[Consensus on intratympanic drug delivery for Menière's disease].

Objective

Intratympanic（IT） drug delivery receives attention due to its effectivity in treatment for Menière's disease（MD）. Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable.

Methods

The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus（ICON） on treatment of Menière's disease（2018）, Clinical Practice Guideline（2020） and European Position statement on Diagnosis and Treatment of Menière's disease（2018） are taken into account for reference, and follow advice from experts from Europe, USA and China.

Results

Experts agree on the following: ①The effectiveness of IT methylprednisolone（ITM） on vertigo control seems to be somewhat better than that of IT dexamethasone（ITD）, and ITM can restore hearing in some cases. ②Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin（ITG） in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. ③Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear.

Conclusion

More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.