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Intratympanic dexamethasone injection in Meniere’s disease




The aim of the study was to investigate the role of intratympanic (IT) dexamethasone in the treatment of medically refractory Meniere’s disease (MD) using two different concentrations.

Patients and methods

Twenty-four adults with unilateral MD received a single IT injection of dexamethasone at 4 or 10 mg/ml concentration. Partial or no improvement over the next 1 month following injection necessitated a second injection. Before and after injection, all patients underwent detailed history taking, were evaluated with the Dizziness Handicap Inventory scale, and underwent basic audiological evaluation and assessment of cervical-vestibular evoked myogenic potential. The presence or absence of spontaneous, post-head-shaking, and positional nystagmus was assessed using a video-nystagmography system. Twelve patients served as the control group and were followed up subjectively for 1 month.


Both 4 and 10 mg/ml IT dexamethasone improved all subjective symptoms and pure-tone audiometry thresholds. The cervical-vestibular evoked myogenic potential asymmetry ratio dropped after injection. However, the 10 mg/ml concentration was superior to the 5 mg/ml concentration in improving the signs of disease activity, Dizziness Handicap Inventory scores, and the duration of vertigo attacks. No change was reported by the controls.


IT dexamethasone injection might be helpful in controlling MD in some patients. The 10 mg/ml dexamethasone concentration controls vertigo at both the subjective and objective level. Especially if used early in the course of the disease


  1. 1

    Nin F, Hibino H, Doi K, Suzuki T, Hisa Y, Kurachi Y. The endocochlear potential depends on two K+ diffusion potentials and an electrical barrier in the stria vascularis of the inner ear. Proc Natl Acad Sci USA 2008; 105: 1751–1756.

    CAS  Article  Google Scholar 

  2. 2

    Phillips JS, Westerberg B. Intratympanic steroids for Ménière’s disease or syndrome. Cochrane Database Syst Rev 2011; 7: CD008514.

    Google Scholar 

  3. 3

    Santos PM, Hall RA, Snyder JM, Hughes LF, Dobie RA. Diuretic and diet effect on Meniere’s disease evaluated by the 1985 Committee on Hearing and Equilibrium guidelines. Otolaryngol Head Neck Surg 1993; 109(4): 680–689.

    CAS  Article  Google Scholar 

  4. 4

    Claes J, Van de Heyning PH. Medical treatment of Meniere’s disease: a review of literature. Acta Otolaryngol 1997 pp. 37–42.

  5. 5

    Suzuki M, Krug MS, Cheng KC, Yazawa Y, Bernstein J, Yoo TJ. Antibodies against inner-ear proteins in the sera of patients with inner-ear diseases. ORL J Otorhinolaryngol Relat Spec 1997; 59: 10–17.

    CAS  Article  Google Scholar 

  6. 6

    Itoh A, Sakata E. Treatment of vestibular disorders. Acta Otolaryngol Suppl 1991; 481: 617–623.

    CAS  Article  Google Scholar 

  7. 7

    Hamid M. Recent advances in medical otology-neurotology. Mediterr J Otol. 2008; 3: 145–153.

    Google Scholar 

  8. 8

    Hamid M, Trune D. Issues, indications, and controversies regarding intratympanic steroid perfusion. Curr Opin Otolaryngol Head Neck Surg 2008; 16: 434–440.

    Article  Google Scholar 

  9. 9

    Hain T. Pharmacological treatment of vertigo. CNS Drugs 2011; 17: 85–100.

    Article  Google Scholar 

  10. 10

    Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Menière’s disease. American Academy of Otolaryngology-Head and Neck Foundation, Inc. Otolaryngol Head Neck Surg 1995;113:181–185.

    Article  Google Scholar 

  11. 11

    El-Gohary M, Kamal N, El-Kahky A, Taha H. Vestibulo-cochlear response to glycerol in Meniere’s patients. Meniere’s disease-update. Proceedings of the 4th International Symposium on Meniere’s disease. 11–14 April; Paris; 2000. pp. 265–274.

  12. 12

    Jacobson G, Newman C. Assessing dizziness-related quality of life. Jacobson GP, Shepard NT, editors. Balance assessment and management. Plural Publishing. San Diego, CA.; 2007. 109.

    Google Scholar 

  13. 13

    Shepard N, Telian S. Practical management of the balance disorder patient. San Diego: Singular Publishing Group Inc.; 1996.

    Google Scholar 

  14. 14

    Colebatch JG. Vestibular evoked potentials. Curr Opin Neurol 2001; 14: 21–26.

    CAS  Article  Google Scholar 

  15. 15

    Kingma CM, Wit Hp. The effect of changes in perilymphatic K+ on the vestibular evoked potential in the guinea pig. Arch Otorhinolaryngol 2011; 267: 1679–1684.

    Article  Google Scholar 

  16. 16

    Boleas-Aguirre MS, Lin FR, Della Santina CC, Minor LB, Carey JP. Longitudinal results with intratympanic dexamethasone in the treatment of Meniere’s disease. Otol Neurotol 2008; 29: 33–38.

    Article  Google Scholar 

  17. 17

    Dallan I, Bruschini L, Nacci A, Bignami M, Casani AP. Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management. Acta Otorhinolaryngol Ital 2005; 25: 370–373.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. 18

    Vassiliou A, Vlastarakos A, Maragoudakis P, Candiloros D, Nikolopoulos T. Meniere’s disease: still a mystery disease with difficult differential diagnosis. Ann Indian Acad Neurol 2011; 14: 12–18.

    CAS  Article  Google Scholar 

  19. 19

    Garduño-Anaya MA, Couthino De Toledo H, Hinojosa-González R, Pane-Pianese C, Ríos-Castañeda LC. Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière’s disease: a two-year prospective, placebo-controlled, double-blind, randomized trial. Otolaryngol Head Neck Surg 2005; 133: 285–294.

    Article  Google Scholar 

  20. 20

    Casani A, Piaggi P, Cerchiai N, Seccia V, Sellari Franceschini S, Dallan I. Intratympanic treatment of intractable unilateral Meniere disease: gentamicin or dexamethasone? A randomized controlled trial. Otolaryngol Head Neck Surg 2011; 18: 29–66.

    Google Scholar 

  21. 21

    ElBeltagya Y, Gouda A, Mahmouda A, Hazaa N. Intratympanic injection in Meniere’s disease; symptomatic and audiovestibular; comparative, prospective randomized 1-year control study. Egypt J Otolaryngol 2012; 28: 171–183.

    Google Scholar 

  22. 22

    Silverstein H, Isaacson JE, Olds MJ, Rowan PT, Rosenberg S. Dexamethasone inner ear perfusion for the treatment of Meniere’s disease: a prospective, randomized, double-blind, crossover trial. Am J Otol 1998; 19: 196–201.

    CAS  PubMed  Google Scholar 

  23. 23

    Lu Y, Ren J, Wu W, Yin T, Yang X, Xie D. Intratympanic dexamethasone injections for intractable Meniere’s disease. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2004; 18: 385–387.

    CAS  PubMed  Google Scholar 

  24. 24

    Huang Y, She Y, Li W, Cheng C. Intratympanic dexamethasone injections for intractable Meniere’s disease. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2005; 19: 748–749.

    PubMed  Google Scholar 

  25. 25

    Silverstein H, Farrugia M, Van Ess M. Dexamethasone inner ear perfusion for subclinical endolymphatic hydrops. Ear Nose Throat J 2009; 88: 778–785.

    Article  Google Scholar 

  26. 26

    Hillman TM, Arriaga MA, Chen DA. Intratympanic steroids: do they acutely improve hearing in cases of cochlear hydrops?. Laryngoscope 2003; 113: 1903–1907.

    CAS  Article  Google Scholar 

  27. 27

    Hamid M. Clinical advances and issues in auditory and vestibular medicine. Egypt J Ear Nose Throat Allied Sci 2010; 11: 1–6.

    Google Scholar 

  28. 28

    Kotimaki J. Meniere’s disease in Finland. An epidemiological and clinical study on occurrence, clinical picture and policy [Dissertation]. Finland: ORL Dept., University of Oulu; 2003.

    Google Scholar 

  29. 29

    Salt AN, Sirjani DB, Hartsock JJ, Gill RM, Plontke SK. Marker retention in the cochlea following injections through the round window membrane. Hear Res 2007; 232: 78–86.

    Article  Google Scholar 

  30. 30

    Murofushi T, Shimizu K, Takegoshi H, Cheng PW. Diagnostic value of prolonged latencies in the vestibular evoked myogenic potential. Arch Otolaryngol Head Neck Surg 2001; 127: 1069–1072.

    CAS  Article  Google Scholar 

  31. 31

    Dodson KM, Woodson E, Sismanis A. Intratympanic steroid perfusion for the treatment of Meniere’s disease: a retrospective study. Ear Nose Throat J 2004; 83: 394–398.

    Article  Google Scholar 

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Corresponding author

Correspondence to Dalia Mohamed Hassan MD.

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None declared.

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Maksoud, A.A., Hassan, D.M., Nafie, Y. et al. Intratympanic dexamethasone injection in Meniere’s disease. Egypt J Otolaryngol 31, 128–134 (2015).

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  • intratympanic steroids
  • Meniere’s disease
  • short-term outcome
  • vertigo