Pharmacologic and surgical therapies for patients with Meniere's disease: A systematic review and network meta-analysis
Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus...
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| Veröffentlicht in: | PloS one 2020-09, Vol.15 (9), p.e0237523 |
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| creator | Ahmadzai, Nadera Cheng, Wei Kilty, Shaun Esmaeilisaraji, Leila Wolfe, Dianna Bonaparte, James Schramm, David Fitzpatrick, Elizabeth Lin, Vincent Skidmore, Becky Hutton, Brian |
| description | Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs).
Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.
We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac deco |
| doi_str_mv | 10.1371/journal.pone.0237523 |
| format | Article |
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Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.
We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002).
To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. However, IT steroid plus high-dose betahistine has not been compared in head-to-head trials against other interventions except for IT steroid alone in one trial, thus future trials that compare it with other interventions will help establish comparative effectiveness with direct evidence.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0237523</identifier><identifier>PMID: 32870918</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adjudication ; Anti-Bacterial Agents - therapeutic use ; Bayesian analysis ; Betahistine - therapeutic use ; Bias ; Blockage ; Care and treatment ; Clinical trials ; Decompression ; Dosage ; Drug dosages ; Drug therapy ; Ear surgery ; Epidemiology ; Gentamicin ; Gentamicins - therapeutic use ; Health risks ; Health sciences ; Health services ; Hearing ; Hearing - drug effects ; Hearing loss ; Hospitals ; Humans ; Inner ear ; Intervention ; Medicine and Health Sciences ; Meniere disease ; Meniere Disease - drug therapy ; Meniere Disease - surgery ; Meniere's disease ; Meta-analysis ; Methods ; Otolaryngology ; Patients ; Pharmacology ; Physical Sciences ; Preservation ; Quality of life ; Research and Analysis Methods ; Signs and symptoms ; Statistical analysis ; Steroids ; Steroids - therapeutic use ; Surgery ; Systematic review ; Tinnitus ; Treatment Outcome ; Uniqueness ; Vasodilator Agents - therapeutic use ; Vertigo</subject><ispartof>PloS one, 2020-09, Vol.15 (9), p.e0237523</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Ahmadzai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Ahmadzai et al 2020 Ahmadzai et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-ca31d0508c62577a2e6657bdca82e26b84b2f043d07bbec26350cfcbfdc6fda53</citedby><cites>FETCH-LOGICAL-c692t-ca31d0508c62577a2e6657bdca82e26b84b2f043d07bbec26350cfcbfdc6fda53</cites><orcidid>0000-0002-1475-4079 ; 0000-0001-8293-9238 ; 0000-0001-5662-8647 ; 0000-0003-3422-4507</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462264/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7462264/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2095,2914,23846,27903,27904,53770,53772,79347,79348</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32870918$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Florez, Ivan D.</contributor><creatorcontrib>Ahmadzai, Nadera</creatorcontrib><creatorcontrib>Cheng, Wei</creatorcontrib><creatorcontrib>Kilty, Shaun</creatorcontrib><creatorcontrib>Esmaeilisaraji, Leila</creatorcontrib><creatorcontrib>Wolfe, Dianna</creatorcontrib><creatorcontrib>Bonaparte, James</creatorcontrib><creatorcontrib>Schramm, David</creatorcontrib><creatorcontrib>Fitzpatrick, Elizabeth</creatorcontrib><creatorcontrib>Lin, Vincent</creatorcontrib><creatorcontrib>Skidmore, Becky</creatorcontrib><creatorcontrib>Hutton, Brian</creatorcontrib><title>Pharmacologic and surgical therapies for patients with Meniere's disease: A systematic review and network meta-analysis</title><title>PloS one</title><addtitle>PLoS One</addtitle><description>Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs).
Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.
We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002).
To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. 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therapeutic use</topic><topic>Surgery</topic><topic>Systematic review</topic><topic>Tinnitus</topic><topic>Treatment Outcome</topic><topic>Uniqueness</topic><topic>Vasodilator Agents - therapeutic use</topic><topic>Vertigo</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahmadzai, Nadera</creatorcontrib><creatorcontrib>Cheng, Wei</creatorcontrib><creatorcontrib>Kilty, Shaun</creatorcontrib><creatorcontrib>Esmaeilisaraji, Leila</creatorcontrib><creatorcontrib>Wolfe, Dianna</creatorcontrib><creatorcontrib>Bonaparte, James</creatorcontrib><creatorcontrib>Schramm, David</creatorcontrib><creatorcontrib>Fitzpatrick, Elizabeth</creatorcontrib><creatorcontrib>Lin, Vincent</creatorcontrib><creatorcontrib>Skidmore, Becky</creatorcontrib><creatorcontrib>Hutton, Brian</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Science</collection><collection>ProQuest Central (Corporate)</collection><collection>Animal Behavior Abstracts</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Ecology Abstracts</collection><collection>Entomology Abstracts (Full archive)</collection><collection>Immunology Abstracts</collection><collection>Meteorological & Geoastrophysical Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Agricultural Science Collection</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>ProQuest Public Health Database</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Materials Science Collection</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Materials Science Database</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Meteorological & Geoastrophysical Abstracts - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>PloS one</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahmadzai, Nadera</au><au>Cheng, Wei</au><au>Kilty, Shaun</au><au>Esmaeilisaraji, Leila</au><au>Wolfe, Dianna</au><au>Bonaparte, James</au><au>Schramm, David</au><au>Fitzpatrick, Elizabeth</au><au>Lin, Vincent</au><au>Skidmore, Becky</au><au>Hutton, Brian</au><au>Florez, Ivan D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacologic and surgical therapies for patients with Meniere's disease: A systematic review and network meta-analysis</atitle><jtitle>PloS one</jtitle><addtitle>PLoS One</addtitle><date>2020-09-01</date><risdate>2020</risdate><volume>15</volume><issue>9</issue><spage>e0237523</spage><pages>e0237523-</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>Meniere's disease (MD) is a chronic condition of the inner ear consisting of symptoms that include vertigo attacks, fluctuating sensorineural hearing loss, tinnitus and aural fullness. Despite availability of various interventions, there is uncertainty surrounding their relative efficacy, thus making it difficult to select the appropriate treatments for MD. The objective of this systematic review was to assess the relative effects of the available pharmacologic and surgical interventions in patients with MD with regard to vertigo and other key patient outcomes based on data from randomized clinical trials (RCTs).
Our published protocol registered with PROSPERO (CRD42019119129) provides details on eligibility criteria and methods. We searched various databases including MEDLINE, Embase and the Cochrane Library from inception to December 10th, 2018. Screening at citation and full-text levels and risk of bias assessment were performed by two independent reviewers in duplicate, with discrepancies resolved by consensus or third-party adjudication. Bayesian network meta-analyses (NMA) were performed for hearing change and vertigo control outcomes, along with pairwise meta-analyses for these and additional outcomes.
We identified 2,889 unique citations, that yielded 23 relevant publications describing 18 unique RCTs (n = 1,231 patients). Overall, risk-of bias appraisal suggested the evidence base to be at unclear or high risk of bias. Amongst pharmacologics, we constructed treatment networks of five intervention groups that included placebo, intratympanic (IT) gentamicin, oral high-dose betahistine, IT steroid and IT steroid plus high-dose betahistine for NMAs of hearing change (improvement or deterioration) and complete vertigo control. IT steroid plus high-dose betahistine was associated with the largest difference in hearing improvement compared to placebo, followed by high-dose betahistine and IT steroid (though 95% credible intervals failed to rule out the possibility of no difference), while IT gentamicin was worse than IT steroid. The NMA of complete vertigo control suggested IT gentamicin was associated with the highest probability of achieving better complete vertigo control compared to placebo, followed by IT steroid plus high-dose betahistine. Only two studies related to surgical interventions were found, and data suggested no statistically significant difference in hearing changes between endolymphatic duct blockage (EDB) versus endolymphatic sac decompression (ESD), and ESD with or without steroid injection. One trial reported that 96.5% of patients in EDB group compared to 37.5% of the patients in ESD group achieved complete vertigo control 24 months after surgery (p = 0.002).
To achieve both hearing preservation and vertigo control, the best treatment option among the pharmacologic interventions compared may be IT steroid plus high-dose betahistine, considering that IT gentamicin may have good performance to control vertigo but may be detrimental to hearing preservation with high cumulative dosage and short interval between injections. However, IT steroid plus high-dose betahistine has not been compared in head-to-head trials against other interventions except for IT steroid alone in one trial, thus future trials that compare it with other interventions will help establish comparative effectiveness with direct evidence.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32870918</pmid><doi>10.1371/journal.pone.0237523</doi><tpages>e0237523</tpages><orcidid>https://orcid.org/0000-0002-1475-4079</orcidid><orcidid>https://orcid.org/0000-0001-8293-9238</orcidid><orcidid>https://orcid.org/0000-0001-5662-8647</orcidid><orcidid>https://orcid.org/0000-0003-3422-4507</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1932-6203 |
| ispartof | PloS one, 2020-09, Vol.15 (9), p.e0237523 |
| issn | 1932-6203 1932-6203 |
| language | eng |
| recordid | cdi_plos_journals_2439291268 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS); EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Adjudication Anti-Bacterial Agents - therapeutic use Bayesian analysis Betahistine - therapeutic use Bias Blockage Care and treatment Clinical trials Decompression Dosage Drug dosages Drug therapy Ear surgery Epidemiology Gentamicin Gentamicins - therapeutic use Health risks Health sciences Health services Hearing Hearing - drug effects Hearing loss Hospitals Humans Inner ear Intervention Medicine and Health Sciences Meniere disease Meniere Disease - drug therapy Meniere Disease - surgery Meniere's disease Meta-analysis Methods Otolaryngology Patients Pharmacology Physical Sciences Preservation Quality of life Research and Analysis Methods Signs and symptoms Statistical analysis Steroids Steroids - therapeutic use Surgery Systematic review Tinnitus Treatment Outcome Uniqueness Vasodilator Agents - therapeutic use Vertigo |
| title | Pharmacologic and surgical therapies for patients with Meniere's disease: A systematic review and network meta-analysis |
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