Long-term Efficacy Of Dexamethasone Treatment Via Tympanic Antrum Catheterization For Intractable Meniere’s Disease

Objective:To investigate the long-term efficacy and safety of dexamethasone treatment via tympanic antrum catheterization(TAC)in patients with intractable Meniere’s disease(MD).Methods:Sixty unilateral intractable MD patients treated with TAC in the Department of Otolaryngology-Head and Neck Surgery of our hospital from January 2020 to August 2020,were recruited in this retrospective study.Clinical date and 2 years follow-up outcome by interview,symptom scales and re-examination were collected and analyzed.Fifty patients who underwent endolymphatic sac decompression(ESD)and 50 patients who received intratympanic corticosteroids(ITC)were established as the control groups.Vertigo control,hearing change,THI,A VS and FLS score were compared among groups to evaluate the long-term efficacy and safety of TAC in refractory MD patients.Results:1.There was no statistically significant difference in demographic and baseline characteristics among the MD patients of TAC,ESD and ITC groups(P>0.05).2.The total effective rate of vertigo control in TAC group was 76.67%(46/60),with 35 cases(58.55%)of Grade A control and 11 cases(18.33%)of Grade B control.While,the total effective rate of vertigo control in ESD and ITC groups were 72.00%(36/50)and 58.00%(29/50),respectively.The vertigo control rate of TAC was comparable to that of ESD(P>0.05),and significantly higher than that of ITC(P<0.05).3.The hearing improvement rate in TAC,ESD and ITC groups were 40.54%(15/37),34.48%(10/29)and 34.38%(11/32),respectively.There was no statistically significant difference in hearing change among the 3 groups(P>0.05).4.The tinnitus improvement rate in TAC,ESD and ITC groups were 56.67%(34/60),24.00%(12/50)and 20.00%(10/50),respectively.MD patients treated with TAC had significantly higher tinnitus improvement rate than patients with ESD(P<0.001)and ITC(P<0.001).5.The aural fullness improvement rate in TAC,ESD and ITC groups were 56.67%(34/60),24.00%(12/50)and 34.00%(17/50),respectively.MD patients treated with TAC had significantly higher aural fullness improvement rate than patients with ESD(P<0.01)and ITC(P<0.05).6.In TAC,ESD and ITC groups,functional level improvement occurred in 71.67%(43/60),66.00%(33/50)and 32.00%(16/50)of patients,respectively.The functional level improvement rate of TAC was much higher than that of ITC(P<0.001),but there was no significant difference between TAC and ESD(P>0.05).7.The effective vertigo control rate of TAC in male and female MD patients were 77.78%and 75.76%,while in left and right MD patients were 72.50%and 85.00%.MD patients in lower,medium and higher age groups had an effective vertigo control rate of 69.23%,79.41%and 76.92%,respectively.And vertigo attacks were effectively controlled in 80.95%and 74.36%of mild(stagel,2)and moderate to severe(stage 3,4)MD patients treated with TAC.There is no significant difference in vertigo control rate of TAC among MD patients with different gender,side,age or clinical stage(P>0.05).Conclusion:Dexamethasone treatment via tympanic antrum catheterization is a safe and effective local treatment for intractable Meniere’s disease.It had favorable effects on vertigo control,which is comparable to ESD and significantly higher than ITC.Moreover,TAC significantly improves symptoms such as hearing loss,tinnitus,and aural fullness,with higher improvement rate of tinnitus and aural fullness than that of ESD and ITC.In addition,Gender,side,age and stage had no significantly influence on vertigo control rate of TAC.Therefore,TAC can be used for extensive indications,regardless of the degree of hearing loss.