European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery · 2025
Dual-target corticosteroid therapy for refractory Ménière's disease: influence of vestibular aqueduct patency and endotypes.
Clinical StudyСтатьяНазвание и аннотация: Перевод в очереди
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Zou Jing, Li Hongbin, Zhu Minhui, Zhang Guoping, Gao Yingna, Lu Tianhao, Arnisalo Antti, Pyykkö Ilmari
Аннотация
PURPOSE: To evaluate the long-term efficacy of dual-target corticosteroid therapy (simultaneously targeting the endolymphatic sac [ES] and vestibule) in refractory Ménière's disease (MD) and assess associations between treatment outcomes, vestibular aqueduct (VA) patency, and endotypes.
MATERIALS AND METHODS: Twenty refractory MD patients with inadequate response to conventional therapies, including intratympanic dexamethasone, underwent gadolinium-enhanced MRI for endolymphatic hydrops (EH) evaluation. VA morphology and angular trajectory (ATVA) were assessed via CT. Methylprednisolone and dexamethasone were delivered to the intact ES surface, while dexamethasone was administered via the oval window (OW) for vestibule-targeted distribution. Follow-up duration: 30.1 ± 13.7 months (mean ± SD).
RESULTS: Younger patients exhibited more severe cochlear (p < 0.01) and vestibular (p < 0.05) EH. Vestibular EH correlated with vertigo duration (p < 0.05), and disease stage was associated with EH severity (p < 0.05). 90% had narrow VA (grades I-II). ATVA αexit ranged 87.40°-158.69° (mean 116.16° ± 20.32°), with 12% (2/17) > 140°. EH severity correlated with ATVA αexit (p < 0.05) but not VA grade. Vertigo abolition: 95% at 3 days; 84.2% achieved ≥ level B control by endpoint. VA size and ATVA did not influence outcomes (p > 0.05).
CONCLUSIONS: Dual-target corticosteroid therapy provides robust and sustained vertigo control in refractory MD, independent of VA anatomy. Most patients had stenotic or undetectable VAs, yet neither VA patency nor ATVA affected efficacy, suggesting compensatory drug delivery mechanisms overcome anatomical limitations.
MATERIALS AND METHODS: Twenty refractory MD patients with inadequate response to conventional therapies, including intratympanic dexamethasone, underwent gadolinium-enhanced MRI for endolymphatic hydrops (EH) evaluation. VA morphology and angular trajectory (ATVA) were assessed via CT. Methylprednisolone and dexamethasone were delivered to the intact ES surface, while dexamethasone was administered via the oval window (OW) for vestibule-targeted distribution. Follow-up duration: 30.1 ± 13.7 months (mean ± SD).
RESULTS: Younger patients exhibited more severe cochlear (p < 0.01) and vestibular (p < 0.05) EH. Vestibular EH correlated with vertigo duration (p < 0.05), and disease stage was associated with EH severity (p < 0.05). 90% had narrow VA (grades I-II). ATVA αexit ranged 87.40°-158.69° (mean 116.16° ± 20.32°), with 12% (2/17) > 140°. EH severity correlated with ATVA αexit (p < 0.05) but not VA grade. Vertigo abolition: 95% at 3 days; 84.2% achieved ≥ level B control by endpoint. VA size and ATVA did not influence outcomes (p > 0.05).
CONCLUSIONS: Dual-target corticosteroid therapy provides robust and sustained vertigo control in refractory MD, independent of VA anatomy. Most patients had stenotic or undetectable VAs, yet neither VA patency nor ATVA affected efficacy, suggesting compensatory drug delivery mechanisms overcome anatomical limitations.