Copyright @ 2009 Otology & Neurotology, Inc. Unauthorized reproduction of this article is prohibited. Transtympanic Steroids for Me ´nie `re’s Disease *†Carlos Herraiz, ‡Guillermo Plaza, *†Jose M. Aparicio, *Inmaculada Gallego, *Sol Marcos, and *Carlos Ruiz *Servicio de Otorrinolaringologı ´a, Hospital Universitario Fundacio ´n Alcorco ´n; ÞUnidad de Otorrinolaringologı ´a, Hospital-Quiro ´n Madrid; and þServicio de Otorrinolaringologı ´a. Hospital Universitario Fuenlabrada, Madrid, Spain Objective: To describe the long-term efficacy of transtympanic steroids (TTS) using methyl-prednisolone in the treatment of Me ´nie `re’s disease (MD). Design: Descriptive prospective study. Main Outcome Measures: Pure-tone average (PTA) corre- sponding to the conversational frequencies on the audiogram (0.5, 1, 2, and 3 kHz), visual analog scale on tinnitus annoy- ance, and number of vertigo spells 24 months after treatment. Results: Thirty-four MD patients referred to a tertiary center were treated with TTS. All patients were diagnosed as prob- able or definitive MD (following American Academy of OtolaryngologyYHead and Neck Surgery 1995 criteria) and treated by TTS (3 consecutive doses). Data from 32 patients were achieved after 12 months. Forty-eight percent of the patients reduced the PTA in 10 or more decibels, average im- provement was 8.6 dB compared with initial PTA ( p = 0.004). Tinnitus relief was achieved by 81.5% of the patients. Number of vertigo spells was reduced from 4.3 to 0.3 after 12 months ( p = 0.002); 81% of the patients were free of vertigo spells, and 92.6% had 1 or less spells of vertigo. Data from 29 patients were achieved after 24 months. A reduction of PTA in 10 or more decibels was shown by the 33.3% of the sample, and PTA improved in 3.3 dB compared with initial PTA (nonsignificant). Tinnitus relief was achieved in 78% of the patients. Number of vertigo spells was reduced from 4.3 to 0.5 ( p = 0.033). Seventy-eight percent of the cases were free of vertigo, and 96% had none or 1 spell. Because of an increase in any of the symptoms, 12 patients (35.2%) required retreatment with 1 or 2 series of TTS (1Y3 doses) along the 2-year period. Two patients of the sample (6.25%) required transtympanic gen- tamicin for vertigo control due to lack of benefit with TTS (14 and 18 mo since TTS). Conclusion: Transtympanic steroids in this cohort were asso- ciated with good preservation of hearing. Tinnitus control is achieved in more than 70% of the patients, and number of vertigo spells can be dramatically reduced in more than 90% of the patients after a 24-month follow-up. Key Words: Hearing lossVMe ´nie `re’s diseaseVMethyl-prednisoloneV TranstympanicVTinnitusVVertigo. Otol Neurotol 31:162Y167, 2010. Me ´nie `re’s disease (MD) is an inner ear disorder, pathophysiologically characterized as an endolymphatic hydrops of unknown cause, and clinically presented by spontaneous vertigo spells, fluctuating sensorineural hearing loss, tinnitus, and aural fullness (1). An incom- plete form of this clinical entity named Bcochlear en- dolymphatic hydrops[ includes cochlear symptoms (hearing loss, tinnitus, aural pressure) without vestibular involvement. The effect of corticosteroids over MD has been described in the literature using a systemic (2) or transtympanic (3,4) delivery. Some cases of MD could be associated with an immune-mediated mechanism. The evidence is based on the presence of immunoglobulin G circulating immune complexes, antibodies to the endo- lymphatic sac proteins, and the immune inflammatory processes (5Y8). Corticosteroids can treat the inflamma- tory response in the inner ear and the stria vascularis (9,10). Their effect on the ionic homeostasis regulation through modifications in the potassium transport re- duces the damage of the intracochlear barriers physio- logically involved in MD (11). The protective role on the aquaporines contributes to the water balance of the inner ear (12). Transtympanic steroid (TTS) perfusion gives some advantages compared with the systemic delivery (13). Higher concentrations of the drug can be achieved in the inner ear liquids with minimal diffusion to the blood. This point makes this path very interesting for all those patients with any contraindication for steroid usage: immunodeficiency, diabetes, osteoporosis, ulcer, hypertension, or psychiatric diseases. It is an easy and office-based proceeding well tolerated by the patient. The risk of perforation of the tympanic membrane is Address correspondence and reprint requests to Carlos Herraiz, M.D., Ph.D., Unidad de Otorrinolaringologı ´a, Hospital Universitario Fundacio ´n Alcorco ´n, C/Budapest, 1. Alcorco ´n 28922, Madrid, Spain; E-mail: cherraizp@seorl.net Otology & Neurotology 31:162Y167 Ó 2009, Otology & Neurotology, Inc. 162