Sunday, 22 April 2012

MORE on Intratympanic Dexamethasone Injections to Reduce Menieres Vertigo Attacks

If you haven't read my post, "Reduce the Frequency of Vertigo Attacks with a Dexamethasone Steroid Injection" I recommend you read that first.

Meniere's Australia - Brisbane South Meeting UPDATE
The organiser of Meniere’s Australia Brisbane South asked me to be a guest speaker at their meeting last Sunday (22 Apr 2012).

We had a good turn out and discussion. I showed the group a video showing an intratympanic Dexamethasone injection for tinnitus (see link in this post). The video will give you a better idea of the procedure; however it doesn’t show the initial incision of the ear drum or the insertion of a myringotomy tube.

I also donated a copy of the book “Let’s Get Better” by S J Blanshard (aka Meniere Man). It’s a light read about one man’s personal experience with the disease (see link in my Recommended Reading column to the right). So now both the MA Brisbane North & Brisbane South groups have a copy that members may borrow.

Below are my speaker notes for the Meniere's Australia - Brisbane South meeting last Sunday where I shared my experience with an intratympanic Dexamethasone injection.

Reduce the Frequency of Menieres Vertigo Attacks with an Intratympanic Dexamethasone Injection

What is Dexamethasone?
Dexamethasone is a synthetic version of glucocorticoid, a class of steroid drug (like Prednisone but many times more potent).
Glucocorticoids are classic anti-inflammatory compounds that are used to treat autoimmune diseases (such as lupus, multiple sclerosis & rheumatoid arthritis).
Dexamethasone prevents the release of substances in the body that cause inflammation.

How can an intratympanic Dexamethasone injection reduce vertigo attacks?
Meniere’s Disease has no known cause or cure. One theory for the cause is that it is an autoimmune disease. 
If this is the case, then an intratympanic Dexamethasone injection could reduce vertigo and tinnitus by reducing the inflammation of the inner ear caused by an autoimmune reaction. This would improve hearing function, equilibrium & quality of life for the patient.

Will Dexamethasone damage my hearing?
There are dangers involved with any procedure, so discuss these with your specialist.
Unlike Gentamicin, Dexamethasone should not damage your hearing further.

How is the Dexamethasone administered?
The Dexamethasone is administered within the middle ear (intratympanic) by injection.
The injection is undertaken by an experienced ENT, Neurotologist or Otologist.

How long does the procedure take?
The procedure takes less than one hour.

What do I need to do before the procedure?
You may wish for someone to accompany you to the procedure and drive you home afterwards. This will give you the opportunity to keep your head tilted after the procedure and maximise the benefits of the injection.
Discuss the pro’s & con’s with your specialist.
Notify your specialist if you, or anyone you are in close contact with, are unwell or have been unwell over the past several weeks.
You may wish to take an anti-nausea tablet (such as Stemetil) and half a tablet of Valium 2mg to assist in remaining calm during the procedure, though this many not be necessary.

What do I need to do during the procedure?
Follow directions. Lay still and relax.
You may benefit from visualising your “happy place” (i.e. warm beach, cool breeze, soft waves on the sand).
You will likely experience some minimal vertigo during the procedure. This will be due to the difference in temperature between your middle ear and the steroid solution. The vertigo will likely pass within a minute or two, so stay calm and try to relax.
After the injection you will be asked to roll over onto your “good side” so that the treated ear is upturned.
For the next 20 to 30 minutes you will need to keep your treated ear turned up (facing the ceiling).
Avoid swallowing, popping your ear, yawning, or blowing your nose. Any of these motions could cause much of the Dexamethasone to flow out through the Eustachian tube (which runs off the middle ear).
The aim is to keep the steroid in the ear as long as possible.

Is it painful?
In my experience the procedure wasn’t painful although it could be for some people. Temporary discomfort &/or a dull ache will likely be experienced; however this is outweighed by the potential benefits of reduced vertigo and tinnitus.

What do I need to do after the procedure?
Keep your treated ear tilted upward for at least 30mins.
Keep the treated ear dry until the incision in the ear drum healed (about 3 to 4 weeks). When showering, use ear putty & a shower cap from the chemist to keep the ear drum dry. 
Steroid medication can weaken your immune system  so avoid people who have, or recently had, an infection. Also try to avoid stress.

Will I benefit and, if so, how long will the benefits last?
Results will vary between individuals and some may require follow up injections every three to six months.
According to one study from 2005*, after five consecutive daily intratympanic injections of Dexamethasone (4 mg/mL), 82% of patients achieved complete control of vertigo at the 2 year follow up, while the remaining 18% showed substantial control of vertigo. There was also a subjective improvement in tinnitus (48%), hearing loss (35%), and aural fullness (48%).

* “Dexamethasone inner ear perfusion by intratympanic injection in unilateral Ménière's disease: a two-year prospective, placebo-controlled, double-blind, randomized trial.” Garduño-Anaya MACouthino De Toledo HHinojosa-González RPane-Pianese CRíos-Castañeda LC. Department of Neurotology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico. 

How much does the procedure cost?
The procedure costs approximately AUD $275 (less Medicare & private health care rebates). This cost would vary between specialists.

For more on the Intratympanic Dexamethasone Injection procedure contact your ENT, Otologist or Neuro-tologist. If you’re in Queensland, Australia, I can recommend Dr Chris Que-Hee.

Dr Chris Que-Hee - ENT / Neurotologist. 
Ph: +61 (0) 7 3831 4400
Watkins Medical Centre,
Level 10, 225 Wickham Tce, Brisbane,
Qld. Australia. 4000

This HD video demonstrates how steroid injection is performed into the ear for patients suffering from sudden sensorineural hearing loss.
As mentioned, the video will give you a better idea of the procedure; however it doesn’t show the initial incision of the ear drum or the insertion of a myringotomy tube.
Copyright owner 

DO YOU HAVE EXPERIENCE WITH INTRATYMPANIC DEXAMETHASONE INJECTIONS, OR A QUESTION? Please post a comment below as I’d love to hear your thoughts.

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  1. When should the fullness disappear?

  2. My wife has had meniere's since 2008,in 2013 read your article and found ad Doctor who was willing to give my wife the dexamethesone injection. He gave here 2 shots 2weeks apart,the vertigo immediately stopped.For 6 months she was almost symptom free.Now 6 months later the vertigo has returned we went back to the doctor but he was hesitant to give here another shot,and he wanted here to take oral prednisone,she had tried this before but made the symptoms worse.Are more shots sometime needed.Thanks so much for your help.

  3. I recommend seeing a surgeon who wears gloves during procedures.

  4. does this procedure cause any destruction of the balance system in the ear being treated?
    is it recommended for persons with Bilateral Menieres?

  5. That is why I always say that we should take care of our ears with all possible precautions we can consider. Ear is one of the most important part of our body and we can’t imagine our life without our ears.

  6. I have tinnitus for 18 years, but it came some times to times.
    Vertigo came later. In the beginning (about 10 years ago), I have a vertigo every 2 years (with vomiting, and the fisrt with diarrhea and vomitting). And the day after, I was ok, I have no other desease. I have a little loss of hearing till that period. The doctors gave me some medecine (serc and something against high blood pressure although I have no problem on blood pressure).
    Tinnitus was there every minutes of the day for 5 years.
    But since the end of last year (end of 2014), it was just like hell. I have 9 vertigo within one month. And I felt very weak after each vertigo. I have a little remission for 2 months without vertigo (I went to an osteopath). And in March 2015, I have another vertigo. And till that one, I was weaker and weaker. I feel as if I was on a boat (loss of balance, rocking). I can't walk in the street alone, hardly at home. I couldn't go to work (I work at home for 4 months now). But during that period, I haven't any vertigo. I was very afraid of having vertigo. And going to see a doctor was very difficult. I have seen many doctors during this last past 7 months.
    And one of them proposed me to have injection of dexamethasone. Before the first injection, my hearing loss was around 50 and 60 %, depending on the frequency). I have 6 injections, once every week. After the 4 first, it seems as if I recovered some hearing (about 10%) and I haven't had vertigo. I feel better, that is to say my sensation of rocking has almost disappeared. And I even could go out alone, just for a walk. I was very happy.
    But 4 days after the 5th injection, I have a vertigo. And another one 3 days later, and another one 2 days later. I felt disarmed, and the rocking feeling came back. So I went to my doctor. And he said that it is a normal reaction. This medecine causes a change in my inner ear, so it is possible to have a vertigo (he said that even a person who has no ear disease could have a vertigo with that kind of injection). And he decided to give me the 6th injection (it was last friday, the 17th July). And I have a very strong vertigo as ever (vomit, diarrhea) that last 4 hours. It happened 3 days after the injection. And since then, I have this rocking feeling even if I move my head just a very litlle bit.
    One benefit: it seems that tinnitus has reduced a little bit. And maybe I could say that hearing is a little bit better (I can perceive some noise I couldn't anymore before).
    I don't know what to think about dexamethasone. Maybe I have to wait a little bit more ?
    Do you hear of that kind of disorder?
    I apologise for my long witness, and, as you can guess, English is not my mother langage. So I apologise for my ackward formula and errors.