| Objective:Meniere diseases(MD)is a disease which is relative to idiopathic ear,but its etiology and pathogenesis is unclear,intratympanic steroid have been used in the treatment of Meniere disease,it can avoid adverse reactions caused by systemic drug such as osteoporosis,peptic ulcer disease,endocrine disorders,compared with gentamicin without the risk of hearing loss,but its effectiveness is still controversial.In this paper.We consulted the Cochrane system evaluation method.The main resources of references are the latest literatures in and abroad related to Meniere diseases,and the published theses of the author,the references are randomized controlled trials O n the basis of strict quality evaluation,clinical curative effect and the safety of intratympanic steroids for the treatment of Meniere diseases(MD)were made a system evaluation.Methods:We systematically searched C hinese biomedical literature database(C BM),C hina national knowledge infrastructure(CNKI),VIP,ten thousand party,Pubmed,Embase,Web of Science,the Cochrane libaray and other databases.We identified all randomized controlled trials in which intratympanic steroid therapy was evaluated comparison with the other treatment or placebo with Meniere diseases.After filtering by criteria of Cochrane Collaboration,Then Meta-analysis was performed by Rev Man 5.2 software.Results:A total of 8 RC Ts met the inclusion criteria in this study,all trials involved were of low quality.There was only 1 articles were included in the study in which intratympanic steroid therapy was evaluated comparison with placebo,the total number of samples 18 cases,intratympanic steroid group of 11 cases,the placebo group 7 cases,the results showed that vertigo effective rate in intratympanic steroid group was 82%,placebo group was 57%,the comparison between the two groups was statistically significant difference(p < 0.001),hearing improvement was 35% and 10% in steroid group and placebo group,and differences between the two groups was statistically significant(p < 0.001).There were 7 articles were included in the study in which intratympanic steroid compared with gentamicin injection:(1)improve dizziness comparison: 6 references,total sample of 320 cases,drum hormone injection group 159 examples,gentamicin group 161 examples,Meta-analysis showed that the curative effect of intratympanic steroid group is lower than the drum gentamicin injection group(O R = 0.54,95% CI(0.32,0.32),p = 0.02).,(2)the hearing improvement: include 2 documents the total sample of 64 cases,intratympanic steroid group 38 examples,gentamicin group of 26 cases,pooling results of Meta-analysis showed no difference between the two groups.(OR = 1.32,95% CI(0.41,0.41),P = 0.64),(3)the change of the mean pure tone audiometry(PTA)comparison: into 2 articles,sample a total of 118 cases,intratympanic steroid group of 60 cases,58 cases of gentamicin group,pooling results of Meta-analysis showed no difference between the two groups.(MD = 0.37,95% CI(6.27,6.27),P = 0.90),(4)the change of speech recognition rate(SDS)comparison: participants included three articles,the total sample of 179 cases,intratympanic steroid group 88 examples,gentamicin group 91 examples,Meta-analysis showed that the curative effect of intratympanic steroid group is superior to the drum gentamicin injection group(MD = 12.58,95% CI(3.53,3.53),P = 0.006).Conclusion:Intratympanic steroids for Meniere’s disease compared with placebo can contral the patient’s vertigo attacks and inprove hearing loss and other symptoms,with small side effects.Intratympanic steroid compared with gentamicin injection for the treatment of Meniere diseases: gentamicin group is better than steroid in contraling Vertigo attack;While to improve the speech recognition rate,hormone group is better than that gentamicin group;Two kinds of treatment methods,to improve pure tone audiometry,there was no statistically significant difference between the two groups;though Intratympanic steroids for Meniere’s disease can less better control the dizziness,compared with gentamicin group,but it can protect the hearing and vestibular function,therefore,our results may provide insightful information for the treatment of distal radius fracture.the quality of literature in this system evaluation is not high,because of few studies and small samples,more high quality trials with large samples and longer following-up are proposed. |
PDF Full Text Request