Ask your doctor about this intervention if your stroke left you with this problem.
Injections of steroid into the ear are an effective treatment for a common form of severe dizziness, suggests a new study.
In a new trial, scientists from Imperial College London compared
current treatments for Meniere’s disease, which causes debilitating
dizzy spells.
They found that injections of the steroid methylprednisolone, through
the ear drum, are as effective as the current ‘gold standard’
treatment. The current option is an antibiotic called gentamicin, and is
also injected into the ear, where it destroys inner ear cells. The
treatment prevents dizziness attacks, but can leave patients with
permanent hearing damage.
The new trial, published in the Lancet, found that the steroid
injections are as effective as gentamicin, but without the side effects.
Patients who received the steroid injections were better at hearing
speech clearly, compared to those who received the gentamicin
injections.
The researchers are now recommending medics offer the steroid injections to patients before trying gentamicin.
Professor Adolfo Bronstein, lead author on the paper from the
Department of Medicine at Imperial, said: “Meniere’s disease causes
disabling attacks of dizziness that in some cases can leave people
unable to work. However at the moment the only treatment we have for
severe cases is a so-called ‘destructive treatment’ that kill cells in
the inner ear. Doctors, including ourselves, always assumed steroid
injections were less effective than the current treatment, but we were
surprised to see they work just as well as gentamicin, but do much less
harm.”
Meniere’s disease affects around 30,000 people in the UK, and causes
intense attacks of dizziness that last anything from a few minutes to 24
hours. During the attacks a person is usually unable to stand, and
suffers from hearing loss, as well as nausea or even vomiting. The
condition usually strikes people over 40, though scientists still do not
know what triggers the disease. One theory is that the condition causes
a build-up of salt and fluid in the inner ear.
This section of the ear, which is closest to the brain, holds
equipment crucial to maintaining balance. This equipment constantly
communicates with the brain, eyes and limbs to keep us on our feet.
Scientists believe the build-up of pressure can cause tiny leaks of
fluid in the inner ear, which can cause the balance equipment to
malfunction. The condition can also lead to permanent hearing loss.
There is no cure, although the early stages of the disease can be
treated with medication and exercises. Severe cases can be treated with
injections of gentamicin. After being injected into the ear, the
medicine travels to the inner ear where it destroys the cells
responsible for balance, and stops the dizzy spells. Usually only one
ear is affected, therefore patients still have a working balance
mechanism in their healthy ear, and can re-train their balance with
exercises.
However, gentamicin can also destroy hearing cells, and up to one in five patients can be left with permanent hearing loss.
In the latest study, researchers at Imperial gave 60 patients with
severe Meniere’s disease either injections of gentamicin or steroids.
The patients were on average having more than one dizziness attack a
week. They were given two injections of one of the treatments, under
local anaesthetic, two weeks apart. Neither the patient nor the
researcher knew whether a patient received steroid or the gentamicin.
After a two year period, all patients’ dizziness attacks had reduced
by around 90 per cent. However the patients who received the steroid
injections had better speech discrimination – the ability to hear words
clearly - than those who received gentamicin.
Neither treatments were found to have any other side effects,
although the injections of gentamicin often triggered a severe dizziness
attack when first administered.
Professor Bronstein added that those who received steroid injections
were more likely to need additional jabs to stop their dizzy spells.
“For a patient who lives in a remote location where accessing repeat
injections would be difficult, then gentamicin would be an option.
However, if a patient is able to receive repeat injections, and is
concerned about future hearing loss, the steroid injections may be a
better choice.”
Natasha Harrington-Benton, Director of the Meniere’s Society, who
funded the research said: “We are pleased to have been able to support
this research and are encouraged by the outcome. The trial has led to a
better understanding of gentamicin and steroid treatments for Meniere’s
disease; giving hope to those affected by this complex condition.”
The research was funded by the Meniere’s Society.
