{"id":2295,"date":"2022-03-15T10:37:02","date_gmt":"2022-03-15T10:37:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/?p=2295"},"modified":"2022-03-15T10:38:04","modified_gmt":"2022-03-15T10:38:04","slug":"treating-patients-with-menieres-disease-what-not-to-do","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/03\/15\/treating-patients-with-menieres-disease-what-not-to-do\/","title":{"rendered":"Treating patients with Meni\u00e8re\u2019s disease \u2013 what not to do?"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Blog entry written on: <\/span><i><span style=\"font-weight: 400\"><a href=\"https:\/\/ebm.bmj.com\/content\/early\/2021\/11\/07\/bmjebm-2020-111410\">Interventions for Meni\u00e8re&#8217;s disease: an umbrella systematic review <\/a><\/span><\/i><span style=\"font-weight: 400\">(bmjebm-2020-111410).<\/span><\/p>\n<p><em>Authors<span style=\"font-weight: 400\">: Babette F. van Esch, Hester J. van der Zaag-Loonen, Tjasse D. Bruintjes, Ton Kuijpers, Peter Paul G. van Benthem<\/span><\/em><\/p>\n<hr \/>\n<p><span style=\"font-weight: 400\">Are we able to rule out any treatment options when treating patients who are suffering from incapacitating attacks of vertigo accompanied with nausea, vomiting, fluctuating hearing loss, tinnitus and\/or aural fullness, altogether known as Meni\u00e8re\u2019s disease (MD)? The findings of a recent umbrella systematic review suggest that oral intake of betahistine or pressure pulse therapy (the Meniett device) do not reduce MD symptoms when compared to placebo.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even though the disease was described as early as 1861 by Prosper Meni\u00e8re, there are still many unanswered questions regarding the pathophysiology of this disease and an evidence-based treatment is yet to be discovered. Current treatment options include: betahistine, diuretics, oral steroids and transtympanic application of gentamicin or corticosteroids, positive pressure therapy (the Meniett device) or ablative surgery such as vestibular nerve section, surgical labyrinthectomy and endolymphatic sac surgery. Since so many treatments exist without convincing results, it may be hard for patients and their physicians to select the best available treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400\">MD affects about 15.0000 adults in the Netherlands in whom symptoms may last up to 20 years. The progression of disease causes deterioration of sensorineural hearing loss due to the vertigo attacks. In general, otological symptoms, including tinnitus and aural fullness, start unilateral but may become bilateral. Moreover, balance problems occur due to damage of the labyrinthine part of the inner ear. Due to the incapacitating character of the disease patients and physicians tend to start with therapy although the beneficial effect of it may not have been established.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">The current team members assessed all available data on systematic reviews (SRs) and placebo-controlled randomised trials (RCTs) aiming to summarise the efficacy of interventions for MD and to report on its clinical implication to identify areas for future valuable research. We identified five SRs and 25 RCTs in total enrolling 1248 MD patients. In general, the evidence was of a low level of certainty, i.e. the true effect may be substantially different from the estimated effect. Nonetheless, studies with the lowest risk of bias identified that betahistine (up to 144 mg per day) and positive pressure therapy probably do not reduce MD symptoms compared to placebo.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Additionally, intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in MD when compared to placebo. These conclusions were based on a low certainty of evidence and studies suffered from clinical heterogeneity: different treatment schedules, follow-up duration and definitions of outcomes.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">It is imperative be aware that the added value of therapy remains disputable due to lack of knowledge on the natural course of the disease. This is considered to be the biggest flaw in current research regarding MD. Knowledge on the natural course of disease will further help us to estimate the added value of therapy and indeed, may be helpful for power calculations when designing future trials.\u00a0\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">An online prospective registration system of patients\u2019 characteristics may provide relevant information on epidemiological aspects and therapy regimes in which betahistine and positive pressure therapy should not be used and do not warrant further research. Resources should be directed elsewhere.<\/span><\/p>\n<hr \/>\n<p><strong>Author<\/strong><\/p>\n<p><span style=\"font-weight: 400\">Dr. Babette F. van Esch, MD, PhD\u00a0<\/span><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/03\/Dr.-Babette-van-Esch.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-2297\" src=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/03\/Dr.-Babette-van-Esch-186x300.jpg\" alt=\"Image of blog author, Dr. Babette van Esch. Dr. Esch has red hair, and is wearing a white shirt. She is smiling showing her teeth. The background is orange and the photo is taken from the chest up.\" width=\"186\" height=\"300\" srcset=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/03\/Dr.-Babette-van-Esch-186x300.jpg 186w, https:\/\/blogs.bmj.com\/bmjebmspotlight\/files\/2022\/03\/Dr.-Babette-van-Esch.jpg 318w\" sizes=\"auto, (max-width: 186px) 100vw, 186px\" \/><\/a><\/p>\n<p><span style=\"font-weight: 400\">Resident Otorhinolaryngology \u2013 Head and Neck Surgery\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Department of Otorhinolaryngology \u2013 Head and Neck Surgery\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Leiden, The Netherlands\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Leiden University Medical Centre\u00a0<\/span><\/p>\n<p><b>Conflict of interest disclosures: <\/b><span style=\"font-weight: 400\">None<\/span><b>\u00a0<\/b><\/p>\n<hr \/>\n<p><b>DISCLAIMER<\/b><\/p>\n<p><span style=\"font-weight: 400\">The views and opinions expressed on this site are solely those of the original authors. They do not necessarily represent the views of the BMJ and should not be used to replace medical advice. All information on this blog is for general information, is not peer-reviewed, requires checking with original sources and should not be used to make any decisions about healthcare. No responsibility for its accuracy and correctness is assumed by us, and we disclaim all liability and responsibility arising from any reliance placed on such commentary or content by any user or visitor to the Website, or by anyone who may be informed of any of its content. Any reliance you place on the material posted on this site is therefore strictly at your own risk.<\/span><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Blog entry written on: Interventions for Meni\u00e8re&#8217;s disease: an umbrella systematic review (bmjebm-2020-111410). Authors: Babette F. van Esch, Hester J. van der Zaag-Loonen, Tjasse D. Bruintjes, Ton Kuijpers, Peter Paul G. van Benthem Are we able to rule out any treatment options when treating patients who are suffering from incapacitating attacks of vertigo accompanied with [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/03\/15\/treating-patients-with-menieres-disease-what-not-to-do\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":405,"featured_media":2296,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14351,14438,14442],"tags":[],"class_list":["post-2295","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ebm","category-ebm-spotlight","category-menieres-disease"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Treating patients with Meni\u00e8re\u2019s disease \u2013 what not to do? - BMJ EBM Spotlight<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmjebmspotlight\/2022\/03\/15\/treating-patients-with-menieres-disease-what-not-to-do\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Treating patients with Meni\u00e8re\u2019s disease \u2013 what not to do? - BMJ EBM Spotlight\" \/>\n<meta property=\"og:description\" content=\"Blog entry written on: Interventions for Meni\u00e8re&#8217;s disease: an umbrella systematic review (bmjebm-2020-111410). 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