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Evidence synthesis
Interventions for Menière’s disease: an umbrella systematic review
  1. Babette Fiebke van Esch1,2,
  2. Hester van der Zaag-Loonen1,
  3. Tjasse Bruintjes1,
  4. Ton Kuijpers3,
  5. Peter Paul G van Benthem4
  1. 1 Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, Apeldoorn, The Netherlands
  2. 2 Otorhinolaryngology, Leids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands
  3. 3 Guideline Development and Research, Dutch College of General Practitioners, Utrecht, The Netherlands
  4. 4 Otorhinolaryngology - Head and Neck Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Babette Fiebke van Esch, Apeldoorn Dizziness Centre, Gelre Ziekenhuizen, 7334 DZ Apeldoorn, The Netherlands; B.F.van_Esch{at}lumc.nl

Abstract

Objectives To systematically review the efficacy of interventions for Menière’s disease (MD) to report clinical implications of the results and to identify areas for future valuable research.

Methods In line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Abstracts (PRISMA-A) guideline, a systematic online database search was conducted in which MEDLINE (PubMed), Embase (Ovid) and CENTRAL (Cochrane Library) were searched until May 2021 in order to search for the efficacy of treatment was analysed in a systematic review. Systematic reviews (SRs) on treatments for MD were screened for eligible interventions. From these SRs, we included placebo randomised controlled trials (RCTs). A separate search was conducted to identify RCTs on treatment modalities that were systematically reviewed yet published after the conduction of these SRs. The primary outcome was control of vertigo as defined by the American guideline as published in 1995. The PRISMA-A and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to appraise and evaluate the certainty of evidence.

Results We found five SRs from which 19 RCTs were extracted. Five RCTs were added by the separate search resulting in a total of 25 RCTs (n=1248) which evaluated the efficacy of betahistine dihydrochloride, intratympanic injections with gentamicin or steroids, endolymphatic sac surgery and pressure pulse therapy. Evidence on the efficacy of interventions for patients with MD is generally of low certainty. Betahistine (48 mg per day and 144 mg per day) and positive pressure therapy probably do not reduce MD symptoms when compared with placebo. Intratympanic injection with gentamicin or steroids, or treatment with endolymphatic surgery may reduce symptoms in MD when compared with placebo.

Conclusions A definite effective and well-tolerated therapy for MD has yet to be discovered and information on the natural course of disease is one of the biggest flaws in current research.

PROSPERO registration number CRD4201502424.

  • otolaryngology
  • otolaryngology
  • patient care
  • otorhinolaryngologic diseases
  • evidence-based practice

Data availability statement

Data sharing not applicable as no data sets generated and/or analysed for this study. No additional avaialabe than the data extracted from previously published studies. No dataset were generated and/or analysed for this study.

https://doi.org/10.1136/bmjebm-2020-111410

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    Data availability statement

    Data sharing not applicable as no data sets generated and/or analysed for this study. No additional avaialabe than the data extracted from previously published studies. No dataset were generated and/or analysed for this study.

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    Footnotes

    • Contributors BFvE, HvdZ-L, TB and PPGvB contributed to the design and conception of the study protocol. The search strategy was developed and run by the ENT Group. BFvE and HvdZ-L screened studies on title and abstract and full text. If disagreement over about eligibility arrived occurred, this was settled by discussion with all authors (BFvE, HvdZ-L, TB and/or PPGvB). BFvE and HvdZ-L independently extracted data from the articles and a third reviewer (TB and/or PPGvB) checked the completeness and correctness of the extracted data of the outcome assessment. All authors drafted and revised this study protocol and approved it for publication. BFvE is the guarantor of the current study.

    • Funding This work was supported solely from institutional and/or departmental sources from the Apeldoorn Dizziness Centre, Gelre Hospital and the Leiden University Medical Centre, Department of Otorhinolaryngology Head and Neck Surgery, Leiden, The Netherlands.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.