
鼓室内（IT）给药因其在梅尼埃病（MD）治疗中的有效性而受到关注。由于关于MD鼓室内给药的共识和新证据不断发布，因此进行旨在补充MD鼓室内治疗细节的综述不可或缺。检索了过去二十年中关于MD鼓室内注射治疗的文献，参考了《梅尼埃病治疗国际共识》（2018年）、《临床实践指南》（2020年）和《欧洲梅尼埃病诊断与治疗立场声明》（2018年），并听取了欧洲、美国和中国专家的建议。专家们达成了以下共识：①鼓室内注射甲泼尼龙（ITM）控制眩晕的效果似乎略优于鼓室内注射地塞米松（ITD），且ITM在某些情况下可恢复听力。②由于氨基糖苷类药物的耳毒性，鼓室内注射庆大霉素（ITG）在听力良好的MD患者中的应用较为保守。然而，一些研究表明低剂量ITG对听力无显著影响，这需要通过高水平证据的临床研究进一步证实。③目前，ITG普遍接受的治疗终点是12个月内无眩晕发作或患耳客观测试中前庭功能丧失。需要更多高水平证据的研究来评估MD鼓室内治疗的药物类型、疗效和治疗终点。
