Intratympanal administration of lidocaine in the management of Ménière’s Disease

Abstract

Background

Ménière’s Disease (MD) is a chronic condition where patients suffer recurrent vertigo attacks. Evidence for treatment concepts are to this date low.

Aims/objective

To evaluate the therapeutic effect of intratympanic lidocaine injections to reduce the number of attacks.

Methods

Twenty patients diagnosed with definitive MD that were treated with 34 intratympanic lidocaine injections were included. Main outcome measures were the number of vertigo attacks in the previous four weeks, the attack free period and the subjective improvement of the condition.

Results

Mean follow up after first lidocaine injection was 25.3 months (±22.2; range 1.9–79.7). Patients expressed subjective improvement in overall situation, vertigo, and aural fullness. The number of vertigo attacks before each assessment decreased from 7.1 (±5.9; range 2–20) per months at baseline to 1.9 (±3.8; range 0–15). 25% of the patients suffered no further attacks, the other patients had an average attack free period of 7.8 months (±15.4; range 0.2–58.4). Hearing thresholds remained unaffected. Repetitive injections proved effective.

Conclusion and significance

Intratympanic lidocaine is an effective nonsurgical and non-ablative therapy for MD. When patients experience an increase of attacks repetitive injections promise improvement.

Chinese abstract

背景：美尼尔病（MD）是一种慢性疾病, 患者反复出现眩晕。迄今为止, 有关治疗的证据很少。

目的：评估鼓膜内注射利多卡因以减少眩晕发作次数的治疗效果。

方法：纳入20例确诊为MD的患者, 接受34次鼓膜内利多卡因注射治疗。主要结局指标是在前四个星期眩晕发作次数、无发作期和病情的主观改善。

结果：首次利多卡因注射后的平均随访时间为25.3个月（±22.2；范围为1.9–79.7）。患者表示总体状况、眩晕和听觉充盈均有主观改善。每次评估前的眩晕发作次数从基线的每月7.1次（±5.9；范围2–20）减少到1.9（±3.8; 范围0–15）。 25％的患者没有进一步发作, 其他患者的平均无发作期为7.8个月（±15.4；范围0.2-58.4）。听力阈值不受影响。反复注射证明有效。

结论和意义：鼓室内利多卡因是一种对MD有效的非手术、非消融疗法。当患者经历发作次数增多时, 反复注射会保证病情改善。

Keywords:

• Ménière’s Disease
• lidocaine
• vertigo

Acknowledgements

The authors are grateful to Jenny Blum, Nadine Dietrich, Bettina Linde, Jeannine Müller and Stefan Thom for excellent technical assistance.

Ethical approval

For this type of study individual patients’ consent is not required; the study has been registered with the proper authorities under the file no. 16/8/17An.

Author contributions

MB, FI and BW designed the study, MB and BW identified the patients and collected the data, BW and JS performed data analysis, MB wrote the manuscript, FI, JS, MC and BW provided critial proofreading and significantly improved the manuscript.

Disclosure statement

The authors do not declare any conflict of interest.

Additional information

Funding

This work was supported by the German Federal Ministry of Education and Health (BMBF) in the context of the foundation of the German Center for Vertigo and Balance Disorders (DSGZ) [grant number 01 EO 0901].