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 MA, Couthino De Toledo H, Hinojosa-González R, Pane-Pianese C, Ríos-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.
CONTACT DETAILS
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 http://www.FauquierENT.net
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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When should the fullness disappear?
ReplyDeleteMy 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.
ReplyDeleteI recommend seeing a surgeon who wears gloves during procedures.
ReplyDeletedoes this procedure cause any destruction of the balance system in the ear being treated?
ReplyDeleteis it recommended for persons with Bilateral Menieres?
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.
ReplyDeleteI have tinnitus for 18 years, but it came some times to times.
ReplyDeleteVertigo 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.