Endolymphatic Sac Decompression And Intratympanic Injection Of Dexamethasone In The Treatment Of Meniere’s Disease:A Meta-analysis

Objective:The clinical efficacy of endolymphatic sac decompression and steroid injection in the treatment of Meniere’s disease was systematically evaluated in order to provide evidence-based basis for clinical treatment of Meniere’s disease.Methods: By searching the full text databases of domestic medical journals,CNKI,Wanfang database,PubMed,and the knowledge warehouse of healthy evidence-based medicine,in the title and abstract,Our search was limited to studies published between 1980 and 2017.We included randomized controlled trials of endolymphatic sac shunt and intracympanic steroid hormone injection in the treatment of Meniere’s disease.Prospective or retrospective studies were conducted by independent literature screening,data extraction and methodological quality evaluation by two researchers.Meta analysis was performed with RevMan 5.2 software.Results: My study included 6 randomized controlled trials of 1158 patients,including endolymphatic sac decompression and shunt(treatment group 640 cases,tympanic cavity injection steroid hormone group 518 cases)Meta analysis showed that there were six studies: vertigo 95%CI(1.03,1.16),RR=1.10,P=0.002);hearing 95%CI(0.02,0.14),RR=0,08,P=0.006 The results showed that endolymphatic sac decompression shunt was better than intracympanic injection of dexamethasone.2Analysis(time > 2 years): vertigo 95%CI(1.01,1.16),RR=1.08,P=0.02,hearing :95%CI(-0.00,0.14),RR=0.07,P=0.05.Vertigo has statistical significance,but hearing has no statistical significance,which indicates that endolymphatic sac operation has advantages in controlling vertigo more than 2 years after operation.But there is no obvious advantage in improving or retaining hearing.Analysis(time ranged from 1 years to 2 years)showed that vertigo was 95%CI(1.00,1.25),RR=1.12,P=0.04,hearing: 95%CI(0.00,0.19),RR=0.09,P=0.04,the difference was statistically significant,indicating that the endolymphatic sac decompression shunt is better than the intraventricular injection of dexamethasone.Conclusion: The effect of endolymphatic sac decompression and shunt inthe treatment of vertigo was better than that of intratympanic injection of steroid(dexamethasone).Due to the limitation of the number of literature included and the number of patients and possible published bias,the above conclusions need to be verified by more high-quality randomized double-blind controlled trials.