Dual-target corticosteroid therapy for refractory Ménière's disease: influence of vestibular aqueduct patency and endotypes.

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.